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Hansen JAL, Fast T, Wangen KR. Productivity Loss Across Socioeconomic Groups Among Patients With Low Back Pain or Osteoarthritis: Estimates Using the Friction-Cost Approach in Norway. PHARMACOECONOMICS 2023; 41:1079-1091. [PMID: 37084066 PMCID: PMC10449709 DOI: 10.1007/s40273-023-01269-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Our aim was to estimate the productivity loss (PL) among patients with low back pain (LBP) or osteoarthritis (OA) across socioeconomic groups, using the friction-cost approach (FCA). METHODS A total of 175,550 patients aged 18-65 years were included at their first diagnosis in specialty care between 2011 and 2016. PL was calculated for the year following diagnosis using individual wages, while adjusting for the friction length at 78 days per episode, a team production multiplier at 1.6, compensation mechanisms of 26.8%, and a chain-of-vacancies multiplier at 3.95. We included a simpler FCA model, omitting the latter three parameters, and a human capital approach (HCA) model. Socioeconomic stratifications were created based on education and income. One-way sensitivity analysis was used to assess the influence of the parameters in the full FCA model. RESULTS The overall mean number of absent days was 23, while it was 25.3 and 20.1 for those with low and high education levels. The per-patient friction costs were €4395 among all patients and when extending the friction length to 98 days costs were €4342. For those with low and high education levels, the costs were €3671 and €4464, respectively. The costs in the simple FCA and HCA models were €1539 and €2088. DISCUSSION Socioeconomic status and model design are sources of variation in PL. In health economic applications with PL and in patient populations with large socioeconomic differences, adjusting for these factors may be as important as sensitivities in parameters such as the friction length.
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Affiliation(s)
- Johan A Liseth Hansen
- Department of Health Management and Health Economics, University of Oslo, Forskningsveien 3a, 0317, Oslo, Norway.
- Quantify Research, Stockholm, Sweden.
| | | | - Knut Reidar Wangen
- Department of Health Management and Health Economics, University of Oslo, Forskningsveien 3a, 0317, Oslo, Norway
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Chen J, Mittendorfer-Rutz E, Berg L, Nørredam M, Sijbrandij M, Klimek P. Association of common mental disorders and related multimorbidity with subsequent labor market marginalization among refugee and Swedish-born young adults. Front Public Health 2023; 11:1054261. [PMID: 37006549 PMCID: PMC10060531 DOI: 10.3389/fpubh.2023.1054261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundCommon mental disorders (CMDs), multimorbidity, and refugee status are associated with poor labor market outcome. Little is known about how these factors interact in young adults.ObjectiveWe aimed to i) investigate whether the association of CMDs and multimorbidity with labor market marginalization (LMM) differs between refugee and Swedish-born young adults and ii) identify diagnostic groups with particularly high risk for LMM.MethodsThis longitudinal registry-based study included individuals aged 20–25 years followed from 2012 to 2016 in Sweden (41,516 refugees and 207,729 age and sex-matched Swedish-born individuals). LMM was defined as granted disability pension (DP) or > 180 days of unemployment (UE). A disease co-occurrence network was constructed for all diagnostic groups from 2009 to 2011 to derive a personalized multimorbidity score for LMM. Multivariate logistic regression was used to estimate odds ratios of LMM in refugee and Swedish-born youth as a function of their multimorbidity score. The relative risk (RR, 95% CI) of LMM for refugees with CMDs compared to Swedish-born with CMDs was computed in each diagnostic group.ResultsIn total, 5.5% of refugees and 7.2% of Swedish-born with CMDs were granted DP; 22.2 and 9.4%, respectively received UE benefit during follow-up. While both CMDs and multimorbidity independently elevated the risk of DP considerably in Swedish-born, CMDs but not multimorbidity elevated the risk of UE. Regarding UE in refugees, multimorbidity with the presence of CMDs showed stronger estimates. Multimorbidity interacted with refugee status toward UE (p < 0.0001) and with CMDs toward DP (p = 0.0049). Two diagnostic groups that demonstrated particularly high RR of UE were schizophrenia, schizotypal and delusional disorders (RR [95% CI]: 3.46 [1.77, 6.75]), and behavioral syndromes (RR [95% CI]: 3.41 [1.90, 6.10]).ConclusionTo combat LMM, public health measures and intervention strategies need to be tailored to young adults based on their CMDs, multimorbidity, and refugee status.
