A low socioeconomic position (SEP) is consistently associated with ill health, sickness absence (SA) and permanent disability, but studies among young employees are lacking. We examined the interrelationships between education, occupational class and income as determinants of SA among 25-34-year-old employees. We also examined, whether the association between SEP and SA varied over time in 2002-2007 and 2008-2013.
The analyses covered young, 25-34-year-old women and men employed by the City of Helsinki over the time periods 2002-2007 and 2008-2013. Four-level education and occupational class classifications were used, as well as income quartiles. The outcome measure was the number of annual SA days.
Education had the strongest and most consistent independent association with SA among women and men in both periods under study. Occupational class had weaker independent and less consistent association with SA. Income had an independent association with SA, which strengthened over time among the men. The interrelationships between the SEP indicators and SA were partly explained by prior or mediated through subsequent SEP indicators. Socioeconomic differences followed only partially a gradient for occupational class and also for income among men.
Preventive measures to reduce the risk of SA should be considered, especially among young employees with a basic or lower-secondary education.
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The aim of this study was to examine the associations of parental education and specific childhood circumstances with adult physical and mental functioning. Self-reported data were collected in 2000, 2001 and 2002 among middle-aged women (n=7,171) and men (n=1,799) employed by the City of Helsinki. Functioning was measured by the physical and mental component summaries of the Short-Form 36 Health Survey (SF-36). The lowest quartile of the scores on each component summary was considered to indicate limited functioning. Adult socio-economic circumstances were measured by their own education. Among women parental education was inversely associated with physical functioning. The association remained after adjusting for specific childhood circumstances but disappeared after adjustment for own education. In contrast, parental education was positively associated with mental functioning among women, and the association remained after adjusting for specific childhood circumstances and the own education. Among women childhood adversities such as own chronic disease, parental mental problems, economic difficulties and having been bullied in childhood were associated with both physical and mental functioning. Parental drinking problems were associated with adult mental functioning among women. Among men, chronic disease, economic difficulties and having been bullied in childhood were associated with physical functioning. Parental mental problems, economic difficulties and having being bullied in childhood were also associated with mental functioning among men. These results suggest that the effect of parental education on physical functioning is mediated through one's own education. The association between parental education and mental functioning and the effects of several specific childhood circumstances may suggest a latency effect. Some evidence of cumulative effects of childhood and adulthood circumstances were found among women in physical functioning. Specific childhood circumstances are therefore important determinants of adult functioning. These circumstances provide detailed information on the association of childhood circumstances with adult functioning over and above parental education.
This study examined the associations of key dimensions of socioeconomic status and long sickness absence spells as well as their changes over time from 1990 to 1999.
Municipal employees of the City of Helsinki, Finland, aged 25-59 were studied. The number of participants varied yearly from 24,029 women and 6,523 men to 27,861 women and 7,521 men. Socioeconomic status was assessed by education, occupational class, and individual income. The outcome was the number of over three days' sickness absence spells/100 person years, for which the employer requires medical certification.
Low education, occupational class, and individual income were consistently associated with a 2-3 times higher sickness absence rates among both men and women. The age-adjusted sickness absence rates were relatively stable from 1990 to 1994 but increased from 1994 to 1999 among men and women. Socioeconomic differences in sickness absence rates tended to increase.
The increase in the level of socioeconomic differences in sickness absence took place during a period of declining unemployment and staff increases at the City of Helsinki, which indicates that labour market conditions play a role in sickness absence.
To examine socioeconomic differences in obesity using several different socioeconomic indicators, ranging from childhood socioeconomic environment and adult socioeconomic status to material resources and economic satisfaction.
The data derived from the Helsinki Health Study baseline surveys in 2000 and 2001. Respondents to postal surveys were middle-aged employees of the City of Helsinki (4,975 women and 1,252 men, response rate 68%). Associations between eight socioeconomic indicators and obesity (BMI > or = 30 kg/m(2)), calculated from self-reported data, were examined by fitting a series of logistic regression models.
