According to previous studies, abstinence from alcohol increases the risk of disability retirement (DR). We studied whether former alcohol users' poor mental or physical health might have contributed to this result.
Prospective population-based study of 3621 occupationally active Finns aged 30-55 years at baseline. Disability pension data for 2000-2011 was retrieved from national pension records. We examined medically certified disability retirement due to all causes and due to mental disorders among lifelong abstainers, former drinkers, those with an alcohol use disorder irrespective of consumption and current users, further classified according to weekly intake of alcohol. Chronic somatic diseases were evaluated in a clinical examination and common mental and alcohol use disorders using the Composite International Diagnostic Interview. Cox regression was used.
Neither lifelong abstinence nor alcohol consumption, even at hazardous levels, without alcohol use disorder was associated with disability retirement. Compared with light drinkers, former drinkers' hazard ratio for DR due to mental disorders was 2.67 (95% CI 1.39-5.13), allowing for somatic and mental morbidity, physical and psychosocial workload, health behaviour and socio-demographic factors. The respective hazard ratio of DR due to all causes for those with alcohol use disorder was 2.17 (1.49-3.16) and of DR due to mental disorders 4.04 (2.02 to 8.06).
Lifelong abstinence did not predict disability retirement. Former drinkers and people with alcohol use disorders were at a multi-fold risk of work disability due to mental disorders compared with light drinkers, thus it is important to support their work ability.
To justify alcohol-related health promotion programs and target them at the correct workplaces, it is important to identify occupations with increased risk of severe health outcomes caused by alcohol.
Data on hospital admissions (854,555 men and 801,653 women) from the Finnish health care register and data on deaths from Statistics Finland from 1 January 2001 to 31 December 2004 were merged with information from the 2000 population census. We assessed the age- and education-adjusted relationship between occupation and the sum of hospitalizations and death primarily caused by alcohol, using Cox proportional hazards regression. We also estimated the fraction of incidence of severe alcohol-induced health outcomes that are attributable to factors related to one's occupation (population attributable fraction).
Most of the cases were men (80%), middle-aged and usually had no more than a secondary level of education. When the reference was professionals, who were at the lowest risk, those at increased risk were mostly manual workers in craft work, construction and service. However, we also found several non-manual occupations at a high risk. According to population attributable fraction, the proportion of severe alcohol-induced health outcomes would have been 31% lower among men and 20% lower among women if all occupational groups had been at the same risk as professionals.
We detected considerable occupational differences in alcohol-induced morbidity and mortality among a nationally representative working population. This indicates a need for alcohol-focused health promotion programs in these high-risk occupations.
Previous studies have not distinguished between different alcohol-use histories, which could have contributed to the current inconsistent evidence regarding the relationship between alcohol use and subsequent sickness absence. We thus examined alcohol use and subsequent diagnosis-specific sickness absence in groups with different levels of alcohol use, as well as in lifelong abstainers, former drinkers, and people with clinical alcohol use disorders.
The data of the population-based Health 2000 Survey (BRIF8901) of 3666 Finns aged 30-55 were linked with national registers on medically certified sickness absences lasting for >?10 working days (long-term) for all causes (2000?-?2010) and for mental or musculoskeletal disorders (2004-2010), as well as with registers on pensions and death (2000-2010). Alcohol use was assessed by questionnaire. Chronic somatic diseases were evaluated at baseline in a clinical examination, and common mental and alcohol use disorders using the Composite International Diagnostic Interview (CIDI). Cox regression analyses were conducted with censoring for death and retirement from work.
During an average 10-year follow-up, 56.0% of the participants had at least one long-term sickness absence period. Compared with light drinkers, those having an alcohol use disorder had increased risk of all-cause sickness absence (HR?=?1.27; 95% CI?=?1.04?-?1.54) and sickness absence due to mental disorders (HR?=?2.16; 95% CI?=?1.39?-?3.35), when somatic and mental disorders as well as demographic, lifestyle-related and occupational factors at baseline were accounted for. Lifelong abstainers did not differ from light drinkers. Also high-volume drinking (HR?=?1.52; 95% CI 1.03?-?2.25) and former drinking (HR?=?1.57; 95% CI?=?1.15?-?2.15) were associated with long-term sickness absence due to mental disorders. Alcohol use was not predictive of sickness absence due to musculoskeletal disorders.
These results highlight the need to distinguish between former drinking and lifelong abstinence, as only former drinking was associated with sickness absence. Alcohol use disorder and high-volume drinking were strongly predictive of sickness absence due to mental disorders. Identifying people with excessive alcohol use e.g. in occupational health care, and mapping and supporting their mental health may help in preventing sickness absences.