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Affiliation(s)
- Jiaying Chen
- Section for Science of Complex Systems, CeDAS, Medical University of Vienna, Vienna, Austria
- Complexity Science Hub Vienna, Vienna, Austria
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Berg
- Department of Public Health Sciences, Stockholm University, Stockholm, Sweden
- Centre for Health Equity Studies, Karolinska Institutet, Stockholm University, Stockholm, Sweden
| | - Marie Nørredam
- Danish Research Centre for Migration, Ethnicity, and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Copenhagen, Denmark
| | - Marit Sijbrandij
- Department of Clinical, Neuro-and Developmental Psychology, WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Peter Klimek
- Section for Science of Complex Systems, CeDAS, Medical University of Vienna, Vienna, Austria
- Complexity Science Hub Vienna, Vienna, Austria
- *Correspondence: Peter Klimek
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Virtanen M, Heikkilä K, Vahtera J, Kivimäki M, Halonen JI, Alexanderson K, Rautiainen S, Lallukka T, Mittendorfer-Rutz E. Clustering of disability pension and socioeconomic disadvantage in Sweden: a geospatial analysis. Eur J Public Health 2022; 32:703-708. [PMID: 35904456 PMCID: PMC9527964 DOI: 10.1093/eurpub/ckac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND To characterize geospatial patterning of disadvantage in Sweden, we examined whether municipal-level indicators of socioeconomic disadvantage and disability pension (DP) rate were clustered, whether the different geospatial clusters were overlapping and whether the findings were similar among women and men. METHODS Administrative national data from all 290 Swedish municipalities were used to determine the prevalence of DP and socioeconomic disadvantage [poverty, long-term unemployment, income inequality (GINI Index) and income inequality between women and men]. Geospatial cold spots (clusters of municipalities with a DP/socioeconomic disadvantage prevalence lower than the nationwide prevalence) and hot spots (clusters of municipalities with a DP/socioeconomic disadvantage higher than the nationwide prevalence) were identified, and whether a hot spot was overlapping with another hot spot and a cold spot overlapping with another cold spot were analysed using the Getis-Ord Gi statistics. RESULTS Among women and men, cold spots of DP were most consistently located in the Stockholm area. Hot spots of DP were found in the mid-south Sweden, characterized by mid-sized urban centres in rural territories. High DP rate and socioeconomic disadvantage were overlapping, except for income inequality. Clusters of gender income inequality and women's high DP rate were observed in mid-south Sweden. CONCLUSION DP and socioeconomic disadvantage are not randomly distributed in Sweden. Geospatial analyses revealed clusters of municipalities with high risk of both DP and socioeconomic disadvantage in certain areas and low risk in other areas. Further research is needed to identify preventive actions to decrease regional inequalities in work capacity.
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Affiliation(s)
- Marianna Virtanen
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
| | - Katriina Heikkilä
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jussi Vahtera
- Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
| | - Mika Kivimäki
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Epidemiology and Public Health, University College London, London, UK.,Finnish Institute of Occupational Health, Helsinki, Finland
| | - Jaana I Halonen
- Finnish Institute for Health and Welfare, Helsinki, Finland.,Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Kristina Alexanderson
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Simo Rautiainen
- Faculty of Social Sciences and Business Sciences, Karelian Institute, University of Eastern Finland, Joensuu, Finland
| | - Tea Lallukka
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Matos Fialho PM, Dragano N, Reuter M, Deindl C, Schleberger S, Metzendorf MI, Hoffmann S, Diehl K, Wachtler B, Schüttig W, Herke M, Richter M, Pischke CR. School-to-work and school-to-university transition and health inequalities among young adults: a scoping review. BMJ Open 2022; 12:e058273. [PMID: 35820759 PMCID: PMC9274510 DOI: 10.1136/bmjopen-2021-058273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The main objective was to systematically map evidence regarding the emergence of health inequalities in individuals aged 16-24 years during school-to-work and school-to-university transition (STWT). Second, we aimed to summarise the evidence on potential effects of contextual and compositional characteristics of specific institutional contexts entered during STWT on health and health behaviours. DESIGN Scoping review. STUDY SELECTION Relevant literature was systematically searched following the methodological framework proposed by Arksey and O'Malley. Ovid MEDLINE and Web of Science, and websites of the International Labour Organization and National Institute for Occupational Safety and Health were searched, using a predetermined search strategy. Articles in English or German published between 1 January 2000 and 3 February 2020 were