Risk Factors For Work Disability Research Articles

Socioeconomic status, psychotherapy duration, and return to work from disability due to common mental disorders

ABSTRACT Objective Low socioeconomic status (SES) is a risk factor for work disability due to common mental disorders (CMDs), one possible reason being inequal use of services. Psychotherapy is an evidence-based treatment for CMDs. This study examines socioeconomic and sociodemographic differences in psychotherapy attendance and an association of psychotherapy duration with return to work (RTW). Methods The study subjects (N = 12,263) were all Finnish citizens granted a disability pension (DP) due to CMDs in 2010–2012. Numbers of psychotherapy sessions (maximum 200) were collected from the nine-year interval around the DP grant. Socioeconomic and sociodemographic differences in psychotherapy duration (dependent variable) among DP recipients were studied using multinomial logistic regression models, likewise, the association between psychotherapy duration and RTW (dependent variable) among temporary DP recipients was examined. Results Higher SES, female gender, and younger age were positively associated with attending longer psychotherapies and surpassing the early treatment termination level (>10 sessions). Attending 11–60 psychotherapy sessions was positively associated with full RTW and partial RTW, whereas longer psychotherapies were not. Early termination was positively associated with partial RTW only. Conclusion This study demonstrates varying tendencies among CMD patients from different backgrounds to attend long rehabilitative psychotherapies, which may create inequalities in RTW.

Occupational risk factors for work disability following carpal tunnel syndrome: a pooled prospective study

BackgroundAlthough recent studies have identified important risk factors associated with incident carpal tunnel syndrome (CTS), risk factors associated with its severity have not been well explored.ObjectiveTo examine the associations between...

Sociodemographic characteristics and disability pensions of frequent attenders in occupational health primary care \u2013 a follow-up study in Finland

BackgroundWork disability is a complex issue that requires preventive efforts from healthcare systems and individuals, and that too often results in disability pensions (DP). While many studies have attempted to characterize risk factors of work disability, many showing for example a link between socioeconomic positions, working conditions and frequent attendance to OH primary care it is not known if frequent attendance is associated with DP despite the sociodemographic factors. This study aims to address this gap and examine the association between frequent attendance to OH primary care and DP, when adjusted by sociodemographic factors.MethodsThis study combines routine medical record data of an occupational health service provider with comprehensive national registers. Medical record data were used to define groups of frequent attenders to OH primary care (FA) (1-year-FA, 2-year-FA, persistent-FA and non-FA) from 2014 to 2016. The sociodemographic factors (including i.e. educational level, occupational class, unemployment periods) were derived from Statistic Finland and DP decisions were derived from Finnish Centre for Pensions. Association of frequent attendance to OH primary care with DP decisions were analyzed and adjusted by sociodemographic factors.ResultsIn total, 66,381 patients were included. Basic and intermediate education along with manual and lower non-manual work predicted frequent attendance to OH primary care. Unemployment in 2013 did not predict frequent attendance to OH primary care. Frequent attendance to OH primary care was associated with DP within next two years, even when adjusted for sociodemographic factors. The association of frequent attendance to OH primary care with DP grew stronger as high service use persisted over time.ConclusionsFrequent attendance to OH primary care is associated with DP risk in the near future despite the underlying sociodemographic differences. Patients using OH primary care services extensively should be identified and rehabilitative needs and measures necessary to continue in the work force should be explored. Sociodemographic issues that co-exist should be explored and considered when planning interventions.

P050 Work Disability, Indirect Costs and Risk Factors in Patients With Crohn's Disease in a Rio De Janeiro Tertiary Care Center.

