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2.
  • Heponiemi, Tarja, et al. (author)
  • Association of Contractual and Subjective Job Insecurity With Sickness Presenteeism Among Public Sector Employees
  • 2010
  • In: Journal of Occupational and Environmental Medicine. - 1076-2752 .- 1536-5948. ; 52:8, s. 830-835
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE:: We examined the associations of contractual job insecurity (fixed-term vs permanent employment contract) and subjectively assessed job insecurity with sickness presenteeism among those who had no sickness absences during the study year. METHODS:: Survey data from a sample of 18,454 Public sector employees were gathered in 2004 (the Finnish Public Sector study). RESULTS:: Fixed-term employees were less likely to report working while ill (odds ratio = 0.88, 95% confidence interval = 0.77 to 0.99) than permanent employees. Subjective insecurity was associated with higher levels of working while ill, and this association was stronger among older employees. These results remained after adjustments for demographics, health-related variables, and optimism. CONCLUSIONS:: Our results suggest that subjective job insecurity might be even more important than contractual insecurity when a public sector employee makes the decision to go to work despite feeling ill.
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3.
  • Lallukka, Tea, et al. (author)
  • Co-occurrence of depressive, anxiety, and somatic symptoms : trajectories from adolescence to midlife using group-based joint trajectory analysis
  • 2019
  • In: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 19
  • Journal article (peer-reviewed)abstract
    • Background: Co-occurrence of mental and somatic symptoms is common, and recent longitudinal studies have identified single trajectories of these symptoms, but it is poorly known whether the symptom trajectories can also co-occur and change across the lifespan. We aimed to examine co-occurring symptoms and their joint trajectories from adolescence to midlife.Methods: Longitudinal data were derived from Northern Sweden, where 506 girls and 577 boys aged 16years participated at baseline in 1981 (99.7% of those initially invited), and have been followed up in four waves until the age of 43. Survey data were collected about depressive, anxiety, and somatic symptoms. Potential joint development of this three-component symptom set was examined with multiple response trajectory analysis, a method that has not been previously used to study co-occurrence of these symptoms.Results: We identified a five trajectory solution as the best: very low (19%), low (31%), high (22%), late sharply increasing (16%) and a very high increasing (12%). In the late sharply increasing and very high increasing groups the scores tended to increase with age, while in the other groups the levels were more stable. Overall, the results indicated that depressive, anxiety, and somatic symptoms co-exist from adolescence to midlife.Conclusions: The multiple response trajectory analysis confirmed high stability in the co-occurrence of depressive, anxiety, and somatic symptoms from adolescence to midlife. Clinicians should consider these findings to detect symptoms in their earliest phase in order to prevent the development of co-occurring high levels of symptoms.
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4.
  • Lietzén, Raija, et al. (author)
  • Multiple adverse childhood experiences and asthma onset in adulthood : Role of adulthood risk factors as mediators
  • 2021
  • In: Journal of Psychosomatic Research. - : Elsevier. - 0022-3999 .- 1879-1360. ; 143
  • Journal article (peer-reviewed)abstract
    • Objective: This population-based study of 21,902 Finnish adults examined whether adulthood risk factors for asthma mediate the association between the exposure to multiple adverse childhood experiences (ACEs) assessed retrospectively and the risk of new-onset asthma in adulthood. Methods: Baseline characteristics, occurrence of ACEs, and risk factors of asthma in adulthood were collected with a postal survey at baseline in 1998. The participants were linked to records on incident asthma from national health registers from 1999 to 2012. Counterfactual mediation analysis was used to examine the effects of multiple ACEs (≥2) on asthma through adulthood risk factors of asthma (mediators). Results: Of the 21,902 participants without asthma at baseline, 7552 (34%) were exposed to multiple ACEs during childhood. During the follow-up period, 2046 participants were diagnosed with incident asthma. Exposure to multiple ACEs increased the risk of asthma onset by 31% compared with ≤1 ACE. The association between ACEs and asthma onset was partly mediated by the following adulthood risk factors: severe life events (29%), smoking (15%), allergic rhinitis (8%), low education level (6%), and obesity (3%). Specific stressful life events mediating the ACE–asthma association were ‘severe financial difficulties’ (24%), ‘emotional, physical or sexual violence’ (15%), ‘major increase in marital problems’ (8%), ‘severe conflicts with supervisor’ (7%), and ‘divorce or separation’ (5%). Conclusions: Exposure to multiple ACEs increased the risk of asthma in adulthood. Adulthood risk factors of asthma mediated a significant proportion of the effect of ACEs on the risk of asthma onset. 
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5.
  • Virtanen, Pekka, et al. (author)
  • Self-Rated Health of the Temporary Employees in a Nordic Welfare State Findings From the Finnish Public Sector Study
  • 2018
  • In: Journal of Occupational and Environmental Medicine. - : LIPPINCOTT WILLIAMS & WILKINS. - 1076-2752 .- 1536-5948. ; 60:2, s. E106-E111
  • Journal article (peer-reviewed)abstract
    • Objective: This 9-year follow-up study explores a possible association between temporary employment and declining health. Methods: Years in temporary employment from 2004 to 2008 to 2009 were measured for a cohort of 26,886 public sector employees. Self-rated health was measured by surveys in 2004 (baseline), 2008/2009 (short-term follow-up), and 2012/2013 (long-term follow-up). Results: Compared with the permanently employed, the baseline health-adjusted odds of poor health were lower both in the short-term and long-term follow-up, but the differences became nonsignificant when adjusted for sociodemographic and work-related factors. Conclusion: The results would suggest that temporary employment in public sector of a Nordic welfare state does not entail health risks. Future research is needed to elucidate if this is true also among those exposed to nonpermanent employment in the private labor market, in particular those with most atypical jobs and unstable job careers.
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6.
  • Agahi, Neda, et al. (author)
  • Heavy alcohol consumption before and after negative life events in late mid-life : longitudinal latent trajectory analyses
  • 2022
  • In: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 76:4, s. 360-366
  • Journal article (peer-reviewed)abstract
    • Background People who experience negative life events report more heavy alcohol consumption compared with people without these experiences, but little is known about patterns of change within this group. This study aims to identify trajectories of heavy alcohol consumption before and after experiencing either divorce, or severe illness or death in the family. Furthermore, the aim is to examine characteristics of individuals belonging to each trajectory.Methods Longitudinal study of public sector employees from the Finnish Retirement and Aging Study with up to 5 years of annual follow-ups (n=6783; eligible sample n=1393). Divorce and severe illness or death in the family represented negative life events. Heavy alcohol consumption was categorised as >14 units/week.Results Based on latent trajectory analysis, three trajectories of heavy drinking were identified both for divorce and for severe illness or death in the family: ‘No heavy drinking’ (82% illness/death, 75% divorce), ‘Constant heavy drinking’ (10% illness/death, 13% divorce) and ‘Decreasing heavy drinking’ (7% illness/death, 12% divorce). Constant heavy drinkers surrounding illness or death in the family were more likely to be men, report depression and anxiety and to smoke than those with no heavy drinking. Constant heavy drinkers surrounding divorce were also more likely to be men and to report depression compared with those with no heavy drinking.Conclusions Most older workers who experience divorce or severe illness or death in the family have stable drinking patterns regarding heavy alcohol consumption, that is, most do not initiate or stop heavy drinking.