considered. DATA EXTRACTION To collect the main information from the selected studies, a data extraction spreadsheet was created. Data were summarised and grouped into five health outcomes and five institutional contexts (school, vocational training, university, work, unemployment). RESULTS A total of 678 articles were screened for inclusion. To be able to draw a picture of the development of various health outcomes over time, we focused on longitudinal studies. Forty-six prospective studies mapping health-related outcomes during STWT were identified. Higher family socioeconomic position (SEP) was associated with higher levels of health behaviour and lower levels of health-damaging behaviour, but there was also some evidence pointing in the opposite direction. Disadvantaged family SEP negatively impacted on mental health and predicted an adverse weight development. There was limited evidence for the outcomes physical/somatic symptoms and self-rated health. Meso-level characteristics of the institutional contexts identified were not systematically assessed, only individual-level factors resulting from an exposure to these contexts, rendering an analysis of effects of contextual and compositional characteristics on health and health behaviours impossible. CONCLUSIONS This scoping review demonstrated a wide range of health inequalities during STWT for various health outcomes. However, knowledge on the role of the core institutional contexts regarding the development of health inequalities is limited.
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Affiliation(s)
- Paula Mayara Matos Fialho
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich-Heine University, Medical Faculty, Duesseldorf, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich-Heine University, Medical Faculty, Duesseldorf, Germany
| | - Marvin Reuter
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich-Heine University, Medical Faculty, Duesseldorf, Germany
| | - Christian Deindl
- Department of Social Sciences, TU Dortmund University, Dortmund, Germany
| | - Sarah Schleberger
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich-Heine University, Medical Faculty, Duesseldorf, Germany
| | - Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice (ifam), Centre for Health and Society, Medical Faculty, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Stephanie Hoffmann
- Department of Public Health, Faculty for Social Work, Health, and Music, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Katharina Diehl
- Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen, Germany
| | - Benjamin Wachtler
- Department of Epidemiology and Health Monitoring, Robert Koch Institut, Berlin, Germany
| | - Wiebke Schüttig
- Department of Health Economics, Technical University Munich, Munich, Germany
| | - Max Herke
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Matthias Richter
- Institute of Medical Sociology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Claudia R Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich-Heine University, Medical Faculty, Duesseldorf, Germany
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Consumption of psychotropic drugs among disability pension applicants with mental disorders: comparing awarded and rejected applicants in Finland. Soc Psychiatry Psychiatr Epidemiol 2021; 56:437-448. [PMID: 32172305 PMCID: PMC7904542 DOI: 10.1007/s00127-020-01850-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 02/28/2020] [Indexed: 12/02/2022]
Abstract
PURPOSE Psychotropic drug consumption as a proxy measure of mental health problems during a disability pension process has only been studied among awarded applicants. This study examined psychotropic drug purchase trajectories among awarded and rejected disability pension applicants. Analyses were conducted in different diagnostic and sociodemographic groups. METHODS A representative 70% sample of Finnish adults applying for disability pension due to a mental disorder in 2009-2011 (N = 18,087) was followed for 4 years in 3-month periods both before and after the pension decision. Register data on purchased drugs measured in defined daily doses (DDDs), gender, age, occupational class, unemployment history, and diagnostic group were used. The DDD levels and trends were analyzed using growth curve models. RESULTS Psychotropic drug purchases increased before the pension decision and decreased gradually thereafter among both awarded and rejected applicants. The average DDD level was higher for rejected than awarded applicants before the decision but lower thereafter. The high pre-decision level for rejected applicants was explicit with a lower socioeconomic status. The pre-decision increase in DDDs was steeper for awarded applicants. Changes in DDDs before and after the decision were most prominent for depression, bipolar disorders, schizophrenia, and anxiety disorders. CONCLUSION Awarded and rejected disability pension applicants differed partly in their trajectories of psychotropic drug consumption. For awarded applicants, the steep rise of consumption prior to the award possibly reflects worsening occupational capacity. Early high consumption for rejected applicants signals long running mental health problems and calls for earlier support.