BACKGROUND: Crohn's disease (CD) is considered one of the most expensive disorders in Europe and the prevalence and incidence of CD is increasing in Brazil in the last decades. During flares, CD can lead to the inability to work with social and economic impact. This study aimed to assess the indirect costs, prevalence and risk factors for work disability in the state of Rio de Janeiro (RJ) and in a tertiary care referral center of the state (UERJ). METHODS: Analysis was performed using the database of the Single System of Social Security Benefits Information (SUIBE), with a crosscheck for aid pension and disability retirement from 2010 to 2018 in RJ state. Demographic characteristics included sex, age, work status, geographic region, days off work, average monthly benefit, and ICD-10 K50 with all subdivisions. A sub-analysis was performed on CD patients from UERJ during the same study period using prospectively collected data from the database, analyzed retrospectively to investigate potential risk factors associated with absence from work among CD patients. Additional demographic and clinical characteristics including sex, age, disease duration, disease location, predominant disease phenotype, perianal disease, extraintestinal manifestations, smoking history, prior medications (steroids, immunosuppressants and biologics), duration of biologic use, history of abdominal surgery (defined as the need for bowel resection), prior spontaneous abdominal abscess, previous appendectomy, and Montreal classification were analyzed. RESULTS: In RJ state, the estimated prevalence of CD was 26.05 per 100,000 inhabitants, while the associated work disability was 16.6%, with indirect costs (focusing on losses related to employment) of US$ 8,562,195.86. Permanent disability occurred more frequently in CD patients aged 40 to 49 years. In UERJ, the prevalence of work disability was 16.7% and the risk factors for absence from work were predominantly disease duration, the A2 profile of the Montreal classification, abdominal surgery and rectovaginal fistulas. Mood disorders were observed in 19% of these UERJ patients, with a mean interval of 3 years between diagnosis of CD and the first benefit. CONCLUSION: The prevalence of work disability in UERJ CD patients is similar to RJ state and may reflect other regions from Brazil. The risk factors are associated with disease duration and complications of disability. The prevalence of psychiatric manifestations has called attention to potentially neglected aspects of CD, and the need to incorporate specialized multidisciplinary care. Rehabilitation programs are still deficient in the country. The increase in the prevalence of CD in Brazil and the resultant socioeconomic impact of a chronic disease affecting relatively young patients, emphasizes the importance of providing quality medical care in order to mitigate the burden of CD. Early diagnosis and full medical therapy might prevent most of the complications that lead to repeat hospitalizations and surgical interventions and the consequent incremental direct and indirect costs associated with CD.

Prevalence, Indirect Costs, and Risk Factors for Work Disability in Patients with Crohn's Disease at a Tertiary Care Center in Rio de Janeiro.

Crohn's disease (CD) can lead to work disability with social and economic impacts worldwide. In Brazil, where its prevalence is increasing, we assessed the indirect costs, prevalence, and risk factors for work disability in the state of Rio de Janeiro and in a tertiary care referral center of the state. Data were retrieved from the database of the Single System of Social Security Benefits Information, with a cross-check for aid pension and disability retirement. A subanalysis was performed with CD patients followed up at the tertiary care referral center using a prospective CD database, including clinical variables assessed as possible risk factors for work disability. From 2010 to 2018, the estimated prevalence of CD was 26.05 per 100,000 inhabitants, while the associated work disability was 16.6%, with indirect costs of US$ 8,562,195.86. Permanent disability occurred more frequently in those aged 40 to 49years. In the referral center, the prevalence of work disability was 16.7%, with a mean interval of 3years between diagnosis and the first benefit. Risk factors for absence from work were predominantly abdominal surgery, anovaginal fistulas, disease duration, and the A2 profile of the Montreal classification. In Rio de Janeiro, work disability affects one-sixth of CD patients, and risk factors are associated with disease duration and complications. In the context of increasing prevalence, as this disability compromises young patients after a relatively short period of disease, the socioeconomic burden of CD is expected to increase in the future.

Risk factors for subsequent work disability in patients with acute myocardial infarction.

Scientific knowledge on risk factors for work disability in terms of long-term sickness absence (SA) and disability pension (DP) following acute myocardial infarction (AMI) is limited. The study aimed to investigate socio-demographic, work-related and medical characteristics as risk factors for long-term SA (>90 days) and DP in patients with a first AMI. This is a population-based cohort study of 8199 individuals aged 19-60 years who had a first AMI during 2008-10 and were alive 30 days after AMI. Univariate and multivariable hazard ratios (HRs) and 95% confidence intervals (CIs) with regard to long-term SA and DP with a 3-year follow-up were estimated by Cox regression. We found a higher risk of long-term SA and DP after AMI in women, those with lower education and previous SA (range of HRs: 1.29-7.34). Older age and being born in non-European countries were associated with a 2- to 3-fold higher risk of DP. Moreover, ST-elevation myocardial infarction (STEMI), musculoskeletal and common mental disorders (CMDs) were risk factors for long-term SA and DP, while diabetes mellitus and stroke were associated with a higher risk of DP (range of HRs: 1.12-2.98). Coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention was associated with a 2-fold higher risk of work disability. Older women, those with lower education and non-European immigrants had a higher risk of work disability after AMI, particularly permanent work disability. STEMI, CABG, diabetes mellitus, stroke, musculoskeletal disorders and CMDs provide important clinical information for work disability after AMI.