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7.
  • Airaksinen, Jaakko, et al. (author)
  • The effect of smoking cessation on work disability risk : a longitudinal study analysing observational data as non-randomized nested pseudo-trials
  • 2019
  • In: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 48:2, s. 415-422
  • Journal article (peer-reviewed)abstract
    • BackgroundSmoking increases disability risk, but the extent to which smoking cessation reduces the risk of work disability is unclear. We used non-randomized nested pseudo-trials to estimate the benefits of smoking cessation for preventing work disability.MethodsWe analysed longitudinal data on smoking status and work disability [long-term sickness absence (≥90 days) or disability pension] from two independent prospective cohort studies—the Finnish Public Sector study (FPS) (n = 7393) and the Health and Social Support study (HeSSup) (n = 2701)—as ‘nested pseudo-trials’. All the 10 094 participants were smokers at Time 1 and free of long-term work disability at Time 2. We compared the work disability risk after Time 2 of the participants who smoked at Time 1 and Time 2 with that of those who quit smoking between these times.ResultsOf the participants in pseudo-trials, 2964 quit smoking between Times 1 and 2. During the mean follow-up of 4.8 to 8.6 years after Time 2, there were 2197 incident cases of work disability across the trials. Quitting smoking was associated with a reduced risk of any work disability [summary hazard ratio = 0.89, 95% confidence interval (CI) 0.81–0.98]. The hazard ratio for the association between quitting smoking and permanent disability pension (928 cases) was of similar magnitude, but less precisely estimated (0.91, 95% CI 0.81–1.02). Among the participants with high scores on the work disability risk score (top third), smoking cessation reduced the risk of disability pension by three percentage points. Among those with a low risk score (bottom third), smoking cessation reduced the risk by half a percentage point.ConclusionsOur results suggest an approximately 10% hazard reduction of work disability as a result of quitting smoking.
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  • Akbaraly, Tasmine, et al. (author)
  • Association of Long-Term Diet Quality with Hippocampal Volume : Longitudinal Cohort Study
  • 2018
  • In: American Journal of Medicine. - : Elsevier BV. - 0002-9343 .- 1555-7162. ; 131:11, s. 1372-1381.e4
  • Journal article (peer-reviewed)abstract
    • Background: Diet quality is associated with brain aging outcomes. However, few studies have explored in humans the brain structures potentially affected by long-term diet quality. We examined whether cumulative average of the Alternative Healthy Eating Index 2010 (AHEI-2010) score during adult life (an 11-year exposure period) is associated with hippocampal volume.Methods: Analyses were based on data from 459 participants of the Whitehall II imaging sub-study (mean age [standard deviation] (SD) = 59.6 [5.3] years in 2002-2004, 19.2% women). Multimodal magnetic resonance imaging examination was performed at the end of follow-up (2015-2016). Structural images were acquired using a high-resolution 3-dimensional T1-weighted sequence and processed with Functional Magnetic Resonance Imaging of the Brain Software Library (FSL) tools. An automated model-based segmentation and registration tool was applied to extract hippocampal volumes.Results: Higher AHEI-2010 cumulative average score (reflecting long-term healthy diet quality) was associated with a larger total hippocampal volume. For each 1 SD (SD = 8.7 points) increment in AHEI-2010 score, an increase of 92.5 mm3 (standard error = 42.0 mm3) in total hippocampal volume was observed. This association was independent of sociodemographic factors, smoking habits, physical activity, cardiometabolic health factors, cognitive impairment, and depressive symptoms, and was more pronounced in the left hippocampus than in the right hippocampus. Of the AHEI-2010 components, no or light alcohol consumption was independently associated with larger hippocampal volume.Conclusions: Higher long-term AHEI-2010 scores were associated with larger hippocampal volume. Accounting for the importance of hippocampal structures in several neuropsychiatric diseases, our findings reaffirm the need to consider adherence to healthy dietary recommendation in multi-interventional programs to promote healthy brain aging.
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9.
  • Amin, Ridwanul, et al. (author)
  • Time period effects in work disability due to common mental disorders among young employees in Sweden-a register-based cohort study across occupational classes and employment sectors
  • 2023
  • In: European Journal of Public Health. - : Oxford University Press. - 1101-1262 .- 1464-360X. ; 33:2, s. 272-278
  • Journal article (peer-reviewed)abstract
    • Background We aimed to investigate time period effects in the risk of work disability, defined as long-term sickness absence (LTSA) and disability pension (DP) due to common mental disorders (CMDs), among young employees according to employment sector (private/public) and occupational class (non-manual/manual).Methods Three cohorts, including all employed individuals with complete information on employment sector and occupational class, aged 19-29 years and resident in Sweden on 31 December 2004, 2009 and 2014 (n = 573 516, 665 138 and 600 889, respectively) were followed for 4 years. Multivariate-adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated to examine the risk of LTSA and DP due to CMDs using Cox regression analyses.Results In all cohorts, public sector employees had higher aHRs for LTSA due to CMDs than private sector employees, irrespective of occupational class, e.g. aHR, 95% CI: 1.24, 1.16-1.33 and 1.15, 1.08-1.23 among non-manual and manual workers in cohort 2004. The rates of DP due to CMDs were much lower in cohorts 2009 and 2014 than 2004 leading to uncertain risk estimates in the later cohorts. Still, public sector manual workers had a higher risk for DP due to CMDs than manual workers in the private sector in cohort 2014 than in 2004 (aHR, 95% CI: 1.54, 1.34-1.76 and 3.64, 2.14-6.18, respectively).Conclusions Manual workers in the public sector seem to have a higher risk of work disability due to CMDs than their counterparts in the private sector calling for the need for early intervention strategies to prevent long-term work disability.
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  • Bean, Christopher G., 1990-, et al. (author)
  • Group activity participation at age 21 and depressive symptoms during boom and recession in Sweden : a 20-year follow-up
  • 2019
  • In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 29:3, s. 475-481
  • Journal article (peer-reviewed)abstract
    • Background: Organized group activities (e.g. sports or arts clubs) have long been noted as important developmental settings for youth, yet previous studies on the relationships between participation and mental health outcomes have focused on short-term effects among school-aged adolescents. The subsequent period of life, emerging adulthood, has been largely overlooked despite being another important life stage where individuals face new existential challenges and may benefit from group activity participation. The potential for macroeconomic conditions to modify these relationships has also not been considered. Methods: Participants (n = 1654) comprise two cohorts, born in either 1965 (n = 968) or 1973 (n = 686), from the same middle-sized industrial town in Northern Sweden. Both cohorts completed detailed questionnaires at age 21 (macroeconomic boom for Cohort 65, recession for Cohort 73) and approximately 20 years follow-up (age 43 for Cohort 65, age 39 for Cohort 73). General linear models were used to assess concurrent and prospective associations between regular group activity participation and depressive symptoms, as well as the potential interaction with boom/recession. Results: After controlling for sociodemographic factors, regular group activity participation at age 21 was associated with lower depressive symptoms, both concurrently and at follow-up. Those exposed to recession at age 21 reported higher depressive symptoms at the time but there was no interaction between cohort (boom/recession) and group activity participation. Conclusions: Regular group activity participation during emerging adulthood is associated with lower depressive symptoms uniformly in times of boom and recession. Beneficial effects of such participation may contribute to better mental health over 20 years.
