Contextual factors and social consequences of incident disease

Sick of social status: A Bourdieusian perspective on morbidity and health inequalities

Self-reported health (SRH) is one of the most frequently used measures for examining socioeconomic inequalities in health. Studies find that when faced with 'identical objective health', individuals in lower socioeconomic groups consistently report worse SRH than those in higher socioeconomic groups. Such findings are often dismissed as being the result of reporting bias, and existing literature dominated by the biomedical conception of SRH has not investigated the underlying social mechanisms at work. To address this limitation, drawing on the work of Bourdieu we employ a relational thinking between health and social position. By way of multiple correspondence analysis, we construct social space of health determinants for three European countries from different welfare states and map the trajectories of educational groups experiencing similar levels of morbidity and their relation to SRH. Differences in SRH observed among social groups for the same level of morbidity are understood in relation to the position and the relative power of individuals in different educational groups to maintain or improve their social conditions, especially with increasing levels of health loss. Our analysis indicates that reporting differences in SRH among educational groups emerges from objectively healthy individuals and follows differences in accumulation of social advantages and disadvantages.

Unemployment, unemployment duration, and health: selection or causation?

This study aims at disentangling the causal effects of unemployment on physical and mental health from the selection of the unhealthy into unemployment. To identify causal effects, it explores hypotheses concerning how physical and mental health deterioration gain additional momentum with a longer duration of unemployment. In contrast, mere selection into unemployment implies time-constant effects of unemployment on physical and mental health. Fixed-effects models are applied to data from the German Socio-Economic Panel (GSOEP, 2002-2014, 74,572 observations). Pointing at causal effects of unemployment, the findings show that physical health does not deteriorate before, during or immediately after the period in which individuals lose their jobs, but that deterioration gains momentum later. The effect further depends on age at transition to unemployment. In contrast, a large part of the poorer mental health of the unemployed might be due to the selection of the unhealthy into unemployment; mental health declines even before job loss. Only for people who experience unemployment early in life, mental health deterioration gains some momentum in the time after the transition, indicating a (weak) causal effect of unemployment on mental health for younger individuals.

The effects of unemployment and perceived job insecurity: a comparison of their association with psychological and somatic complaints, self-rated health and life satisfaction

PURPOSE

Research has provided convincing evidence for the adverse effects of both short- and long-term unemployment, and perceived job insecurity on individuals' health and well-being. This study aims to go one critical step further by comparing the association between short- and long-term unemployment, and perceived job insecurity with a diverse set of health and well-being indicators.

METHODS

We compare four groups: (1) secure permanent employees (N = 2257), (2) insecure permanent employees (N = 713), (3) short-term unemployed (N = 662), and (4) long-term unemployed (N = 345) using cross-sectional data from the nationally representative Living Conditions Survey in Finland.

RESULTS

Covariance analyses adjusted for background variables support findings from earlier studies that long-term unemployment and perceived job insecurity are detrimental: short-term unemployed and secure permanent employees experienced fewer psychological complaints and lower subjective complaints load, reported a higher self-rated health, and were more satisfied with their life compared to long-term unemployed and insecure permanent employees. Second, whereas unemployment was found to be more detrimental than insecure employment in terms of life satisfaction, insecure employment was found to be more detrimental than unemployment in terms of psychological complaints. No differences were found regarding subjective complaints load and self-rated health.

CONCLUSIONS

Our findings suggest that (1) insecure employment relates to more psychological complaints than short-term unemployment and secure permanent employment, (2) insecure employment and long-term unemployment relate to more subjective complaints load and poorer health when compared to secure permanent employment, and (3) insecure employment relates to higher life satisfaction than both short- and long-term unemployment.

Hypothyroidism is a predictor of disability pension and loss of labor market income: a Danish register-based study

BACKGROUND

Hypothyroidism is associated with an increased somatic and psychiatric disease burden. Whether there are any socioeconomic consequences of hypothyroidism, such as early retirement or loss of income, remains unclarified.

AIM

Our aim was to examine, compared with a matched control group, the risk of receiving disability pension (before the age of 60) and the effect on labor market income in patients diagnosed with hypothyroidism.