Cites: Drug Alcohol Rev. 2016 Mar;35(2):158-69 PMID 26331574
Both clinical and epidemiologic studies have shown an association between atherosclerotic changes in the aorta or lumbar arteries and lumbar disc degeneration. However, the association between atherosclerosis and sciatica remains unknown. The aim of this study was to investigate the association between carotid intima-media thickness and sciatica.
The target population consisted of people aged 45 to 74 years, who had participated in a Finnish nationwide population study during the period 2000 to 2001 and lived within 200 km of the 6 study clinics. Of the 1867 eligible subjects, 1386 (74%) were included in the study. We used high-resolution B-mode ultrasound imaging to measure intima-media thickness, and local or radiating low back pain was determined by a standard interview and clinical signs of sciatica through a physician's clinical examination.
Carotid intima-media thickness was associated with continuous radiating low back pain and with a positive unilateral clinical sign of sciatica among men only. After adjustment for potential confounders, each standard deviation (0.23 mm) increment in carotid intima-media thickness showed an odds ratio of 1.6 (95% confidence interval 1.1-2.3) for continuous radiating low back pain and 1.7 (95% confidence interval 1.3-2.1) for a positive unilateral clinical sign of sciatica. Carotid intima-media thickness was not associated with local low back pain.
Sciatica may be a manifestation of atherosclerosis, or both conditions may share common risk factors.
To examine the association of the interleukin 1 gene (IL1) cluster polymorphisms and their haplotypes with bilateral distal interphalangeal joint osteoarthritis (DIP OA).
Radiographs of both hands of 295 dentists and 248 teachers were examined and classified for the presence of OA using reference images. Bilateral DIP OA was defined by the presence of radiographic findings of grade 2 or more in at least 1 symmetrical pair of the DIP joints. We genotyped 10 single-nucleotide polymorphisms (SNP) in the IL1R1, IL1RL2, IL1A, IL1B, and IL1RN genes using polymerase chain reaction-based methods. Haplotypes were statistically reconstructed using the PHASE program. The association between the genotypes/diplotypes and bilateral DIP OA was examined with logistic regression analysis.
Two IL1B SNP (rs1143634 and rs1143633) were associated with bilateral DIP OA. The carriers of the IL1B rs1143634 minor allele had an increased OA risk [odds ratio (OR) 1.6; 95% confidence interval (CI) 1.08-2.26] compared to the noncarriers. The association was stronger in the dentists. The distribution of the IL1B rs1143633 genotype fit a recessive mode of inheritance (OR 3.03, 95% CI 1.35-6.83, p = 0.006). Two IL1B-IL1RN extended haplotype alleles (211-1 and 121-1) were associated with bilateral DIP OA. An interaction between the IL1B rs1143634 and the IL1R1-IL1RL2 and IL1B-IL1RN extended haplotypes and occupation (increased risk of OA among dentists only) was observed.
Our results provide further evidence for the role of IL1 gene cluster polymorphisms in the etiology of OA and suggest that some of these may predispose DIP joints to the effects of mechanical overload.
To assess the association between smoking and low back pain with meta-analysis.
We conducted a systematic search of the MEDLINE and EMBASE databases until February 2009. Eighty-one studies were reviewed and 40 (27 cross-sectional and 13 cohort) studies were included in the meta-analyses.
In cross-sectional studies, current smoking was associated with increased prevalence of low back pain in the past month (pooled odds ratio [OR] 1.30, 95% confidence interval [CI], 1.16-1.45), low back pain in the past 12 months (OR 1.33, 95% CI, 1.26-1.41), seeking care for low back pain (OR 1.49, 95% CI, 1.38-1.60), chronic low back pain (OR 1.79, 95% CI, 1.27-2.50) and disabling low back pain (OR 2.14, 95% CI, 1.11-4.13). Former smokers had a higher prevalence of low back pain compared with never smokers, but a lower prevalence of low back pain than current smokers. In cohort studies, both former (OR 1.32, 95% CI, 0.99-1.77) and current (OR 1.31, 95% CI, 1.11-1.55) smokers had an increased incidence of low back pain compared with never smokers. The association between current smoking and the incidence of low back pain was stronger in adolescents (OR 1.82, 95% CI, 1.42-2.33) than in adults (OR 1.16, 95% CI, 1.02-1.32).
Our findings indicate that both current and former smokers have a higher prevalence and incidence of low back pain than never smokers, but the association is fairly modest. The association between current smoking and the incidence of low back pain is stronger in adolescents than in adults.
We reviewed work histories of manual handling of loads >20 kg in relation to hip osteoarthritis by age, exposure and work participation.
A nationally representative sample of 3110 Finnish men and 3446 women aged 30-97 was recruited. Diagnosis of hip osteoarthritis was based on standardised clinical examination by trained physicians. Previous exposure to physically loading work was evaluated through interviews. Logistic regression was used to estimate associations between work factors and hip osteoarthritis.