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11.
  • Bentham, James, et al. (author)
  • A century of trends in adult human height
  • 2016
  • In: eLIFE. - 2050-084X. ; 5
  • Journal article (peer-reviewed)abstract
    • Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.522.7) and 16.5 cm (13.319.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.
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12.
  • Bentham, James, et al. (author)
  • A century of trends in adult human height
  • 2016
  • In: eLIFE. - : eLife Sciences Publications Ltd. - 2050-084X. ; 5
  • Journal article (peer-reviewed)abstract
    • Being taller is associated with enhanced longevity, and higher education and earnings. We reanalysed 1472 population-based studies, with measurement of height on more than 18.6 million participants to estimate mean height for people born between 1896 and 1996 in 200 countries. The largest gain in adult height over the past century has occurred in South Korean women and Iranian men, who became 20.2 cm (95% credible interval 17.5–22.7) and 16.5 cm (13.3– 19.7) taller, respectively. In contrast, there was little change in adult height in some sub-Saharan African countries and in South Asia over the century of analysis. The tallest people over these 100 years are men born in the Netherlands in the last quarter of 20th century, whose average heights surpassed 182.5 cm, and the shortest were women born in Guatemala in 1896 (140.3 cm; 135.8– 144.8). The height differential between the tallest and shortest populations was 19-20 cm a century ago, and has remained the same for women and increased for men a century later despite substantial changes in the ranking of countries.
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13.
  • Berg, Noora, et al. (author)
  • The contribution of drinking culture at comprehensive school to heavy episodic drinking from adolescence to midlife
  • 2020
  • In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 30:2, s. 357-363
  • Journal article (peer-reviewed)abstract
    • Background: The school context is associated with adolescent alcohol use, but it is not clear whether this association continues into adulthood. This study examined whether exposure to drunkenness oriented drinking culture in 9th grade school class is associated with individuals' heavy episodic drinking (HED) from adolescence to midlife. Methods: Participants in the 'Northern Swedish Cohort' study aged 16 years in 1981 were followed-up when aged 18, 21, 30 and 43 (N = 1080). Individual-level factors were HED, positive attitudes towards drunkenness, early initiation of HED and peer-oriented spare-time. School class-level drinking culture was measured as classmate reported HED, positive attitudes, early initiation of HED and peer-oriented spare time. Multilevel log-binomial regression analyses were adjusted for gender, parental socioeconomic background, family structure and HED at age 16. Results:After adjustment for sociodemographic factors several cross-sectional and longitudinal associations were found between class-level indicators of drinking culture and individual HED. After additional adjustment for age 16 HED, most associations attenuated. The risk ratio (95% confidence interval) for engaging in HED at age 43 was 1.58 (1.03-2.42) times higher for those who at age 16 had many classmates reporting positive attitude towards drunkenness. Conclusions: These findings suggest that drinking culture in school may have a long-lasting impact on drinking habits in adulthood. The associations with HED at follow-ups are likely mediated by HED in adolescence. Studies on alcohol use would benefit from taking into account both individual and contextual factors in a life course perspective.
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  • Björkenstam, Emma, et al. (author)
  • Occupational class and employment sector differences in common mental disorders : a longitudinal Swedish cohort study
  • 2021
  • In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 31:4, s. 809-815
  • Journal article (peer-reviewed)abstract
    • Background Recent increases in common mental disorders (CMDs) among young adults are of great concern although studies of CMDs in young employees are sparse. This study investigated the independent and interacting effects of sector of employment, occupational class and CMDs. Additionally, associations between type of employment branch and CMDs within each sector were examined.Methods This population-based longitudinal cohort study included 665 138 employees, 19–29 years, residing in Sweden in 2009. Employment sector (i.e. private/public) and occupational class (non-manual/manual workers) were measured in 2009. Risk estimates of CMDs, measured as new prescription of antidepressants and/or psychiatric care with a diagnosis of CMDs, between 2010 and 2016, were calculated as hazard ratios (HRs) with 95% confidence intervals (CIs), using Cox multivariable regression analysis.Results Public sector employees (whereof 60% manual workers) had an elevated risk for CMDs compared to private sector employees [adjusted HR: 1.14 (95% CI 1.12–1.16)]. Within each sector, manual workers were at increased risk of CMDs compared to non-manual workers. There was an interaction between sector of employment and occupational class; manual workers in the public sector had the highest CMD risk [adjusted synergy index: 1.51 (95% CI 1.29–1.76)]. The most elevated risk for CMDs was observed in those employed in health and social services and the lowest risk among construction workers.Conclusion Sector of employment and occupational class play a role in CMDs in young employees. These findings should be taken into account in the attempts to reduce CMDs in the young working population.
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  • Björkenstam, Emma, et al. (author)
  • Sickness absence due to common mental disorders in young employees in Sweden : Are there differences in occupational class and employment sector?
  • 2022
  • In: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 57, s. 1097-1106
  • Journal article (peer-reviewed)abstract
    • Background A large proportion of sickness absence (SA) in young adults is due to common mental disorders (CMDs). Still studies on CMD-related SA in young workers are lacking, especially studies for those employed in the private sector. The current study investigated the associations between sector of employment, occupational class and SA due to CMDs. In addition, associations between type of employment branch and SA due CMDs within each sector were examined.Methods This population-based longitudinal cohort study included 663,583 employees, 19-29 years, residing in Sweden in 2009. Employment sector (i.e., private/public) and occupational class (non-manual/manual workers) were measured in 2009. Risk estimates of SA due to CMDs, between 2010 and 2016, were calculated as Hazard Ratios (HR) with 95% confidence intervals (CI), using Cox regression analysis.Results Sector of employment was associated with SA due to CMDs, such that public sector workers had an elevated risk when compared with private sector employees (adjusted HR: 1.31 (95% CI 1.29-1.33). Moreover, manual workers had a slightly elevated risk for SA due to CMDs compared to non-manual workers. Within the private sector, in both manual and non-manual workers, those employed in education and health and social services evidenced the highest rates and risks of SA due to CMDs.Conclusion Sector of employment and occupational class play a role in SA due to CMDs in young employees. These findings should be considered when identifying high-risk groups for SA in the young working population.