In women, all socioeconomic indicators except household income and economic satisfaction were associated with obesity. Parental education and childhood economic difficulties, i.e., socioeconomic conditions in childhood, remained associated with obesity after adjusting for all indicators of current socioeconomic position. Indicators of adult socioeconomic status, own education and occupational class, were no longer associated with obesity when childhood socioeconomic conditions were adjusted for. Home ownership and economic difficulties were associated with obesity after full adjustments. In men, the findings paralleled those among women, but few associations reached statistical significance.
Obesity was associated with several dimensions of socioeconomic position. Childhood socioeconomic disadvantage was associated with obesity independently of the various indicators of current socioeconomic position. Associations between obesity and both educational level and occupational class disappeared after adjustment for other indicators of socioeconomic position. This suggests that the variation observed in the prevalence of obesity by these key socioeconomic indicators may reflect differences in the related material resources.
Measures of socio-economic position, such as education, occupational class and income, are well-known determinants of ill-health, injury and sickness absence. The aim was to analyse socio-economic and occupational determinants of work injury absence and their contribution to overall socio-economic inequalities in all-cause sickness absence.
A register-based follow-up study included municipal employees of the City of Helsinki aged 25-59 years in 2004. The number of participants was 16,471 women and 5033 men. The mean follow-up time was 3.0 years. Education, occupational class and individual income were used as measures of socio-economic position. The main outcome was medically confirmed work injury and all-cause sickness absence of =4 days. Inequality indices were calculated using Poisson regression analysis.
High education, occupational class and individual income were consistently associated with lower work injury absence among both women and men. The inequalities in work injury absence were larger than in all-cause sickness absence, especially among men, but the contribution to overall socio-economic inequalities was limited. Among women, bus drivers, cooks and hospital attendants had the highest rates of work injuries. Among men, youth mentors, firemen and janitors had the highest rates.
Our results indicate that relative socio-economic inequalities in work injury absence are larger than in all-cause sickness absence. Prevention of work injuries provides a source of reducing socio-economic inequalities in health, but their effect is not very large. Prevention of work injuries should be targeted to lower white-collar and manual workers and vulnerable occupations.
BACKGROUND: Changes over time in inequalities in self-reported health are studied for increasingly more countries, but a comprehensive overview encompassing several countries is still lacking. The general aim of this article is to determine whether inequalities in self-assessed health in 10 European countries showed a general tendency either to increase or to decrease between the 1980s and the 1990s and whether trends varied among countries. METHODS: Data were obtained from nationally representative interview surveys held in Finland, Sweden, Norway, Denmark, England, The Netherlands, West Germany, Austria, Italy, and Spain. The proportion of respondents with self-assessed health less than 'good' was measured in relation to educational level and income level. Inequalities were measured by means of age-standardized prevalence rates and odds ratios (ORs). RESULTS: Socioeconomic inequalities in self-assessed health showed a high degree of stability in European countries. For all countries together, the ORs comparing low with high educational levels remained stable for men (2.61 in the 1980s and 2.54 in the 1990s) but increased slightly for women (from 2.48 to 2.70). The ORs comparing extreme income quintiles increased from 3.13 to 3.37 for men and from 2.43 to 2.86 for women. Increases could be demonstrated most clearly for Italian and Spanish men and women, and for Dutch women, whereas inequalities in health in the Nordic countries showed no tendency to increase. CONCLUSIONS: The results underscore the persistent nature of socioeconomic inequalities in health in modern societies. The relatively favourable trends in the Nordic countries suggest that these countries' welfare states were able to buffer many of the adverse effects of economic crises on the health of disadvantaged groups.
Comment In: Int J Epidemiol. 2005 Apr;34(2):306-815563585
Socio-economic position measures, such as education, occupational class and income, are well-known determinants of health. However, previous studies have not paid attention to mutual interrelationships between these socio-economic position measures and medically confirmed sickness absence.
The study is a register-based study. The participants were municipal employees of the City of Helsinki aged 25-59 years in 2003. There were 21,599 women and 5841 men participants. Three socio-economic position measures were used, namely three-level education, four-level occupational class and gross individual income quartiles. Main outcome measure was medically confirmed sickness absence spells of 4 days or longer. Inequality indices were calculated using Poisson regression analysis.
High education, occupational class and individual income were all consistently associated with lower sickness absence rates among both women and men. After mutual adjustment, education and occupational class remained independent determinants of sickness absence. The association of individual income with sickness absence was practically explained by temporally preceding education and occupational class.