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Lallukka T, Shiri R, Pietiläinen O, Kausto J, Sumanen H, Halonen JI, Lahelma E, Rahkonen O, Mänty M, Kouvonen A. Timing of Entry into Paid Employment, Adverse Physical Work Exposures and Health: The Young Helsinki Health Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217854. [PMID: 33120885 PMCID: PMC7662500 DOI: 10.3390/ijerph17217854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/12/2020] [Accepted: 10/23/2020] [Indexed: 01/07/2023]
Abstract
It is not well known how the timing of entry into paid employment and physical work exposures contribute to different health outcomes in young employees. Thus, we determined the associations of age at entry into paid employment and physical work exposures with general and mental health in young employees and determined whether associations differ by behavior-related risk factors. Data were collected via online and mailed surveys in autumn 2017 from employees of the City of Helsinki aged 18–39 years (n = 5897; 4630 women and 1267 men, response rate 51.5%). Surveys comprised measures of age at entry into paid employment, seven working conditions, behavior-related risk factors and health outcomes (self-rated health [SRH] and common mental disorders [CMD] as generic indicators of physical and mental health). Logistic regression analysis was used. After full adjustment, age at entry was not associated with the health outcomes; however, in additional analyses, younger age at first employment was associated with smoking and obesity (OR 3.00, 95% CI 2.34–3.85 and 1.67, 95% CI 1.32–2.11 for those started working at age of ≤18 years, respectively). Of the working conditions, sitting and standing were positively associated with poor SRH and CMD and uncomfortable working postures with CMD. Working conditions were broadly similarly associated with health outcomes among those with and without behavior-related risk factors. Although we found little support for modification by behavior-related risk factors, overweight, obesity and smoking were associated with poor SRH and binge drinking and smoking with CMD. Additionally, moderate and high levels of leisure-time physical activity were inversely associated with poor SRH. In conclusion, early entry into paid employment appears not to associate to immediate poorer health in young employees, although it was associated with smoking and obesity even after full adjustment. Exposure to physically heavy work and uncomfortable working postures may increase the risk of adverse health outcomes.
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Affiliation(s)
- Tea Lallukka
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland; (R.S.); (J.K.)
- Correspondence: ; Tel.: +358-505-704-399
| | - Rahman Shiri
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland; (R.S.); (J.K.)
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
| | - Johanna Kausto
- Finnish Institute of Occupational Health, P.O. Box 18, 00032 Helsinki, Finland; (R.S.); (J.K.)
| | - Hilla Sumanen
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
- Department of Health Care and Emergency Care, South Eastern Finland University of Applied Sciences, 48220 Kotka, Finland
| | - Jaana I. Halonen
- Department of Health Security, Finnish Institute for Health and Welfare, P.O. Box 30, 00271 Helsinki, Finland;
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
| | - Minna Mänty
- Department of Public Health, University of Helsinki, P.O. Box 20, 00014 Helsinki, Finland; (O.P.); (H.S.); (E.L.); (O.R.); (M.M.)
- Department of Strategy and Research, City of Vantaa, 01030 Vantaa, Finland
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, 00014 Helsinki, Finland;
- Research Institute of Psychology, SWPS University of Social Sciences and Humanities, 53-238 Wroclaw, Poland
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Kääriälä A, Haapakorva P, Pekkarinen E, Sund R. From care to education and work? Education and employment trajectories in early adulthood by children in out-of-home care. CHILD ABUSE & NEGLECT 2019; 98:104144. [PMID: 31678608 DOI: 10.1016/j.chiabu.2019.104144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 08/08/2019] [Accepted: 08/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Temporal dynamics during the early adulthood transition among children in out-of-home care is a neglected research area, leaving the possibility of coping with childhood adversity over time a poorly understood topic. OBJECTIVE To explore early adulthood education and employment trajectories among young adults who experienced out-of-home care during childhood and to examine how various care history factors predict these trajectories. PARTICIPANTS We use longitudinal birth cohort data comprising individual-level information from national registers of all children born in Finland in 1987 (N = 59,476, of whom 1893 were in care). SETTING AND METHODS We use trajectory clustering from a previous study on the 1987 birth cohort to compare trajectories between children in care and a propensity score-matched group of peers never in care. We investigated the association between care history factors and trajectories with multinomial logistic regression modeling. RESULTS Compared with the matched peer group, children in care were less likely to enter trajectories characterized by education and employment (38%) and more likely to enter trajectories involving early parenthood (14%) or long periods of fragmented social assistance benefit receipt and unemployment (21%). Those on early parenthood trajectories were almost exclusively women, whereas those receiving social assistance benefits and experiencing unemployment for lengthy periods were mostly men. Entering disadvantaged trajectories was associated with, inter alia, placement as an adolescent, residential care, and aging out of care. CONCLUSION The study demonstrates the relevance of examining longitudinal trajectories in children in care's early adulthood. Many young adults with care experience need support in education and employment beyond young adult age.