METHODS

This was an observational register-based cohort study. By record linkage between different Danish health registers, 1745 hypothyroid singletons diagnosed before the age of 60 were each matched with 4 non-hypothyroid controls and followed for a mean of 5 (range 1-31) years. Additionally, we included 277 same-sex twin pairs discordant for hypothyroidism. The risk of disability pension was evaluated by the Cox regression analysis. Changes in labor market income progression over 5 years were evaluated using a difference in difference model.

RESULTS

With a hazard ratio of 2.24 (95% confidence interval = 1.73-2.89), individuals diagnosed with hypothyroidism had a significantly increased risk of disability pension. This remained significant when adjusting for educational level and comorbidity (hazard ratio = 1.89; 95% confidence interval = 1.42-2.51). In an analysis of labor market income, 2 years before compared with 2 years after the diagnosis of hypothyroidism, the hypothyroid individuals had on average a €1605 poorer increase than their euthyroid controls (P < .001). Essentially similar results were found in the twin population.

CONCLUSION

A diagnosis of hypothyroidism before the age of 60 is associated with loss of labor market income and an 89% increased risk of receiving a disability pension.

Are age-related differences in the consequence of work injury greater when occupational physical demands are high?

BACKGROUND

To examine if age differences in the consequences of work injury are exacerbated when occupational physical demands are higher.

METHODS

A secondary analysis of workers' compensation claims in British Columbia (N = 373,672). Regression models examined the relationship between age and health care expenditures, days of wage replacement and the occurrence of long-term-disability following a work-related injury in occupations with lower and higher physical demands. Models were adjusted for individual and injury related covariates.

RESULTS

Older age and higher occupational physical demands were associated with worse work-injury outcomes. The relationship between age and each outcome was not exacerbated when occupational physical demands were higher compared to when they were lower. Counter to our hypotheses age differences in health care expenditures were smaller among women in more demanding occupations.

CONCLUSIONS

In this study, we found no evidence that the relationship between age and the consequences of work injury is exacerbated when physical occupational demands are high.

Health promotion for unemployed jobseekers: new developments in Germany

OBJECTIVES

The objective of the paper is to present findings from a health promotion programme for long-term unemployed older job seekers in Germany and to discuss conditions for successful linking health and employment promotion.

METHODS

Implementation analysis: interviews with actors who implemented the programme and case studies of job centres where the programme took place.

RESULTS

Health promotion with labour market programmes is possible, but requires (a) agreements and coordination between different branches of social security, (b) an enlargement of the dominant activation paradigm in labour market policy with a stronger emphasis on voluntary programme participation, (c) skills and competencies of the staff in job centres as well as an adapted work organization.

CONCLUSIONS

Efforts to connect health and employment promotion and to induce the related social security's to cooperation are still in their infancy. Further practical steps as well as research and evaluation are necessary to bring these areas together.

Examining the relationship between chronic conditions, multi-morbidity and labour market participation in Canada: 2000–2005

Relatively little attention has been paid to understanding and addressing the potential health-related barriers faced by older workers to stay at work. Using three representative samples from the Canadian Community Health Survey, we examined the relationship between seven physical chronic conditions and labour market participation in Canada between 2000 and 2005. We found that all conditions were associated with an increased probability of not being able to work due to health reasons. In our adjusted models, heart disease was associated with the greatest probability of not working due to health reasons. Arthritis was associated with the largest population attributable fraction. Other variables associated with not being able to work due to health reasons included older age, female gender and lower educational attainment. We also found particular combinations of chronic conditions (heart disease and diabetes; and arthritis and back pain) were associated with a greater risk than the separate effects of each condition independently. The results of this study demonstrate that chronic conditions are associated with labour market participation limitations to differing extents. Strategies to keep older workers in the labour market in Canada will need to address barriers to staying at work that result from the presence of chronic conditions, and particular combinations of conditions.

Health in the long-term unemployed

BACKGROUND

Although the unemployment rate in Germany is currently low, more than a million persons in the country have been out of work for more than a year. In this review article, we address these persons' state of health, the effect of unemployment on health, and the influence of macroeconomic factors and social policy.