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  • Blomqvist, Sandra, 1985-, et al. (author)
  • Associations between COVID-19-related changes in the psychosocial work environment and mental health
  • 2023
  • In: Scandinavian Journal of Public Health. - : Sage Publications. - 1403-4948 .- 1651-1905. ; 51:5, s. 664-672
  • Journal article (peer-reviewed)abstract
    • Background: Individuals' lives have been substantially affected by the COVID-19 pandemic. We aimed to describe changes in psychosocial work environment and mental health and to investigate associations between job insecurity and mental ill-health in relation to changes in other psychosocial work factors, loneliness and financial worries.Methods: A sub-sample of individuals from the eighth Swedish Longitudinal Occupational Survey of Health answered a web-based survey in early 2021 about current and pandemic-related changes in health, health behaviours, work and private life. We investigated participants working before the pandemic (N=1231) in relation to standardised measures on depression, anxiety and loneliness, together with psychosocial work factors, in descriptive and logistic regression analyses.Results: While 9% reached the clinical threshold for depression and 6% for anxiety, more than a third felt more worried, lonelier or in a low mood since the start of the pandemic. Two per cent had been dismissed from their jobs, but 16% experienced workplace downsizings. Conditioning on socio-demographic factors and prior mental-health problems, the 8% experiencing reduced job security during the pandemic had a higher risk of anxiety, but not of depression, compared to employees with unaltered or increased job security. Loneliness and other psychosocial work factors explained more of the association than objective measures of job insecurity and financial worries. Conclusions: Reduced job security during the COVID-19 pandemic seems to have increased the risk of anxiety among individuals with a strong labour market attachment, primarily via loneliness and other psychosocial work factors. This illustrates the potentially far-reaching effects of the pandemic on mental health in the working population.
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17.
  • Blomqvist, Sandra, 1985-, et al. (author)
  • Job loss and job instability during the COVID-19 pandemic and the risk of depression and anxiety among Swedish employees
  • 2023
  • In: SSM - Population Health. - 2352-8273. ; 22
  • Journal article (peer-reviewed)abstract
    • The COVID-19 pandemic led to permanent and temporary job losses but the mental health consequences of different types of employment transitions are not well-understood. In particular, knowledge is scarce concerning furloughs, which was a common job protection strategy in many high-and upper middle-income countries during this crisis. This study focuses on how different types of job instability and job loss during the pandemic influences depression and anxiety in the context of Sweden.A subset of participants from the Swedish Longitudinal Occupational Survey of Health were contacted in February 2021 and again in February 2022. A total of 1558 individuals participated in either or both waves and worked before the pandemic. We examined whether i) workplace downsizing, ii) furlough, or iii) unemploy-ment/job loss were associated with depression and anxiety over this one-year period during the pandemic. Logistic regression models with cluster-robust standard errors were estimated, adjusting for sociodemographic factors and prior mental health problems. Effect modification by sex and prior mental health problems was also examined.In comparison to stable employment, being furloughed was unrelated to mental health, while experiencing workplace downsizing during the pandemic was associated with an increased risk of anxiety (adjusted Odds Ratio (OR) = 2.09, 95% Confidence interval (CI) = 1.08-4.05). Job loss/unemployment increased the risk of depression (OR = 1.91, 95% CI = 1.02-3.57) compared to being stably employed, but the risk estimate crossed unity when considering prior mental health status. No effect modification by sex or by prior mental health problems was found.This study found that while job loss and downsizing during the COVID-19 pandemic were associated with depression and anxiety, respectively, being furloughed was not. These findings thus suggest that job retention schemes in the form of short-time work allowances, as implemented in Sweden during the COVID-19 pandemic, may prevent mental health problems among employees during economic crises.
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19.
  • Blomqvist, Sandra, 1985-, et al. (author)
  • Perceived job insecurity and risk of suicide and suicide attempts : a study of men and women in the Swedish working population
  • 2022
  • In: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 48:4, s. 293-301
  • Journal article (peer-reviewed)abstract
    • Objective Whether perceived job insecurity increases the risk of suicidal behaviors is unclear. Improved understanding in this area could inform efforts to reduce suicide risk among those experiencing elevated job insecurity during the COVID-19 pandemic as well as post-pandemic. We aimed to investigate if perceived job insecurity predicted increased risk of suicide mortality and suicide attempts.Method Employees (N=65 571), representative of the Swedish working population who participated in the Swedish Work Environment Survey in 1991–2003, were followed up through 2016 in the National Inpatient and Death Registers. Suicide deaths and suicide attempts were defined according to International Classification of Diseases (ICD) 10 and ICD-8/9 codes of underlying cause of death and in-/outpatient care. Job insecurity and subsequent risk of suicide and suicide attempt were investigated with marginal structural Cox regression analyses and inverse probability of treatment weighting to control for confounding.Results Perceived job insecurity was associated with an elevated risk of suicide [hazard ratio (HR) 1.51, 95% confidence interval (CI) 1.03–2.20], but not with incident suicide attempts (HR 1.03, CI 0.86–1.24). Estimates remained similar after considering prevalent/previous poor mental health, other work factors, and when restricting the follow up time to ten years.Conclusion The study suggests that job insecurity is associated with an increased risk of suicide mortality. Concerns about elevated job insecurity and suicide levels in the wake of the current pandemic could thus be considered in strategies to reduce the population health impact job insecurity both during and following the COVID-19 pandemic.
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20.
  • Danaei, Goodarz, et al. (author)
  • Effects of diabetes definition on global surveillance of diabetes prevalence and diagnosis: a pooled analysis of 96 population-based studies with 331288 participants
  • 2015
  • In: The Lancet Diabetes & Endocrinology. - 2213-8595 .- 2213-8587. ; 3:8, s. 624-637
  • Journal article (peer-reviewed)abstract
    • Background Diabetes has been defined on the basis of different biomarkers, including fasting plasma glucose (FPG), 2-h plasma glucose in an oral glucose tolerance test (2hOGTT), and HbA(1c). We assessed the effect of different diagnostic definitions on both the population prevalence of diabetes and the classification of previously undiagnosed individuals as having diabetes versus not having diabetes in a pooled analysis of data from population-based health examination surveys in different regions. Methods We used data from 96 population-based health examination surveys that had measured at least two of the biomarkers used for defining diabetes. Diabetes was defined using HbA(1c) (HbA(1c) >= 6 . 5% or history of diabetes diagnosis or using insulin or oral hypoglycaemic drugs) compared with either FPG only or FPG-or-2hOGTT definitions (FPG >= 7 . 0 mmol/L or 2hOGTT >= 11 . 1 mmol/L or history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated diabetes prevalence, taking into account complex survey design and survey sample weights. We compared the prevalences of diabetes using different definitions graphically and by regression analyses. We calculated sensitivity and specificity of diabetes diagnosis based on HbA1c compared with diagnosis based on glucose among previously undiagnosed individuals (ie, excluding those with history of diabetes or using insulin or oral hypoglycaemic drugs). We calculated sensitivity and specificity in each survey, and then pooled results using a random-effects model. We assessed the sources of heterogeneity of sensitivity by meta-regressions for study characteristics selected a priori. Findings Population prevalence of diabetes based on FPG- or-2hOGTT was correlated with prevalence based on FPG alone (r= 0 . 98), but was higher by 2-6 percentage points at different prevalence levels. Prevalence based on HbA(1c) was lower than prevalence based on FPG in 42 . 8% of age-sex-survey groups and higher in another 41 . 6%; in the other 15 . 6%, the two definitions provided similar prevalence estimates. The variation across studies in the relation between glucose-based and HbA(1c)-based prevalences was partly related to participants' age, followed by natural logarithm of per person gross domestic product, the year of survey, mean BMI, and whether the survey population was national, subnational, or from specific communities. Diabetes defined as HbA(1c) 6 . 5% or more had a pooled sensitivity of 52 . 8% (95% CI 51 . 3-54 . 3%) and a pooled specificity of 99 . 74% (99 . 71-99 . 78%) compared with FPG 7 . 0 mmol/L or more for diagnosing previously undiagnosed participants; sensitivity compared with diabetes defined based on FPG-or-2hOGTT was 30 . 5% (28 . 7-32 . 3%). None of the preselected study-level characteristics explained the heterogeneity in the sensitivity of HbA(1c) versus FPG. Interpretation Different biomarkers and definitions for diabetes can provide different estimates of population prevalence of diabetes, and differentially identify people without previous diagnosis as having diabetes. Using an HbA(1c)-based definition alone in health surveys will not identify a substantial proportion of previously undiagnosed people who would be considered as having diabetes using a glucose-based test.