Determinants of work disability following lumbar spine decompression surgery.

Scientific knowledge about risk factors for work disability in terms of long-term sickness absence and disability pension following lumbar spine decompression surgery remains insufficient. This study aimed to investigate the associations between socio-demographic, work-related, and medical characteristics with subsequent long-term sickness absence (>90 days) and disability pension for individuals who underwent lumbar spine decompression surgery. A prospective cohort study of all individuals aged 19-60 years with diagnosed dorsopathies, who underwent lumbar spine decompression surgery 2008-10 in Sweden ( n=7373) was performed. Univariate and multivariate hazard ratios with 95% confidence intervals regarding long-term sickness absence and disability pension with a 3-year follow-up period were estimated by Cox proportional regression. Low educational level, being a non-European immigrant and preoperative sickness absence were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.8). Female sex was a risk factor for long-term sickness absence (hazard ratios: 1.3) whereas age >44 years and being a Nordic immigrant were risk factors for disability pension (hazard ratios: 1.9-2.6). Medical factors as common mental disorders, other mental disorders, prescribed psychiatric medication and somatic comorbidity were risk factors for both long-term sickness absence and disability pension (hazard ratios: 1.2-3.4). A simultaneous lumbar fusion surgery and high preoperative pain severity were risk factors for long-term sickness absence (hazard ratios 1.2-1.8). To prevent long-term work disability after lumbar spine decompression surgery, specific focus is required on older and female patients, those with mental or somatic comorbidities, high levels of preoperative pain or sickness absence, with a simultaneous lumbar fusion surgery, a low educational level or a non-European immigrant background.

Clustering of job strain, effort-reward imbalance, and organizational injustice and the risk of work disability: a cohort study.

Objectives The aim of this study was to examine the association between co-occurring work stressors and risk of disability pension. Methods The work stressors job strain, effort-reward imbalance (ERI), and organizational injustice were measured by a survey in 2008 of 41 862 employees linked to national records of all-cause and cause-specific disability pensions until 2011. Co-occurring work stressors were examined as risk factors of work disability using Cox regression marginal models. Results Work stressors were clustered: 50.8% had no work stressors [observed-to-expected ratio (O/E)=1.2], 27.4% were exposed to one stressor (O/E=0.61-0.81), 17.7% to two stressors (O/E=0.91-1.73) and 6.4% to all three stressors (O/E=2.59). During a mean follow-up of 3.1 years, 976 disability pensions were granted. Compared to employees with no work stressors, those with (i) co-occurring strain and ERI or (ii) strain, ERI and injustice had a 1.9-2.1-fold [95% confidence interval (CI) 1.7-2.6] increased risk of disability retirement. The corresponding hazard ratios were 1.2 and 1.5 (95% CI 1.0-1.8) for strain and ERI alone. Risk of disability pension from depressive disorders was 4.4-4.7-fold (95% CI 2.4-8.0) for combinations of strain+ERI and strain+ERI+injustice, and 1.9-2.5-fold (95% CI 1.1-4.0) for strain and ERI alone. For musculoskeletal disorders, disability risk was 1.6-1.9-fold (95% CI 1.3-2.3) for strain+ERI and ERI+injustice combinations, and 1.3-fold (95% CI 1.0-1.7) for strain alone. Supplementary analyses with work stressors determined using work-unit aggregates supported these findings. Conclusions Work stressors tend to cluster in the same individuals. The highest risk of disability pension was observed among those with work stressor combinations strain+ERI or strain+ERI+injustice, rather than for those with single stressors.

