The impact of working conditions on sickness absence among older workers: a systematic review.

Working time characteristics and long-term sickness absence among Danish and Finnish nurses: A register-based study

IntroductionThe working environment may contribute strongly to the development and manifestation of health problems leading to reduced work participation. To maintain high workforce participation, it is important to target workplace...

Little is known about the work environmental risk factors for opioid use disorder (OUD) in working populations. The purpose of this study is to examine whether adverse physical and psychosocial working conditions are associated with OUD in a working population of the United States (US). Among the participants of the National Survey of Midlife Development in the United States (MIDUS) II Study (2004-2006), 2134 workers (1059 men and 1075 women; mean age, 51years) were chosen for this study. OUD was measured with self-administered questions in line with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSD-5). Physical demands (physical efforts, heavy lifting, and crouching/stooping/kneeling) and psychosocial work stressors (skill discretion, decision authority, job control, psychological job demands, supervisor and coworker support at work, job insecurity, and work hours) were measured with a standard questionnaire. The prevalence of OUD was 3.8%. In multivariate analyses, low skill discretion, high psychological job demands, job strain (a combination of low control and high demands), and high physical job demands were significantly associated with OUD. The multivariate prevalence ratios for OUD by job strain and frequent heavy lifting were 1.98 (1.27-3.10) and 2.23 (1.22-4.10), respectively. Job strain was more strongly associated with OUD in men, while high physical job demands were more strongly associated with OUD in women. This study implies that adverse physical and psychosocial working conditions may be important risk factors for OUD in US working populations. Future longitudinal and mechanistic studies are urgently warranted.

This study aimed to test the hypotheses that individuals with obesity are at higher risk of unemployment and sickness absence and have a lower chance of getting employed compared with individuals with normal weight. Data on weight and height were collected at baseline from 87,796 participants in the Danish National Health Survey 2010. Participants were then followed in national registers for 5 years. Outcome measures were transitions from employment to unemployment and sickness absence and the transitions from unemployment or sickness absence to employment. Data were analyzed by Cox proportional hazards models adjusted for potential confounders. Hazard ratios for unemployment were 1.18 (95% CI: 1.10-1.26) for individuals with obesity and 1.27 (95% CI: 1.14-1.41) for individuals with severe obesity compared with individuals with normal weight. Participants with obesity also had a higher risk of sickness absence. Additionally, participants with obesity who were unemployed at baseline had a lower chance of becoming employed compared with participants with normal weight. Obesity was associated with a higher risk of unemployment and sickness absence compared with individuals with normal weight. Additionally, obesity was associated with a lower chance of employment.

Background Psychosocial working conditions such as job demands and job control have been found to be associated with employee health and well-being, but studies on the associations with sickness absence (SA) and disability pension (DP) are scarce. We examined 11-year SA/DP trajectories and the association between psychosocial working conditions and subsequent SA/DP trajectories in the Swedish workforce. Methods Using a prospective cohort study with microdata we explored SA/DP trajectories among female and male employees, respectively, aged 30-53 years in 2001 in Sweden (1,076,042 women; 1,102,721 men). Group-based trajectory analysis was used to model annual mean SA/DP net days trajectories in 2002-2012. Based on a Swedish Job Exposure Matrix (JEM), individuals were assigned an age-, sex- and occupation-specific mean score for demands and control, respectively. Mean scores were categorized into tertiles and categorised into 3x3 combinations of exposure categories. Using multinomial regression we predicted trajectory group memberships for the JEM. Results The highest rate of women were in occupations with low demands and control (24.8%), while the highest rate of men (22.9%) was in occupations with high demands and control. We found three SA/DP trajectories for women (low, medium, high increasing) and two for men (low, high increasing). In fully adjusted models, those in occupations with low demands and low control were at higher risk of belonging to the high increasing SA/DP trajectory compared to those in occupations with high job demands and control in both women (OR 3.86; 95% CI: 3.75-3.97) and men (OR 3.0; 2.99-3.16). Conclusions Low job demands and low job control were associated with more high increasing future SA/DP trajectories compared to high job demands and job control in both women and men. Key messages In Sweden, women are more often in occupations characterized by low job demands and low job control and men are more often in occupations with high job demands and high job control. Occupations with low job demands and low job control were associated with more adverse SA/SP trajectories compared to occupations with high job demands and high job control in both women and men.

ObjectivesThe aims of the study were to trace the patterns of work environment factors and compensated sickness absence (SA) among nurses and care assistants compared with other occupations and to...