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22.
  • Dragano, Nico, et al. (author)
  • Effort-Reward Imbalance at Work and Incident Coronary Heart Disease A Multicohort Study of 90,164 Individuals
  • 2017
  • In: Epidemiology. - : Lippincott Williams & Wilkins. - 1044-3983 .- 1531-5487. ; 28:4, s. 619-626
  • Journal article (peer-reviewed)abstract
    • Background: Epidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease.Methods: This multicohort study (the "IPD-Work" consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort-reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis.Results: At baseline, 31.7% of study members reported effort-reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00-1.35) was observed for effort-reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01-1.34) for having either effort-reward imbalance or job strain and 1.41 (1.12-1.76) for having both these stressors compared to having neither effort-reward imbalance nor job strain.Conclusions: Individuals with effort-reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress.
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23.
  • Ervasti, Jenni, et al. (author)
  • Contribution of comorbid conditions to the association between diabetes and disability pensions : a population-based nationwide cohort study
  • 2016
  • In: Scandinavian Journal of Work, Environment and Health. - : Nordic Association of Occupational Safety and Health. - 0355-3140 .- 1795-990X. ; 42:3, s. 209-216
  • Journal article (peer-reviewed)abstract
    • OBJECTIVES: Using Swedish population-based register data, we examined the extent to which comorbid conditions contribute to the risk of disability pension among people with diabetes.METHODS: We carried out Cox proportional hazard analyses with comorbid conditions as time-dependent covariates among 14 198 people with newly diagnosed diabetes in 2006, and 39 204 people free from diabetes during the follow-up from 2007-2010. The average follow-up times were 46 and 48 months for those with and without diabetes, respectively.RESULTS: For those with diabetes only, the incidence of all-cause disability pension was 9.5 per 1000 person-years. The highest incidence of disability pension were for those with: diabetes and depression (23.6); diabetes and musculoskeletal disorder (30.6), and those with diabetes and more than one comorbid condition (36.5). The incidence rate was 5.8 for those without diabetes. Diabetes was associated with a 2.30 times [95% confidence interval (95% CI) 2.09-2.54] higher risk of disability pension (adjusted for sociodemographic factors). This association attenuated by 41% after further adjustment for comorbid chronic conditions. While diabetes was a risk factor for disability pension due to musculoskeletal disorders and diseases of the circulatory system, even after accounting for the above-mentioned conditions, the association between disability pension due to mental disorders and diabetes was diluted after adjustment for mental disorders.CONCLUSIONS: Although diabetes is an independent risk factor for disability pension, comorbid conditions contribute to this risk to a large degree.
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24.
  • Ervasti, Jenni, et al. (author)
  • Does increasing physical activity reduce the excess risk of work disability among overweight individuals?
  • 2019
  • In: Scandinavian Journal of Work, Environment and Health. - : Nordic Association of Occupational Safety and Health (NOROSH). - 0355-3140 .- 1795-990X. ; 45:4, s. 376-385
  • Journal article (peer-reviewed)abstract
    • Objectives We examined the extent to which an increase in physical activity would reduce the excess risk of work disability among overweight and obese people (body mass index >= 25kg/m(2)).Methods We used counterfactual modelling approaches to analyze longitudinal data from two Finnish prospective cohort studies (total N=38 744). Weight, height and physical activity were obtained from surveys and assessed twice and linked to electronic records of two indicators of long-term work disability (>= 90-day sickness absence and disability pension) for a 7-year follow-up after the latter survey. The models were adjusted for age, sex, socioeconomic status, smoking, and alcohol consumption.Results The confounder-adjusted hazard ratio (HR) of long-term sickness absence for overweight compared to normal-weight participants was 1.43 [95% confidence interval (CI) 1.35-1.53]. An increase in physical activity among overweight compared to normal-weight individuals was estimated to reduce this HR to 1.40 (95% CI 1.31-1.48). In pseudo-trial analysis including only the persistently overweight, initially physically inactive participants, the HR for long-term sickness absence was 0.82 (95% CI 0.70-0.94) for individuals with increased physical activity compared to those who remained physically inactive. The results for disability pension as an outcome were similar.Conclusions These findings suggest that the excess risk of work disability among overweight individuals would drop by 3-4% if they increased their average physical activity to the average level of normal-weight people. However, overweight individuals who are physically inactive would reduce their risk of work disability by about 20% by becoming physically active.
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25.
  • Ervasti, Jenni, et al. (author)
  • Long working hours and risk of 50 health conditions and mortality outcomes : a multicohort study in four European countries
  • 2021
  • In: The Lancet Regional Health. - : Elsevier BV. - 2666-7762. ; 11
  • Journal article (peer-reviewed)abstract
    • Background: Studies on the association between long working hours and health have captured only a narrow range of outcomes (mainly cardiometabolic diseases and depression) and no outcome-wide studies on this topic are available. To achieve wider scope of potential harm, we examined long working hours as a risk factor for a wide range of disease and mortality endpoints.Methods: The data of this multicohort study were from two population cohorts from Finland (primary analysis, n=59 599) and nine cohorts (replication analysis, n=44 262) from Sweden, Denmark, and the UK, all part of the Individual-participant Meta-analysis in Working Populations (IPD-Work) consortium. Baseline-assessed long working hours (≥55 hours per week) were compared to standard working hours (35-40 h). Outcome measures with follow-up until age 65 years were 46 diseases that required hospital treatment or continuous pharmacotherapy, all-cause, and three cause-specific mortality endpoints, ascertained via linkage to national health and mortality registers.Findings: 2747 (4·6%) participants in the primary cohorts and 3027 (6·8%) in the replication cohorts worked long hours. After adjustment for age, sex, and socioeconomic status, working long hours was associated with increased risk of cardiovascular death (hazard ratio 1·68; 95% confidence interval 1·08-2·61 in primary analysis and 1·52; 0·90-2·58 in replication analysis), infections (1·37; 1·13-1·67 and 1·45; 1·13-1·87), diabetes (1·18; 1·01-1·38 and 1·41; 0·98-2·02), injuries (1·22; 1·00-1·50 and 1·18; 0·98-1·18) and musculoskeletal disorders (1·15; 1·06-1·26 and 1·13; 1·00-1·27). Working long hours was not associated with all-cause mortality.Interpretation: Follow-up of 50 health outcomes in four European countries suggests that working long hours is associated with an elevated risk of early cardiovascular death and hospital-treated infections before age 65. Associations, albeit weak, were also observed with diabetes, musculoskeletal disorders and injuries. In these data working long hours was not related to elevated overall mortality.