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Affiliation(s)
- Antti Kääriälä
- Faculty of Social Sciences, University of Helsinki, P.O. Box 18, FI-00014, Helsinki, Finland.
| | - Pasi Haapakorva
- National Institute for Health and Welfare, THL, P.O. Box 310, FI-90101, Oulu, Finland.
| | - Elina Pekkarinen
- Finnish Youth Research Network, Asemapäällikönkatu 1, FI-00520, Helsinki, Finland.
| | - Reijo Sund
- Institute of Clinical Medicine, University of Eastern Finland, P.O. Box 1627 (Mediteknia building), FI-70211, Kuopio, Finland.
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Laura S, Sanna KL, Heta P. Unravelling the relationship between parental resources and disability pension in young adulthood. SOCIAL SCIENCE RESEARCH 2019; 83:102315. [PMID: 31422840 DOI: 10.1016/j.ssresearch.2019.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 05/06/2019] [Accepted: 06/29/2019] [Indexed: 06/10/2023]
Abstract
A vast literature exists on the relationship between family background and health outcomes. However, there is a shortage of evidence on the relationship between parental resources and offsprings' disability pension, a severe form of general poor health and functionability. This article analyses how parental income and education are associated with offsprings' disability pension in young adulthood (19-27 years) among 1980-1985 birth cohorts using Finnish register data. The results of discrete-time event history analysis demonstrate that parental income and education have contrasting impacts. High parental income is found to decrease, and parental education to increase, the probability of offspring having disability pension, although mainly among offspring with compulsory education. Further, young adults with high parental resources are better off two years after their first disability pension. We conclude that the influence of parental resources operates via offsprings' educational attainment but also has divergent direct impacts on offsprings' disability pension.
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Affiliation(s)
- Salonen Laura
- Sociology, Department of Social Research, University of Turku,Assistentinkatu 7, Publicum, 20014, Turku, Finland.
| | - Kailaheimo-Lönnqvist Sanna
- Sociology, Department of Social Research, University of Turku,Assistentinkatu 7, Publicum, 20014, Turku, Finland.
| | - Pöyliö Heta
- Sociology, Department of Social Research, University of Turku,Assistentinkatu 7, Publicum, 20014, Turku, Finland.
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Salonsalmi A, Pietiläinen O, Lahelma E, Rahkonen O. Childhood adversities, parental education and disability retirement among Finnish municipal employees. PLoS One 2019; 14:e0219421. [PMID: 31323034 PMCID: PMC6641080 DOI: 10.1371/journal.pone.0219421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/24/2019] [Indexed: 11/19/2022] Open
Abstract
Background There is increasing evidence that childhood socioeconomic position and childhood adversities influence adult health. However, the potential contribution of these factors to disability retirement is poorly understood. This study aimed to examine the associations between childhood adversities, parental education and disability retirement. Methods Data on parental education and childhood adversities were derived from the Helsinki Health Study baseline survey, conducted in 2000–02 among 40- to 60-year old employees of the City of Helsinki, Finland. Data on disability retirement and their diagnoses were obtained from the Finnish Centre of Pensions and followed until the end of 2016. The analyses included 5992 employees. The associations of parental education and childhood adversities with disability retirement due to any cause, musculoskeletal diseases and mental disorders were analysed using Cox regression analysis. Results Low parental education was associated with an increased risk of disability retirement due to any cause (maternal education: HR 1.74, 95% CI 1.16–2.62; paternal education: 1.86, 1.38–2.51) and due to musculoskeletal diseases (maternal education: 4.44, 1.66–11.92; paternal education: 3.81, 2.02–7.17). However, adjustment for own education mainly abolished the associations. Economic difficulties in the childhood family, parental alcohol problems and having been bullied at school or by peers increased the risk of disability retirement due to all studied diagnostic groups, whereas parental death or divorce had no effect. Childhood illness (1.53, 1.20–1.95) and parental mental illness (1.68, 1.28–2.20) were associated with disability retirement due to any cause and due to mental disorders (1.65, 1.05–2.59; 3.60, 2.46–5.26). The associations between childhood adversities and disability retirement remained after adjustment for own education, whereas working conditions, and weight and health behaviours somewhat attenuated the associations. Conclusions Parental education and childhood adversities contributed to disability retirement even in midlife. Policy actions investing in children’s well-being might promote work ability in midlife.