The rapid growth in life expectancy of four years over the past two decades in most EU countries is a great testament to the success of achieving healthy ageing (1). In any ageing society, it is of paramount importance for economic prosperity to prolong working life in order to balance a population of active versus inactive persons. However, health and wealth are not distributed very fairly across society. Poorer educational attainment and lack of paid employment are persistent causes for inequalities in health and wealth (2). There is ample evidence of a recent widening of social inequalities in life expectancy in many countries. In Denmark – one of the most egalitarian societies in the world – educational inequality life expectancy increased among men from 4.8 years in 1987 to 6.4 years in 2011. For women, an increase was observed from 3.7 to 4.7 years (3). Two important theories are put forward to explain this striking development. The first theory points at the strong trend of decreasing prevalence of unhealthy behaviors with higher educational attainment. Since health promotion programs generally have higher uptake and effectiveness among better educated persons (4), the so-called “intervention-generated inequalities” might contribute to increased inequalities (3). The second theory posits that labor market conditions are more unfavorable for those with lower education and their jobs are more strenuous as well (3). A recent comparative study across selected European countries showed that lower educated persons had substantially higher rates of disability and unemployment and also had more often less stable employment contracts (5). A longitudinal study among older workers in 11 European countries reported that among work-related factors studied, perceived lack of job control was consistently a risk factor for disability benefits, unemployment, and early retirement during the four years of follow-up (6). Many countries are developing policies and strategies to encourage workers to remain at work longer. These seldom take into account the particular role of health and working conditions, which impact the ability of older workers to remain in paid employment until statutory retirement age. For example, if strenuous work has adverse effects on health, especially at older age with declining physical and cognitive functions, timely retirement may be health-preserving. It may also prevent such workers from spending the required added years before retirement in disability and unemployment rather than paid employment. The current issue of the Scandinavian Journal of Work, Environment & Health contains publications that contribute to the unravelling the role of work in socioeconomic inequalities. Addressed in this issue, two distinct mechanisms can be distinguished: educational differences in working conditions encountered on the job and educational attainment as a determinant of labor market position. The first study by Kaikkonen and colleagues (7) demonstrates a marked socioeconomic gradient in sickness absence in a longitudinal study with 8-year follow-up among Finnish citizens. The difference between the lowest and highest educational level was 4.8 days/year (60%) among men and 5.7 days/year (56%) among women for registered episodes of sickness absence of ≥10 days. In a mediation analysis, about 20–25% of these differences could be attributed to self-reported health status, health behavior, and physical and psychosocial working conditions. Interestingly, the crude influence of physical working conditions was substantially higher than all other factors with a maximum effect of 1.2–1.4 days/year (7). The study has several limitations that hamper more precise estimates of the direct and indirect effects of working conditions, health, and health behavior. For example, these factors were all based on self-reports in the baseline questionnaire and, thus, may suffer from common source bias. Another obvious problem is that these factors were measured only at baseline and treated as time-independent variables in the statistical analysis. When working conditions, health, and health behavior vary considerably over time, the reported associations will most likely underestimate the impact of these factors on sickness absence. A third point of concern may be that only sickness absence periods of ≥10 days were available from the register, but other studies have indicated that educational differences are more prominent in longer sickness absence periods (8). In spite of this critique, the study certainly corroborates the hypothesis that educational differences in working conditions have a substantial impact on the ability of workers to be productive at work. It complements earlier studies on educational differences in disability benefits due to musculoskeletal disorders linked to physically demanding work (9), and physical strain and low job control as explanatory factors for educational differences in disability benefits (10). The second publication presents a longitudinal study with 6-year follow-up among a national sample of households in Korea. Using annual waves with time-varying information on independent and dependent variables, precarious employment was associated with onset of severe depressive symptoms with a stronger effect among women than men. Moreover, change from a permanent to a temporary employment contract was also associated with an increase in onset of severe depressive symptoms. Precarious employment was more prevalent among those with intermediate or lower education, hence, employment status at the labor market introduced social inequalities (11). These results reflect previous reports in Asia that precarious employment increased the risk on serious psychological distress (12) and in Finland where adverse effects were observed for prolonged sickness absence and disability pension for depression, especially among the lower educated and older workers (13). Given the rapid growth in flexible labor contracts in most countries, their impact on socioeconomic health inequalities raises concerns on the effectiveness of current policies and social and institutional systems for temporary employees that will support them to work longer in good health. There is increasing evidence that work plays a key role in socioeconomic health inequalities. However, there is a shocking lack of evidence how current labor market and retirement policies will influence socio-economic inequalities in health and wealth. Currently available evidence suggests that disparities may increase when these policies are blind to the mechanisms of how work influences health. There is an urgent need for studies that present empirical evidence on the consequences of the rapid changes in national policies on disability and retirement aimed at prolonging working careers for the health of the workforce.