Our results indicate that education and occupational class-rather than income-are strong determinants of sickness absence. Education, occupational class and income are complementary socio-economic position measures. To better inform sickness absence policy, future studies should aim to establish whether the observed socio-economic differences reflect broader differences in ill-health, lifestyle and working conditions.
Socioeconomic inequalities in health in the Baltic countries are possibly increasing due to concomitant pressures. This study compared time trends from 1994 to 2004 in the pattern and magnitude of educational inequalities in health in Estonia, Latvia, Lithuania and Finland.
The data were gathered from cross-sectional postal surveys of the Finbalt project, conducted every second year since 1994 on adult populations (aged 20-64 years) in Estonia (n=9049), Latvia (n=7685), Lithuania (n=11,634) and Finland (n=18,821). Three self-reported health indicators were used: (i) less than good perceived health, (ii) diagnosed diseases, and (iii) symptoms.
The existing educational inequalities in health in three Baltic countries and Finland remained generally stable over time from 1994 to 2004. Also, the overall prevalence of all three health indicators was generally stable, but in the Baltic countries improvement in perceived health was mainly found among the better-educated men and women. Diagnosed diseases increased in the Baltic countries, except Lithuania, where diseases decreased among the better-educated women. Symptoms increased among the better-educated Estonian and Finnish women.
The period from 1994 to 2004 of relative stabilization since the worst conditions of the social transition has not been followed by notable changes in self-reported health, and this appears to be the situation across all educational groups in the Baltic countries. While health inequalities did not markedly change, substantial inequalities do remain, and there were indications of favourable developments mainly among the better-educated respondents. The factors contributing towards increasing health inequalities may only be visible in the future.
Common mental disorders do not always show as consistent socioeconomic gradients as severe mental disorders and physical health. This inconsistency may be due to the multitude of socioeconomic measures used and the populations and national contexts studied. We examine the associations between various socioeconomic circumstances and common mental disorders among middle-aged Finnish and British public sector employees.
We used survey data from the Finnish Helsinki Health Study (n = 6028) and the British Whitehall II Study (n = 3116). Common mental disorders were measured by GHQ-12. The socioeconomic indicators were parental education, childhood economic difficulties, own education, occupational class, household income, housing tenure and current economic difficulties. Logistic regression analysis was the main statistical method used.
Childhood and current economic difficulties were strongly associated with common mental disorders among men and women in both the Helsinki and the London cohort. The more conventional indicators of socioeconomic circumstances showed weak or inconsistent associations. Differences between the two cohorts and two genders were small.
Our findings emphasize the importance of past and present economic circumstances to common mental disorders across different countries and genders. Overall, our results suggest that among employee populations, the socioeconomic patterning of common mental disorders may differ from that of other domains of health.
Comment In: Int J Epidemiol. 2007 Aug;36(4):786-817644529
Disability retirement (DR) among young employees is an increasing problem affecting work life and public health, given the potential major loss of working time. Little is known about educational differences in the risk of DR among young employees, despite the need for such knowledge in targeting preventive measures. We examined the association between education and DR due to any cause and to mental and non-mental causes among young employees.
Personnel register data of the City of Helsinki from the years 2002-2013 for 25-to-34-year-old employees (n= 41225) were linked to register data from the Finnish Centre for Pensions on DR (n= 381), and from Statistics Finland on education. Education was categorised into four hierarchical groups. The mean follow-up time was 5.7 years. Cox regression analysis was used.
There were 381 DR events and of the events, over 70% were due to mental disorders and 72% were temporary. A consistent educational gradient was found. Those with a basic education were at the highest risk of DR due to any cause (HR 4.64, 95% CI 3.07, 7.02), and to mental (HR 4.79, 95% CI 2.89, 7.94) and non-mental causes (HR 4.32, 95% CI 2.10, 8.91).
DR due to any cause, and to mental and non-mental causes, followed a clear educational gradient. Early intervention, treatment and rehabilitation with a view to maintaining work ability are needed among young employees, especially those with low education. Adapting working conditions to their health and work ability may also help to avoid premature exit from work.