Predictors of fatigue and work ability in cancer survivors.

Workers diagnosed with cancer are at risk for job loss or work disability. To determine predictors of fatigue and work ability at 36 months after diagnosis in a population of cancer survivors. Individuals diagnosed with cancer and who applied for work disability benefit at 24 months of sick leave were surveyed at the time of application and again 12 months later. Fatigue was measured using the Functional Assessment of Chronic Illness-Fatigue scale questionnaire and work ability was measured using the work ability index. Linear regression analyses were applied to identify predictors. There were 336 participants. Participants who were divorced or widowed had more physical limitations, more depressive symptoms and were more fatigued at baseline, and who worked in health care demonstrated higher levels of fatigue. Lower fatigue was predicted by having received chemotherapy. A higher level of work ability was predicted by having received chemotherapy, better global health and better work ability at baseline. Lower work ability was predicted by being principal wage earner, insecurity about being free of disease, having more physical limitations and having greater wage loss. Socio-demographic, health- and work-related factors were associated with fatigue and work ability in cancer survivors on long-term sick leave. As fatigue and poor work ability are important risk factors for work disability, addressing the identified predictive factors may assist in mitigation of work disability in cancer survivors.

Childhood adversity, adult socioeconomic status and risk of work disability: a prospective cohort study

ObjectivesTo examine the combined effects of childhood adversities and low adult socioeconomic status (SES) on the risk of future work disability.MethodsIncluded were 34 384 employed Finnish Public Sector study participants...

Expectancies mediate the relationship between perceived injustice and return to work following whiplash injury: A 1-year prospective study.

Emerging evidence suggests that perceived injustice is a risk factor for work disability in individuals with whiplash injury. At present, however, little is known about the processes by which perceived injustice impacts on return to work. The purpose of this study was to examine whether expectancies mediated the relationship between perceived injustice and return to work in patients with whiplash injury. One hundred and fifty-two individuals (81 men, 71 women) with a primary diagnosis of whiplash injury completed self-report measures of pain intensity, perceived injustice and return-to-work expectancies following admission to a rehabilitation programme. Work status was assessed 1year after discharge. Consistent with previous research, high scores on a measure of perceived injustice were associated with prolonged work disability. Results indicated that high perceptions of injustice were associated with low return-to-work expectancies. Causal mediation analyses revealed that expectancies fully mediated the relationship between perceived injustice and return to work. The findings suggest that intervention techniques designed to target expectancies could improve return-to-work outcomes in patients with whiplash injury. Discussion addresses the processes by which expectancies might impact on return-to-work outcomes and the manner in which negative return-to-work expectancies might be modified through intervention. The study confirms that expectancies are the mechanism through which perceived injustice impacts return to work following whiplash injury. The findings suggest that interventions designed to specifically target return-to-work expectancies might improve rehabilitation outcomes in patients with whiplash injury.

Work Disability among Employees with Diabetes: Latent Class Analysis of Risk Factors in Three Prospective Cohort Studies.

BackgroundStudies of work disability in diabetes have examined diabetes as a homogeneous disease. We sought to identify subgroups among persons with diabetes based on potential risk factors for work disability.MethodsParticipants were 2,445 employees with diabetes from three prospective cohorts (the Finnish Public Sector study, the GAZEL study, and the Whitehall II study). Work disability was ascertained via linkage to registers of sickness absence and disability pensions during a follow-up of 4 years. Study-specific latent class analysis was used to identify subgroups according to prevalent comorbid disease and health-risk behaviours. Study-specific associations with work disability at follow-up were pooled using fixed-effects meta-analysis.ResultsSeparate latent class analyses for men and women in each cohort supported a two-class solution with one subgroup (total n = 1,086; 44.4%) having high prevalence of chronic somatic diseases, psychological symptoms, obesity, physical inactivity and abstinence from alcohol and the other subgroup (total n = 1,359; 55.6%) low prevalence of these factors. In the adjusted meta-analyses, participants in the ‘high-risk’ group had more work disability days (pooled rate ratio = 1.66, 95% CI 1.38–1.99) and more work disability episodes (pooled rate ratio = 1.33, 95% CI 1.21–1.46). These associations were similar in men and women, younger and older participants, and across occupational groups.ConclusionsDiabetes is not a homogeneous disease in terms of work disability risk. Approximately half of people with diabetes are assigned to a subgroup characterised by clustering of comorbid health conditions, obesity, physical inactivity, abstinence of alcohol, and associated high risk of work disability; the other half to a subgroup characterised by a more favourable risk profile.