ObjectivesIncreasing sickness absence (SA) has been reported among healthcare workers in Sweden. Our aim was to analyse the impact of work environment factors on short-term and long-term SA based on...

The aim of this study was to investigate differences in burnout, self-rated health (SRH) and sickness absence between human service occupations (HSOs) and other occupations, and whether they can be attributed to differences in psychosocial work environment and organizational resources. Data were derived from the Swedish Longitudinal Occupational Survey of Health, an approximately representative sample of the Swedish working population ( n = 4408). Employment in HSOs, psychosocial work environment and organizational resources in 2012 predicted relative risks of sickness absence, burnout and suboptimal SRH in 2014 using modified Poisson regressions. The psychosocial work factors' and organizational resource variables' relative importance were estimated by adding them to the models one by one, and with population attributable fractions (PAFs). Employment in HSOs was associated with a higher risk of sickness absence and the risk was explained by psychosocial and organizational factors, particularly high emotional demands, low work-time control and exposure to workplace violence. Employment in HSOs was not associated with burnout after sociodemographic factors were adjusted for, and furthermore not with SRH. A lower risk of suboptimal SRH was found in HSOs than in other occupations with equivalent psychosocial work environment and organizational resources. PAFs indicated that psychosocial work environment and organizational resource improvements could lead to morbidity reductions for all outcomes; emotional demands were more important in HSOs. HSOs had higher risks of sickness absence and burnout than other occupations. The most important work factors to address were high emotional demands, low work-time control, and exposure to workplace violence.

Mental health problems are associated with considerable occupational, medical, social, and economic burdens. Psychosocial stressors at work have been associated with a higher risk of mental disorders, but the risk of sickness absence due to a diagnosed mental disorder, indicating a more severe condition, has never been investigated in a systematic review and meta-analysis. To synthesize the evidence of the association of psychosocial stressors at work with sickness absence due to a diagnosed mental disorder among adult workers. Seven electronic databases (MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, Sociological Abstracts, and International Bibliography of the Social Sciences), 3 gray literature databases (Grey Literature Report, WHO-IRIS and Open Grey), and the reference lists of all eligible studies and reviews were searched in January 2017 and updated in February 2019. Only original prospective studies evaluating the association of at least 1 psychosocial stressor at work from the 3 most recognized theoretical models were eligible: the job demand-control-support model, including exposure to job strain (high psychological demands with low job control); effort-reward imbalance model; and organizational justice model. Study selection was performed in duplicate by blinded independent reviewers. Among the 28 467 citations screened, 23 studies were eligible for systematic review. This meta-analysis followed the PRISMA and MOOSE guidelines. Data extraction and risk of bias evaluation, using the Risk of Bias in Nonrandomized Studies-Interventions tool, were performed in duplicate by blinded independent reviewers. Data were pooled using random-effect models. Sickness absence due to a mental disorder with a diagnosis obtained objectively. A total of 13 studies representing 130 056 participants were included in the 6 meta-analyses. Workers exposed to low reward were associated with a higher risk of sickness absence due to a diagnosed mental disorder compared with nonexposed workers (pooled risk ratio [RR], 1.76 [95% CI, 1.49-2.08]), as were those exposed to effort-reward imbalance (pooled RR, 1.66 [95% CI, 1.37-2.00]), job strain (pooled RR, 1.47 [95% CI, 1.24-1.74]), low job control (pooled RR, 1.25 [95% CI, 1.02-1.53]), and high psychological demands (pooled RR, 1.23 [95% CI, 1.04-1.45]). This meta-analysis found that workers exposed to psychosocial stressors at work were associated with a higher risk of sickness absence due to a mental disorder. A better understanding of the importance of these stressors could help physicians when evaluating their patients' mental health and work capacity.