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26.
  • Ervasti, Jenni, et al. (author)
  • Permanent work disability before and after ischaemic heart disease or stroke event : a nationwide population-based cohort study in Sweden.
  • 2017
  • In: BMJ Open. - : BMJ. - 2044-6055. ; 7:9
  • Journal article (peer-reviewed)abstract
    • OBJECTIVES: We examined the risk of disability pension before and after ischaemic heart disease (IHD) or stroke event, the burden of stroke compared with IHD and which factors predicted disability pension after either event.DESIGN: A population-based cohort study with follow-up 5 years before and after the event. Register data were analysed with general linear modelling with binary and Poisson distributions including interaction tests for event type (IHD/stroke).SETTING AND PARTICIPANTS: All people living in Sweden, aged 25‒60 years at the first event year, who had been living in Sweden for 5 years before the event and had no indication of IHD or stroke prior to the index event in 2006‒2008 were included, except for cases in which death occurred within 30 days of the event. People with both IHD and stroke were excluded, resulting in 18 480 cases of IHD (65%) and 9750 stroke cases (35%).PRIMARY OUTCOME MEASURES: Disability pension.RESULTS: Of those going to suffer IHD or stroke event, 25% were already on disability pension a year before the event. The adjusted OR for disability pension at first postevent year was 2.64-fold (95% CI 2.25 to 3.11) for people with stroke compared with IHD. Economic inactivity predicted disability pension regardless of event type (OR=3.40; 95% CI 2.85 to 4.04). Comorbid mental disorder was associated with the greatest risk (OR=3.60; 95% CI 2.69 to 4.83) after an IHD event. Regarding stroke, medical procedure, a proxy for event severity, was the largest contributor (OR=2.27, 95% CI 1.43 to 3.60).CONCLUSIONS: While IHD event was more common, stroke involved more permanent work disability. Demographic, socioeconomic and comorbidity-related factors were associated with disability pension both before and after the event. The results help occupational and other healthcare professionals to identify vulnerable groups at risk for permanent labour market exclusion after such an event.
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27.
  • Ervasti, Jenni, et al. (author)
  • Sickness absence diagnoses among abstainers, low-risk drinkers and at-risk drinkers : consideration of the U-shaped association between alcohol use and sickness absence in four cohort studies
  • 2018
  • In: Addiction. - : Wiley-Blackwell Publishing Inc.. - 0965-2140 .- 1360-0443. ; 113:9, s. 1633-1642
  • Journal article (peer-reviewed)abstract
    • Aims To estimate differences in the strength and shape of associations between alcohol use and diagnosis-specific sickness absence. Design A multi-cohort study. Participants (n = 47 520) responded to a survey on alcohol use at two time-points, and were linked to records of sickness absence. Diagnosis-specific sickness absence was followed for 4-7 years from the latter survey. Setting and participants From Finland, we had population cohort survey data from 1998 and 2003 and employee cohort survey data from 2000-02 and 2004. From France and the United Kingdom, we had employee cohort survey data from 1993 and 1997, and 1985-88 and 1991-94, respectively. Measurements We used standard questionnaires to assess alcohol intake categorized into 0, 1-11 and > 11 units per week in women and 0, 1-34 and > 34 units per week in men. We identified groups with stable and changing alcohol use over time. We linked participants to records from sickness absence registers. Diagnoses of sickness absence were coded according to the International Classification of Diseases. Estimates were adjusted for sex, age, socio-economic status, smoking and body mass index. Findings Women who reported drinking 1-11 units and men who reported drinking 1-34 units of alcohol per week in both surveys were the reference group. Compared with them, women and men who reported no alcohol use in either survey had a higher risk of sickness absence due to mental disorders [rate ratio = 1.51, 95% confidence interval (CI) = 1.22-1.88], musculoskeletal disorders (1.22, 95% CI = 1.06-1.41), diseases of the digestive system (1.35, 95% CI = 1.02-1.77) and diseases of the respiratory system (1.49, 95% CI = 1.29-1.72). Women who reported alcohol consumption of > 11 weekly units and men who reported alcohol consumption of > 34 units per week in both surveys were at increased risk of absence due to injury or poisoning (1.44, 95% CI = 1.13-1.83). Conclusions In Finland, France and the United Kingdom, people who report not drinking any alcohol on two occasions several years apart appear to have a higher prevalence of sickness absence from work with chronic somatic and mental illness diagnoses than those drinking below a risk threshold of 11 units per week for women and 34 units per week for men. Persistent at-risk drinking in Finland, France and the United Kingdom appears to be related to increased absence due to injury or poisoning.
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28.
  • Ervasti, Jenni, et al. (author)
  • Sociodemographic Differences Between Alcohol Use and Sickness Absence : Pooled Analysis of Four Cohort Studies
  • 2018
  • In: Alcohol and Alcoholism. - : Oxford University Press. - 0735-0414 .- 1464-3502. ; 53:1, s. 95-103
  • Journal article (peer-reviewed)abstract
    • Aims: We examined differences in sickness absence in relation to at-risk drinking and abstinence, taking into account potential changes in consumption.& para;& para;Methods: We used individual-participant data (n = 46,514) from four prospective cohort studies from Finland, France and the UK. Participants responded to a survey on alcohol use at two time points 4-6 years apart, and were linked to records of sickness absence for an similar to 6-year follow-up after the latter survey. Abstainers were those reporting no alcohol use in either survey. At-risk drinkers at T1 were labelled as 'former', at-risk drinkers at T2 as 'current' and at-risk drinkers at both times as 'consistent' at-risk drinkers. The reference group was low-risk drinkers at both times. Study-specific analyses were stratified by sex and socioeconomic status (SES) and the estimates were pooled using meta-analysis.& para;& para;Results: Among men (n = 17,285), abstainers (6%), former (5%), current (5%) and consistent (7%) at-risk drinkers had an increased risk of sickness absence compared with consistent low-risk drinkers (77%). Among women (n = 29,229), only abstainers (12%) had a higher risk of sickness absence compared to consistent low-risk drinkers (74%). After adjustment for lifestyle and health, abstaining from alcohol was associated with sickness absence among people with intermediate and high SES, but not among people with low SES.& para;& para;Conclusions: The U-shaped alcohol use-sickness absence association is more consistent in men than women. Abstinence is a risk factor for sickness absence among people with higher rather than lower SES. Healthy worker effect and health selection may partly explain the observed differences.& para;& para;Short summary: In a pooled analysis from four cohort studies from three European countries, we demonstrated a U-shaped association between alcohol use and sickness absence, particularly among men. Abstinence from alcohol was associated with increased sickness absenteeism among both sexes and across socioeconomic strata, except those with low SES.
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29.