WS03.5 Employment and work disability in adults with cystic fibrosis: A cohort study

Background As a result of prolonged survival, more patients with CF participate in the labour force. The available data on employment in CF have been based on cross-sectional studies. To our knowledge, no cohort study, evaluating the evolution of employment status in CF patients has been conducted so far. In 2009, we assessed occupational levels and risk factors for work disability in 207 patients cared for at our CF centre in Paris. Five years later, we reassessed employment status in the same cohort, with a special focus on lung transplantation recipients. Methods We first reviewed the status of the patients from the 2009 cohort (alive, deceased, lost to follow-up). A self-administered questionnaire, identical to the one used in 2009 on work status and treatment, was submitted to the patients still in the cohort. A section relating to lung transplantation was added when appropriate. In parallel, medical records were reviewed for illness severity indicators. Results Of the 207 initial patients, 16 had died, 7 were lost to follow-up and 184 were still alive (35 of which had received a lung transplantation). To date, data have been collected for 166 patients (80%). In comparison to 2009, 97 (58%) vs 117 (57%) were employed, 14 (8%) vs 13 (6%) were unemployed, 45 (27%) vs 38 (18%) were inactive and 9 (5%) vs 39 (19%) were students. Conclusion The proportion of employed patients was unchanged after 5 years but fewer patients were students. Data collection will be completed for the patients in the cohort who have moved and are no longer followed in our CF center. We plan to analyze employment promoting factors and the impact of lung transplantation on occupational life.

"Employment and arthritis: making it work" a randomized controlled trial evaluating an online program to help people with inflammatory arthritis maintain employment (study protocol).

BackgroundArthritis and musculoskeletal conditions are the leading cause of long-term work disability (WD), an outcome with a major impact on quality of life and a high cost to society. The importance of decreased at-work productivity has also recently been recognized. Despite the importance of these problems, few interventions have been developed to reduce the impact of arthritis on employment. We have developed a novel intervention called “Making It Work”, a program to help people with inflammatory arthritis (IA) deal with employment issues, prevent WD and improve at-work productivity. After favorable results in a proof-of-concept study, we converted the program to a web-based format for broader dissemination and improved accessibility. The objectives of this study are: 1) to evaluate in a randomized controlled trial (RCT) the effectiveness of the program at preventing work cessation and improving at-work productivity; 2) to perform a cost-utility analysis of the intervention.Methods/Design526 participants with IA will be recruited from British Columbia, Alberta, and Ontario in Canada. The intervention consists of a) 5 online group sessions; b) 5 web-based e-learning modules; c) consultations with an occupational therapist for an ergonomic work assessment and a vocational rehabilitation counselor. Questionnaires will be administered online at baseline and every 6 months to collect information about demographics, disease measures, costs, work-related risk factors for WD, quality of life, and work outcomes. Primary outcomes include at-work productivity and time to work cessation of > 6 months for any reason. Secondary outcomes include temporary work cessation, number of days missed from work per year, reduction in hours worked per week, quality adjusted life year for the cost utility analysis, and changes from baseline in employment risk factors. Analysis of Variance will evaluate the intervention’s effect on at-work productivity, and multivariable Cox regression models will estimate the risk of work cessation associated with the intervention after controlling for risk factors for WD and other important predictors imbalanced at baseline.DiscussionThis program fills an important gap in arthritis health services and addresses an important and costly problem. Knowledge gained from the RCT will be useful to health care professionals, policy planners and arthritis stakeholders.Trial registrationClinicalTrials.gov NCT01852851; registered April 13, 2012; first participant randomized on July 6, 2013.