<sec><st>Objective</st> Previous studies indicate that evening workers have increased risk of long-term sickness absence. The aim of the present study was to examine if evening work is associated with higher risk of sickness absence compared to daytime work. </sec> <sec><st>Methods</st> The Danish Working Hour Database (DWHD) contains administrative payroll data from all Danish regions from 2007 to 2013. It includes 249,218 unique participants with 224,485,710 observations with starting and ending times for each worked shift and sickness absence on daily basis. For the present explorative study we selected all employees in a single hospital in 2009 (6,254 unique participants; 83% women; age: 40.8 years (SD = 11.9 years); 1,461,690 observations). The dataset was further restricted by excluding short (≤3 hours) and long (≥9 hours) shifts and observations with sickness absence or non-day/evening (e.g. night) shifts during the past 28 days. A sensitivity analysis with evening workers as their own controls, was carried out by excluding participants, who never worked evening. Evening work was defined as one or more evening shifts (≥3 hours between 18:00–23:00) during the past 28 days. The reference was dayshift (≥3 hours between 06:00–20:00). Using a multi-state model we analysed recurrent transitions between three states: work, sickness absence and temporary out of work e.g. holiday. Hazard ratios (HR) for sickness absence were calculated by Cox proportional hazards models adjusted for age and sex. </sec> <sec><st>Results</st> Analyses showed that evening work was associated with lower risk of sickness absence (HR: 0.84, 95% CI: 0.73–0.96). The sensitivity analysis yielded similar results (HR: 0.87, 95% CI: 0.72–1.06). </sec> <sec><st>Conclusion</st> When comparing periods with evening work to periods of day work the present study showed that evening work was associated with a decreased occurrence of sickness absence. This is in contrast to previous studies which compare evening workers with day workers. </sec>

ObjectiveNight work is associated with increased risk of disease, but it is unclear if it is associated with sickness absence. The aim of the study was to examine if working...

Work Arrangements, Physical Working Conditions, and Psychosocial Working Conditions as Risk Factors for Sickness Absence: Bayesian Analysis of Prospective Data

The purpose of this study was to examine the association between psychosocial job stress (by the Job Control-Demand (JCD) model and Effort-Reward imbalance (ERI) model) and musculoskeletal (MS) symptoms among workers in China. Overall, 3,632 male and 1,706 female workers from 13 factories/companies participated in this study. Perceived job stress was evaluated by the Chinese version of the Job Content Questionnaire (JCQ) and ERI Questionnaire. Neck, shoulder and wrist symptoms were assessed by self-report during the past year. Workers reporting high job demands and low job control or high effort and low rewards had moderately increased risk for all MS symptoms. Odds ratios (ORs) were higher in workers reporting both high effort and low rewards. The combination of high physical job demands with low job control showed significant associations with MS symptoms. The effects of psychological demands on symptoms in women, effort and effort-reward imbalance on symptoms among both genders were increased as the number of regions with symptoms increased. These results suggest that high job strain and ERI are associated with neck, shoulder and wrist symptoms in Chinese factory workers independent of individual factors, physical factors, and other psychological variables.

Context:Little is known about how thyroid diseases affect work ability.Objective:The objective of this study was to evaluate the risk of work disability for patients with thyroid disease compared with the general population.Design, Setting, and Participants:In a longitudinal register study, outpatients (n = 862) with nontoxic goiter, hyperthyroidism, Graves' orbitopathy (GO), autoimmune hypothyroidism, or other thyroid diseases and their matched controls (n = 7043) were observed in the years 1994–2011 in Danish national registers of social benefits, health, and work characteristics. Cox regression analyses estimated adjusted hazard ratios (HRs) for the first year after diagnosis and subsequent years.Main Outcome Measures:Transitions between work, long-term sickness absence, unemployment, and disability pension were measured.Results:Patients differed significantly from the general population with regard to sickness absence, disability pension, return from sickness absence, and unemployment. In the first year after diagnosis, higher risks of sickness absence was seen for GO (HR 6.94) and other hyperthyroid patients (HR 2.08), who also had lower probability of returning from sickness absence (HR 0.62) and higher risk of disability pension (HR 4.15). Patients with autoimmune hypothyroidism showed a lower probability of returning from sickness absence (HR 0.62). In subsequent years, GO patients had significantly higher risk of sickness absence (HR 2.08), lower probability of return from sickness absence (HR 0.51), and unemployment (HR 0.52) and a higher risk of disability pension (HR 4.40). Hyperthyroid patients also had difficulties returning from sickness absence (HR 0.71).Conclusions:Thyroid patients' risk of work disability is most pronounced in the first year after diagnosis and attenuates in subsequent years. GO patients have the highest risk of work disability.