METHODS

This article is based on a selective review of pertinent literature in the PubMed database.

RESULTS

Large-scale meta-analyses and systematic reviews have shown that the long-term unemployed have an at least twofold risk of mental illness, particularly depression and anxiety disorders, compared to employed persons. Their mortality is 1.6-fold higher. Unemployment seems to be not only an effect of illness, but also a cause of it (i.e., there is evidence for both selection and causality). Learned helplessness is an important psychological explanatory model. Limited evidence indicates that the long-term unemployed have a moderately elevated prevalence of alcoholism; unemployment can be both an effect and a cause of alcoholism. Unemployment also seems to be associated with higher risks of heart attack and stroke. Cancer can lead to loss of employment. The link between unemployment and poorer health is strengthened by macroeconomic crises and weakened by governmental social interventions.

CONCLUSION

The long-term unemployed carry a markedly higher burden of disease, particularly mental illness, than employed persons and those who are unemployed only for a short time. The burden of disease increases with the duration of unemployment. The vicious circle of unemployment and disease can be broken only by the combined effects of generally available health care, special health-promoting measures among the unemployed, and social interventions.

Multivariate Bayesian spatial model of preterm birth and cardiovascular disease among Georgia women: Evidence for life course social determinants of health

BACKGROUND

There is epidemiologic evidence that women who experience preterm birth (PTB) are at elevated risk for cardiovascular disease (CVD) later in life. Each outcome independently has noted spatial and socioeconomic gradients; we test for spatial structure in the population correlation of the two.

METHODS

Exploratory spatial data analysis and multivariate Bayesian spatial models were fit to describe the spatial correlation of PTB with CVD among women in Georgia counties from 2002 to 2006.

RESULTS

Global Moran's I and local-indicators of spatial association statistics suggest significant co-occurrence of CVD and PTB. Bayesian posterior estimates for multivariate correlation of these outcomes range from r=0.11-0.34 for CVD and PTB. Significant spatial correlation persists with control for county covariates among whites but not blacks.

CONCLUSION

Modest evidence for spatial structure of the ecologic correlation of PTB and women's CVD is consistent with a lifecourse perspective on socially clustered determinants of health.

Lifetime occupational physical activity and musculoskeletal aging in middle-aged men and women in denmark: retrospective cohort study protocol and methods

Background

Physical function is essential for performing most aspects of daily life and musculoskeletal aging leads to a decline in physical function. The onset and rate of this process vary and are influenced by environmental, genetic, and hormonal factors. Although everyone eventually experiences musculoskeletal aging, it is beneficial to study the factors that influence the aging process in order to prevent disability. The role of occupational physical activity in the musculoskeletal aging process is unclear. In the past, hard physical work was thought to strengthen the worker, but current studies in this field fail to find a training effect in jobs with a high level of occupational physical activity.

Objective

The aim of this study is to examine the influence of lifetime occupational physical activity on physical function in midlife. The study follows the “occupational life-course perspective,” emphasizing the importance of occupational exposures accumulated throughout life on the musculoskeletal aging process taking socioeconomic and lifestyle factors into consideration.

Methods

This study is a retrospective cohort study including a cross-sectional measurement of physical function in 5000 middle-aged Danes. Data was obtained from the Copenhagen Aging and Midlife Biobank (CAMB) which is based on three existing Danish cohorts. Using questionnaire information about the five longest-held occupations, the job history was coded from the Danish version of the International Standard Classification of Occupations (D-ISCO 88) and a job exposure matrix containing information about occupational physical activity in Danish jobs was applied to the dataset. The primary outcomes are three tests of physical function: handgrip strength, balance, and chair rise. In the analyses, we will compare physical function in midlife according to accumulated exposure to high levels of occupational physical activity.

Conclusions

We have a unique opportunity to study the influence of work on early musculoskeletal aging taking other factors into account. In this study, the “healthy worker effect” is reduced due to inclusion of people from the working population and people who are already retired or have been excluded from the labor market. However, low participation in the physical tests can lead to selection bias.