Is temporary employment a risk factor for work disability due to depressive disorders and delayed return to work? The Finnish Public Sector Study

Research on temporary employment as a risk factor for work disability due to depression is mixed, and few studies have measured work disability outcome in detail. We separately examined the associations of temporary employment with (i) the onset of work disability due to depression, (ii) the length of disability episodes, and (iii) the recurrence of work disability, taking into account the possible effect modification of sociodemographic factors. We linked the prospective cohort study data of 107 828 Finnish public sector employees to national registers on work disability (>9 days) due to depression from January 2005 to December 2011. Disability episodes were longer among temporary than permanent employees after adjustment for age, sex, level of education, chronic somatic disease, and history of mental/behavioral disorders [cumulative odds ratio (COR) 1.37, 95% confidence interval (95% CI) 1.25-51). The association between temporary employment and the length of depression-related disability episodes was more pronounced among participants with a low educational level (COR 1.95, 95% CI 1.54-2.48) and older employees (>52 years; COR 3.67, 95% CI 2.83-4.76). The association was weaker in a subgroup of employees employed for ≥ 50% of the follow-up period (95% of the original sample). Temporary employment was not associated with the onset or recurrence of depression-related work disability. Temporary employment is associated with slower return to work, indicated by longer depression-related disability episodes, especially among older workers and those with a low level of education. Continuous employment might protect temporary employees from prolonged work disability.

Prevalence and associated risk factors for work disability in Egyptian patients with ankylosing spondylitis from one center

To determine the prevalence of work disability (WD) in Egyptian patients with ankylosing spondylitis (AS) and to identify the main factors associated with this. A cross-sectional survey was conducted among all patients with AS during an extended outpatient visit in the period between July, 2011 and December, 2012. Demographic data were collected and a physical examination was performed. Multivariate modeling was applied to determine the factors associated with work disability. The questionnaire was completed by 90 patients (85 males; 94.4%). The mean age of the participants was 37.8 (SD 9.7) years, mean disease duration was 12.1 (SD 8.9) years, and the mean symptom duration was 15 (SD 2.9) years. A total of 36 (40%) patients of working age were not working due to AS. The factors that associated with work disability, after completing logistic regression models, were older age (odds ratio [OR]=1.8, 95%, confidence interval [CI]=1.04-1.17), longer disease duration (OR=1.60, 95% CI=1.12-2.8), increasing diagnostic delay (OR=2.1, 95% CI=1.0-3.4), lower educational level (OR=3.5, 95% CI=1.6-6.4), manual profession (OR=1.80, 95% CI=1.10-2.6), living in a rural zone (OR=3.14, 95% CI=1.98-5.05), peripheral arthritis (OR=2.04, 95% CI=1.20-3.43) and psychological symptoms (OR=2.3, 95% CI=1.9-4.6). The prevalence of WD among Egyptian patients with AS is considerably high. Clinical and psychosocial factors, in particular, appear to be associated with WD and should therefore be prioritized in clinical practice.

Risk factors of work disability in patients with inflammatory bowel disease — A Dutch nationwide web-based survey: Work disability in inflammatory bowel disease

BackgroundInflammatory bowel disease (IBD) is associated with high costs to society. Few data on the impact of IBD on work disability and potential predictive factors are available. AimTo assess the prevalence of and predictive factors for work disability in Crohn's disease (CD) and ulcerative colitis (UC). MethodsA web-based questionnaire was sent out in seven university hospitals and seven general hospitals in the Netherlands. Initially, 3050 adult IBD patients were included in this prospective, nationwide cohort study, whereof 2629 patients were within the working-age (18–64years). We used the baseline questionnaire to assess the prevalence rates of work disability in CD and UC patients within working-age. Prevalence rates were compared with the Dutch background population using age- and sex-matched data obtained from Statistics Netherlands. Multivariable logistic regression analyses were performed to identify independent demographic- and disease-specific risk factors for work disability. ResultsIn CD, 18.3% of patients was fully disabled and 8.8% partially disabled, compared to 9.5% and 5.4% in UC patients (p<0.01), respectively. Compared to Dutch controls, the prevalence was significantly higher, especially in CD patients. Higher age, low education, depression, chronic back pain, joint manifestations and typical disease-related risk factors such as penetrating disease course and surgery in the past were all found to be associated with work disability. ConclusionWe report high work disability rates in a large sample of IBD patients in the Netherlands. CD patients suffer more frequently from work disability than UC patients. A combination of demographic and disease-related factors is predictive of work disability.