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Affiliation(s)
- Aino Salonsalmi
- Department of Public Health, University of Helsinki, Helsinki, Finland
- * E-mail:
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
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10
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Jablonska B, Dalman C, Lundin A, Kosidou K. Has the association between low school performance and the risk of disability benefit due to mental disorders become stronger over time? BMC Public Health 2019; 19:376. [PMID: 30943936 PMCID: PMC6448315 DOI: 10.1186/s12889-019-6703-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The proportion of young adults on disability benefits due to mental disorders has increased in Europe since the early 2000's. Poor educational achievement is a risk factor for disability benefits due to mental disorders in early adulthood, yet no study has examined whether this association has become stronger over time. METHODS All residents of Stockholm County at the time of graduation from compulsory education between 2000 and 2007 (N = 169,125) were followed prospectively for recipient of disability benefits due to a mental disorder from 2003 to 2011. Information about the study participants was obtained by linkage of national registers. Low school performance in the last year of compulsory school was defined as having a merit rating corresponding to the lowest quintile. The association between school performance and disability benefits was examined using Cox proportional hazards models. RESULTS Low school performers had a greater risk of disability benefits due to mental disorders during early adulthood, as compared to their better performing counterparts, and this association was more pronounced for the more recent graduation cohorts (OR = 1.12, 95% CI 1.08-1.16). CONCLUSIONS The association between low school performance and the risk of disability benefits due to mental disorders seems to become stronger during the first decade of the twenty-first century. It is plausible that this trend indicates an increased vulnerability of poor school performers to exclusion from the labor market. Prevention of school failure and adjustment of the labour market to individual variability in academic performance appear to be critical approaches to counteract this trend.
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Affiliation(s)
- Beata Jablonska
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 45436, 104 31, Stockholm, Sweden. .,Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden.
| | - Christina Dalman
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 45436, 104 31, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Andreas Lundin
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 45436, 104 31, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Kyriaki Kosidou
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Box 45436, 104 31, Stockholm, Sweden.,Department of Public Health Sciences, Karolinska Institutet, 171 77, Stockholm, Sweden
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11
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Halonen JI, Merikukka M, Gissler M, Kerkelä M, Virtanen M, Ristikari T, Hiilamo H, Lallukka T. Pathways from parental mental disorders to offspring's work disability due to depressive or anxiety disorders in early adulthood-The 1987 Finnish Birth Cohort. Depress Anxiety 2019; 36:305-312. [PMID: 30329200 DOI: 10.1002/da.22847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 08/14/2018] [Accepted: 09/22/2018] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Parental mental disorders have been shown to predict offspring's mental health problems. We examined whether pathways from parental mental disorders to offspring's psychiatric work disability in early adulthood are mediated through offspring's mental disorders and social disadvantage in adolescence. METHODS Study population consisted of the 1987 Finnish Birth Cohort. Data on parents' psychiatric care or work disability due to mental diagnosis between 1987 and 2000 and the cohort participants' health and social factors between 2001 and 2005 were derived from administrative national registers. From 2006 through 2015, 52,182 cohort participants were followed for admittance of psychiatric work disability due to depressive or anxiety disorders. First, we applied a pathway analysis to examine the occurrence of each path. We then used mediation analysis to assess the proportion of association between parental mental disorders and work disability mediated by offspring's health and social disadvantage. RESULTS The pathway model indicated that the association from parental mental disorders to offspring's work disability due to depressive or anxiety disorder is through mental disorders and social disadvantage in adolescence. Odds Ratio for the total effect of parental mental disorders on offspring's psychiatric work disability was 1.85 (95% confidence interval [CI] 1.46-2.34) in the model including offspring's mental disorders that mediated this association by 35%. Corresponding results were 1.86 (95% CI 1.47-2.35) and 28% for social disadvantage in adolescence. CONCLUSIONS These findings suggest that intergenerational determination of work disability due to mental disorders could be addressed by actions supporting mental health and social circumstances in adolescence.