  • Ervasti, Jenni, et al. (author)
  • Trends in diagnosis-specific work disability before and after ischaemic heart disease : a nationwide population-based cohort study in Sweden
  • 2018
  • In: BMJ Open. - : BMJ. - 2044-6055. ; 8:4
  • Journal article (peer-reviewed)abstract
    • OBJECTIVES: We examined trends of diagnosis-specific work disability before and after ischaemic heart disease (IHD).DESIGN: Participants were followed 4 years before and 4 years after an IHD event for diagnosis-specific work disability (sickness absence and disability pension).SETTING AND PARTICIPANTS: A Swedish population-based cohort study using register data on all individuals aged 25-60 years, living in Sweden, and who suffered their first IHD event in 2006-2008 (n=23 971) was conducted.RESULTS: Before the event, the most common diagnoses of work disability were musculoskeletal disorders (21 annual days for men and 44 for women) and mental disorders (19 men and 31 for women). After multivariable adjustments, we observed a fivefold increase (from 12 to 60 days) in work disability due to diseases of the circulatory system in the first postevent year compared with the last pre-event year among men. Among women, the corresponding increase was fourfold (from 14 to 62 days). By the second postevent year, the number of work disability days decreased significantly compared with the first postevent year among both sexes (to 19 days among men and 23 days among women). Among women, mean days of work disability due to diseases of the circulatory system remained at a higher level than among men during the postevent years. Work disability risk after versus before an IHD event was slightly higher among men (rate ratio (RR) 2.49; 95% CI 2.36 to 2.62) than among women (RR 2.29, 95% CI 2.12 to 2.49). When pre-event long-term work disability was excluded, diseases of the circulatory system were the most prevalent diagnosis for work disability after an IHD event among both men and women.CONCLUSIONS: An IHD event was strongly associated with an increase in work disability due to diseases of the circulatory system, especially among men and particularly in the first postevent year.
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30.
  • Ervasti, Jenni, et al. (author)
  • Work disability before and after diabetes diagnosis : a nationwide population-based register study in Sweden.
  • 2015
  • In: American Journal of Public Health. - : American Public Health Association. - 0090-0036 .- 1541-0048. ; 105:6, s. e22-e29
  • Journal article (peer-reviewed)abstract
    • OBJECTIVES: We evaluated the risk of work disability (sick leave and disability pension) before and after diabetes diagnosis relative to individuals without diabetes during the same time period, as well as the trajectory of work disability around the diagnosis.METHODS: This Swedish population-based cohort study with register data included 14 428 individuals with incident diabetes in 2006 and 39 702 individuals without diabetes during 2003 to 2009.RESULTS: Work disability was substantially higher among people with diabetes (overall mean = 95 days per year over the 7 years, SD = 143) than among those without diabetes (mean = 35 days, SD = 95). The risk of work disability was slightly higher after diabetes diagnosis than before and compared with the risk of those without diabetes. The trajectory of work disability was already increasing before diagnosis, increased even more at the time of diagnosis, and leveled off after diagnosis. Individual sociodemographic characteristics and comorbid conditions contributed both to the risk and to the trajectory of work disability.CONCLUSIONS: Although diabetes has an independent effect on work disability, sex, age, education, and comorbid conditions play a significant role.
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31.
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32.
  • Ferrie, Jane E., et al. (author)
  • Job insecurity and risk of diabetes : a meta-analysis of individual participant data
  • 2016
  • In: CMJA. Canadian Medical Association Journal. Onlineutg. Med tittel. - : Canadian Medical Association,Association Medicale Canadienne. - 0820-3946 .- 1488-2329. ; 188:17-18, s. E447-E455
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Job insecurity has been associated with certain health outcomes. We examined the role of job insecurity as a risk factor for incident diabetes.METHODS: We used individual participant data from 8 cohort studies identified in 2 open-access data archives and 11 cohort studies participating in the Individual-Participant-Data Meta-analysis in Working Populations Consortium. We calculated study-specific estimates of the association between job insecurity reported at baseline and incident diabetes over the follow-up period. We pooled the estimates in a meta-analysis to produce a summary risk estimate.RESULTS: The 19 studies involved 140 825 participants from Australia, Europe and the United States, with a mean follow-up of 9.4 years and 3954 incident cases of diabetes. In the preliminary analysis adjusted for age and sex, high job insecurity was associated with an increased risk of incident diabetes compared with low job insecurity (adjusted odds ratio [OR] 1.19, 95% confidence interval [CI] 1.09-1.30). In the multivariable-adjusted analysis restricted to 15 studies with baseline data for all covariates (age, sex, socioeconomic status, obesity, physical activity, alcohol and smoking), the association was slightly attenuated (adjusted OR 1.12, 95% CI 1.01-1.24). Heterogeneity between the studies was low to moderate (age- and sex-adjusted model: I(2) = 24%, p = 0.2; multivariable-adjusted model: I(2) = 27%, p = 0.2). In the multivariable-adjusted analysis restricted to high-quality studies, in which the diabetes diagnosis was ascertained from electronic medical records or clinical examination, the association was similar to that in the main analysis (adjusted OR 1.19, 95% CI 1.04-1.35).INTERPRETATION: Our findings suggest that self-reported job insecurity is associated with a modest increased risk of incident diabetes. Health care personnel should be aware of this association among workers reporting job insecurity.
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33.
  • Fransson, Eleonor I, et al. (author)
  • Job strain and the risk of stroke : an individual-participant data meta-analysis
  • 2015
  • In: Stroke. - 0039-2499 .- 1524-4628. ; 46:2, s. 557-559
  • Journal article (peer-reviewed)abstract
    • BACKGROUND AND PURPOSE: Psychosocial stress at work has been proposed to be a risk factor for cardiovascular disease. However, its role as a risk factor for stroke is uncertain.METHODS: We conducted an individual-participant-data meta-analysis of 196 380 males and females from 14 European cohort studies to investigate the association between job strain, a measure of work-related stress, and incident stroke.RESULTS: In 1.8 million person-years at risk (mean follow-up 9.2 years), 2023 first-time stroke events were recorded. The age- and sex-adjusted hazard ratio for job strain relative to no job strain was 1.24 (95% confidence interval, 1.05;1.47) for ischemic stroke, 1.01 (95% confidence interval, 0.75;1.36) for hemorrhagic stroke, and 1.09 (95% confidence interval, 0.94;1.26) for overall stroke. The association with ischemic stroke was robust to further adjustment for socioeconomic status.CONCLUSION: Job strain may be associated with an increased risk of ischemic stroke, but further research is needed to determine whether interventions targeting job strain would reduce stroke risk beyond existing preventive strategies.
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34.
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35.
  • Fransson, Eleonor, 1971-, et al. (author)
  • Job strain as a risk factor for leisure-time physical inactivity : an individual-participant meta-analysis of up to 170,000 men and women
  • 2012
  • In: American Journal of Epidemiology. - Cary : Oxford University Press. - 0002-9262 .- 1476-6256. ; 176:12, s. 1078-1089
  • Research review (peer-reviewed)abstract
    • Unfavorable work characteristics, such as low job control and too high or too low job demands, have been suggested to increase the likelihood of physical inactivity during leisure time, but this has not been verified in large-scale studies. The authors combined individual-level data from 14 European cohort studies (baseline years from 19851988 to 20062008) to examine the association between unfavorable work characteristics and leisure-time physical inactivity in a total of 170,162 employees (50 women; mean age, 43.5 years). Of these employees, 56,735 were reexamined after 29 years. In cross-sectional analyses, the odds for physical inactivity were 26 higher (odds ratio 1.26, 95 confidence interval: 1.15, 1.38) for employees with high-strain jobs (low control/high demands) and 21 higher (odds ratio 1.21, 95 confidence interval: 1.11, 1.31) for those with passive jobs (low control/low demands) compared with employees in low-strain jobs (high control/low demands). In prospective analyses restricted to physically active participants, the odds of becoming physically inactive during follow-up were 21 and 20 higher for those with high-strain (odds ratio 1.21, 95 confidence interval: 1.11, 1.32) and passive (odds ratio 1.20, 95 confidence interval: 1.11, 1.30) jobs at baseline. These data suggest that unfavorable work characteristics may have a spillover effect on leisure-time physical activity.