1.9% of men and 2.1% of women had hip osteoarthritis. Almost half the men and a quarter of the women had recurrently handled heavy loads at work. Subjects who had manually handled loads >20 kg had a 1.8-fold increased risk of hip osteoarthritis compared to non-exposed references, when age, body mass index, traumatic fractures and smoking were accounted for. Results were similar for men (OR 2.0; 95% CI 1.0 to 4.0) and women (1.8; 1.1 to 2.8). In a sub-analysis of subjects with hip replacement, the OR was 1.7 (1.0 to 2.9). Risk increased first after 12 years' exposure: among men it was 2.2 (0.8 to 5.9) for 13-24 years' exposure, and 2.3 (1.2 to 4.3) for >24 years' exposure. Among women it was 3.8 (1.7 to 8.1) for 13-24 years' exposure. Work participation among men aged 20 kg showed a strong association with hip osteoarthritis in all age groups except the youngest.
To examine the association between relative body weight and health status and the potential modifying effects of socioeconomic position and working conditions on this association.
The data were derived from three identical cross-sectional surveys conducted in 2000, 2001, and 2002. Respondents to postal surveys were middle-aged employees of the City of Helsinki (7148 women and 1799 men, response rate 67%). BMI was based on self-reported weight and height. Health status was measured by the Short-Form 36 subscales and component summaries.
Body weight was inversely associated with physical health, but in mental health, differences between BMI categories were small and inconsistent. In women, physical health deteriorated monotonically with increasing BMI, whereas in men, poor physical health was found among the obese only. Socioeconomic position did not modify the association between BMI and health. In women, the association between body weight and physical health became stronger with decreasing job control and increasing physical work load, whereas in men, a similar modifying effect was found for high job demands.
Body weight was associated with physical health only. Lower levels of relative weight in women than in men may be associated with poor physical health. High body weight combined with adverse working conditions may impose a double burden on physical health.
To assess whether symptoms of fibromyalgia (FM) predict disability retirement or mortality.
All Finnish Twin Cohort members and diagnosed FM-patients who had answered the same health questionnaire in 1990-1992 were studied. A sample of 10,608 working aged individuals of the cohort was classified in homogenous groups based on symptom profile with latent class analysis, using a battery of questions addressing FM-associated symptoms validated between FM-patients and twins. This resulted in three classes: no or few symptoms (LC1), some symptoms (LC2), and high load of FM-symptoms (LC3). In a 14-year follow-up, 1990-2004, information on disability retirement was obtained from official pension registers. Further linkage with Population Register Centre data for 1990-2009 yielded information on the vital status of the cohort subjects. Those with malignancies or inflammatory rheumatic diseases were excluded.
Cumulative incidence of early disability retirement was 9.5% among all 8448 individuals (after exclusions), and 26% in LC3. Adjusted hrs for early retirement were 1.0 (reference class) in LC1, 1.5 (95%CI 1.2-1.7) in LC2, and 2.9 (2.4-3.6) in LC3 for all causes and 1.8 (1.4-2.5) in LC2 and 5.0 (3.6-6.9) in LC3 for musculoskeletal disorders. In 173,675 person-years, the high symptom class (LC3) had a 43% (95% CI 17-75%) increased overall mortality risk, which was fully accounted for by adjustment for lifestyle factors, mainly smoking.
Symptoms associated with FM strongly correlate with early disability retirement. Lifestyle problems associated with high symptom load need prompt management to avoid increased risk of mortality.
The objective was to assess the prevalence and heritability of symptoms associated with fibromyalgia in a population-based working-age twin sample. The study was based on the 12,502 like-sexed twins of the Finnish Twin Cohort and 49 diagnosed fibromyalgia patients who answered the same questionnaire in 1990-1992. Questions that were considered to best match symptoms of fibromyalgia were validated between the twins and the fibromyalgia patients. Latent class analysis was used to classify the subjects into more homogeneous groups with respect to the symptom items. The pairwise distribution of symptom classes in relation to zygosity and gender was modelled using quantitative genetic models to estimate heritability. Responses to all fibromyalgia-related items were obtained from 10,608 twins. A similar proportion of men (12%) and women (13%) was placed in the third latent class, which best represented possible fibromyalgia patients. Subjects in this class had a similar symptom profile as the diagnosed fibromyalgia patient group, but they were less severely affected. The two other latent classes represented subjects that were virtually symptom free and subjects with some symptoms. The heritability of liability to symptom class membership was estimated to be 51% (95% CI 45-56%). The prevalence of symptoms associated with fibromyalgia in our population-based sample unselected for disease status was comparable to the prevalence of widespread pain reported in population based studies. The symptoms known to be associated with fibromyalgia seem to have a strong genetic background.