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Affiliation(s)
| | - Marko Merikukka
- Department of Welfare, National Institute for Health and Welfare (THL), Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare (THL), Helsinki, Finland.,Research Centre for Child Psychiatry, University of Turku, Turku, Finland.,Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Karolinska Institute, Stockholm, Sweden
| | - Martta Kerkelä
- Department of Welfare, National Institute for Health and Welfare (THL), Oulu, Finland
| | - Marianna Virtanen
- Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden
| | - Tiina Ristikari
- Department of Welfare, National Institute for Health and Welfare (THL), Oulu, Finland
| | - Heikki Hiilamo
- Social and Public Policy, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Finnish Institute of Occupational Health, Helsinki, Finland.,Department of Public Health, University of Helsinki, Helsinki, Finland
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12
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Merikukka M, Ristikari T, Tuulio-Henriksson A, Gissler M, Laaksonen M. Childhood determinants for early psychiatric disability pension: A 10-year follow-up study of the 1987 Finnish Birth Cohort. Int J Soc Psychiatry 2018; 64:715-725. [PMID: 30394811 DOI: 10.1177/0020764018806936] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Mental disorders can affect work ability and lead to early exit from the labour market through disability pension. AIMS This study aimed to identify childhood determinants of psychiatric disability pension in early adulthood. METHODS The 1987 Finnish Birth Cohort includes a complete census of children born in a single year. The children were followed up from birth until 31 December 2012 using official registers maintained by the Finnish authorities. Risk factors for disability pension were examined in the full 1987 cohort (N = 58,739) and among children who had received mental health care (N = 9,599). Odds ratios were calculated for disability pension due to all mental disorders and separately for schizophrenia, depressive and anxiety and other mental and behavioural disorders in association with childhood determinants. RESULTS Altogether, 1.4% of cohort members had retired due to mental disorders in 2003-2012. In the full 1987 cohort, female sex, parental divorce and social assistance, both mother's and father's psychiatric care and mother's psychiatric disability pension increased the risk for disability pension due to mental disorders. Among children who had received mental health care, risk factors for psychiatric disability pension were father's psychiatric care and mother's psychiatric disability pension. CONCLUSION Childhood determinants were related to the risk of psychiatric disability pension before the age of 25. The risk factors varied by the diagnosis of the disability pension. Using knowledge of this study's risk factors should enable the identification of adolescents and young adults in general population and especially in the mental health care population who are at greatest risk of receipt of psychiatric disability pension.
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Affiliation(s)
- Marko Merikukka
- Department of Welfare, National Institute for Health and Welfare (THL), Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Tiina Ristikari
- Department of Welfare, National Institute for Health and Welfare (THL), Oulu, Finland
| | - Annamari Tuulio-Henriksson
- Research Department, Social Insurance Institution (KELA), Helsinki, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Mikko Laaksonen
- Research Department, Finnish Centre for Pensions (ETK), Helsinki, Finland
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13
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Harkko J, Virtanen M, Kouvonen A. Unemployment and work disability due to common mental disorders among young adults: selection or causation? Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Rehabilitation Foundation, Helsinki, Finland
| | - Marianna Virtanen
- Finnish Institute of Occupational Health, Helsinki, Finland
- Department of Public Health and Caring Sciences, University of Uppsala, Uppsala, Sweden
| | - Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- SWPS University of Social Sciences and Humanities in Wroclaw, Wroclaw, Poland
- Administrative Data Research Centre – Northern Ireland, Centre for Public Health, Queen’s University Belfast, Belfast, UK
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