Work-related psychosocial and mechanical risk factors for work disability: a 3-year follow-up study of the general working population in Norway

This study examines the impact of work-related psychosocial and mechanical risk factors for work disability in the general working population. A randomly drawn cohort from the general population in Norway aged 18-66 years was followed for 3 years (N = 12 550, 67% response rate at baseline). Eligible respondents were in paid work for ≥ 10 hours per week in 2006 and were still in paid work or had quit working because of health problems (work disability) in 2009 (N = 6745). Five work-related psychosocial factors and eight mechanical exposures were measured. The outcome of interest was self-reported work disability at 3-year follow-up. In total, 2.6% (176 individuals) reported work disability at the 3-year follow-up. Disability rates were higher among women, older workers, and those with fewer years of education and higher levels of psychological distress and musculoskeletal complaints. After adjusting for these factors, work-related psychosocial predictors of disability were low levels of supportive leadership [odds ratio (OR) 1.61, 95% confidence interval (95% CI) 1.02-2.56] and monotonous work (OR 1.53, 95% CI 1.09-2.16). Mechanical factors were neck flexion (OR 2.49, 95% CI 1.36-4.56), prolonged standing (OR 1.79, 95% CI 1.21-2.46), whole-body vibration (OR 4.15, 95% CI 1.77-9.71), and heavy physical work (OR 2.23. 95% CI 1.08-4.57). The estimated population risk attributable to these factors was about 45%. Monotonous work, prolonged standing, neck flexion, and whole-body vibration appear to be the most consistent and important predictors of work disability.

Risk factors for work disability associated with arthritis and other rheumatic conditions

In our first columnin this series on arthritis and em-ployment, we reviewed the evidence showing that thevarious forms of arthritis and other rheumatic condi-tions are associated with a substantial amount of workdisability.Whilemedicaltreatmentisofcoursethema-jor intervention for work disability, curative or evensubstantially effective treatment is often not availableleaving many people with arthritis continuing to expe-rience arthritis-related work limitations [1]. If factorsthat increase people’s risk for work disability – i.e.,work disability risk factors – can be identified and arepotentially modifiable, these factors would help guidethe development of interventions to enhance people’swork participation and performance.The purpose of this article is to review the litera-ture on risk factors for arthritis and other rheumaticcondition-related work disability. We reviewed stud-ies providing quantitative or qualitative data on riskfactors for any type of work disability outcome, e.g.,premature work cessation and productivity limitation.Productivity limitation includes absenteeism and pre-senteeism, the latter being reduced capacity to workwhile at work due to health.Risk factor studies have primarily been conductedusing samples of persons with a particular rheumatic

Work disability after road traffic injury in a mixed population with and without hospitalisation

BackgroundStudies addressing work disability after road traffic injury are generally aimed at seriously injured hospital patients, and less is known about the disability burden associated with injuries not requiring hospitalisation. The aim of this study was to describe the distribution and determinants of work disability outcomes for patients with musculoskeletal and orthopaedic traffic injuries, including those not sufficiently severe to require hospitalisation. MethodsPersons injured in road traffic accidents in 2005–2007 claiming compensation via the Transport Accident Commission (Victoria, Australia) were included if they had compensated time off work, and their most serious injury was musculoskeletal or orthopaedic (n=5970). Work disability outcomes were determined from income compensation payments over 17 months following the accident. Logistic regression models were used relating demographic and injury characteristics to work disability. ResultsOf the injuries, 59% required hospitalisation; 15% required hospitalisation of >1 week. Long-term work disability was common with 32% of injuries resulting in work disability ≥6 months after the accident. The duration of work disability increased markedly with length of hospital stay. Those with no hospital stay accounted for 27% of all work disability days; those with ≤7 days in hospital (including no hospital stay) accounted for 71%. Female sex, age ≥35 years and early opioid prescriptions were also risk factors for work disability ≥6 months after the accident. ConclusionThe majority of work disability days were among patients with one week or less in hospital. Because (short) hospitalisation was relatively common after traffic accidents, the relative work disability burden of non-hospitalised injury is not as great as in a mixed injury aetiology population.