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36.
  • Hakulinen, Christian, et al. (author)
  • Social isolation and loneliness as risk factors for myocardial infarction, stroke and mortality : UK Biobank cohort study of 479 054 men and women
  • 2018
  • In: Heart. - : BMJ. - 1355-6037 .- 1468-201X. ; 104:18, s. 1536-1542
  • Journal article (peer-reviewed)abstract
    • Objective: To examine whether social isolation and loneliness (1) predict acute myocardial infarction (AMI) and stroke among those with no history of AMI or stroke, (2) are related to mortality risk among those with a history of AMI or stroke, and (3) the extent to which these associations are explained by known risk factors or pre-existing chronic conditions.Methods: Participants were 479 054 individuals from the UK Biobank. The exposures were self-reported social isolation and loneliness. AMI, stroke and mortality were the outcomes.Results: Over 7.1 years, 5731 had first AMI, and 3471 had first stroke. In model adjusted for demographics, social isolation was associated with higher risk of AMI (HR 1.43, 95% CI 1.3 to –1.55) and stroke (HR 1.39, 95% CI 1.25 to 1.54). When adjusted for all the other risk factors, the HR for AMI was attenuated by 84% to 1.07 (95% CI 0.99 to 1.16) and the HR for stroke was attenuated by 83% to 1.06 (95% CI 0.96 to 1.19). Loneliness was associated with higher risk of AMI before (HR 1.49, 95% CI 1.36 to 1.64) but attenuated considerably with adjustments (HR 1.06, 95% CI 0.96 to 1.17). This was also the case for stroke (HR 1.36, 95% CI 1.20 to 1.55 before and HR 1.04, 95% CI 0.91 to 1.19 after adjustments). Social isolation, but not loneliness, was associated with increased mortality in participants with a history of AMI (HR 1.25, 95% CI 1.03 to 1.51) or stroke (HR 1.32, 95% CI 1.08 to 1.61) in the fully adjusted model.Conclusions: Isolated and lonely persons are at increased risk of AMI and stroke, and, among those with a history of AMI or stroke, increased risk of death. Most of this risk was explained by conventional risk factors.
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37.
  • Halonen, Jaana, et al. (author)
  • Bi-directional relation between effort-reward imbalance and risk of neck-shoulder pain : assessment of mediation through depressive symptoms using occupational longitudinal data
  • 2019
  • In: Scandinavian Journal of Work, Environment and Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 45:2, s. 126-133
  • Journal article (peer-reviewed)abstract
    • Objectives Bi-directional associations between perceived effort-reward imbalance (FRI) at work and neck-shoulder pain have been reported. There is also evidence of associations between ERI and depressive symptoms, and between depressive symptoms and pain while the links between ERI, depressive symptoms and pain have not been tested. We aimed to assess whether depressive symptoms mediate the association between ERI and neck-shoulder pain, as well as the association between neck-shoulder pain and ERI.Methods We used prospective data from three consecutive surveys of the Swedish Longitudinal Occupational Survey of Health (SLOSH) study. ERI was assessed with a short version of the ERI questionnaire, and pain was defined as having had neck-shoulder pain that affected daily life during the past three months. Depressive symptoms were assessed with a continuous scale based on six-items of the (Hopkins) Symptom Checklist. Counterfactual mediation analyses were applied using exposure measures from 2010/2012 (T1), depressive symptoms from 2012/2014 (T2), and outcomes from 2014/2016 (T3), and including only those free of outcome at T1 and T2 (N=2876-3239).Results ERI was associated with a higher risk of neck-shoulder pain [risk ratio (RR) for total effect 1.22, 95% confidence interval (CI) 1.00-1.48] and 41% of this total effect was mediated through depressive symptoms. Corresponding RR for association between neck-shoulder pain and ERI was 1.34 (95% CI 1.09-1.64), but the mediating role of depressive symptoms was less consistent.Conclusions Depressive symptoms appear to be an intermediate factor in the relationship between ERI and neck-shoulder pain.
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38.
  • Halonen, Jaana I., et al. (author)
  • Associations between onset of effort-reward imbalance at work and onset of musculoskeletal pain : analyzing observational longitudinal data as pseudo-trials
  • 2018
  • In: Pain. - : Ovid Technologies (Wolters Kluwer Health). - 0304-3959 .- 1872-6623. ; 159:8, s. 1477-1483
  • Journal article (peer-reviewed)abstract
    • Existing evidence of an association between effort-reward imbalance (ERI) at work and musculoskeletal pain is limited, preventing reliable conclusions about the magnitude and direction of the relation. In a large longitudinal study, we examined whether the onset of ERI is associated with subsequent onset of musculoskeletal pain among those free of pain at baseline, and vice versa, whether onset of pain leads to onset of ERI. Data were from the Swedish Longitudinal Occupational Survey of Health (SLOSH) study. We used responses from 3 consecutive study phases to examine whether exposure onset between the first and second phases predicts onset of the outcome in the third phase (N = 4079). Effort-reward imbalance was assessed with a short form of the ERI model. Having neck-shoulder and low back pain affecting life to some degree in the past 3 months was also assessed in all study phases. As covariates, we included age, sex, marital status, occupational status, and physically strenuous work. In the adjusted models, onset of ERI was associated with onset of neck-shoulder pain (relative risk [RR] 1.51, 95% confidence interval [CI] 1.21-1.89) and low back pain (RR 1.21, 95% CI 0.97-1.50). The opposite was also observed, as onset of neck-shoulder pain increased the risk of subsequent onset of ERI (RR 1.36, 95% CI 1.05-1.74). Our findings suggest that when accounting for the temporal order, the associations between ERI and musculoskeletal pain that affects life are bidirectional, implying that interventions to both ERI and pain may be worthwhile to prevent a vicious cycle.
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39.
  • Halonen, Jaana I., et al. (author)
  • Psychological distress and sickness absence : Within- versus between-individual analysis
  • 2020
  • In: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 264, s. 333-339
  • Journal article (peer-reviewed)abstract
    • Background: Uncertainty remains whether associations for psychological distress and sickness absence (SA) observed between and within individuals differ, and whether age, gender and work-related factors moderate these associations.Methods: We analyzed SA records of 41,184 participants of the Finnish Public Sector study with repeated survey data between 2000 and 2016 (119,024 observations). Psychological distress was measured by the General Health Questionnaire (GHQ-12), while data on SA days were from the employers' registers. We used a hybrid regression estimation approach adjusting for time-variant confounders-age, marital status, occupational class, body mass index, job contract type, months worked in the follow-up year, job demand, job control, and workplace social capital-and time-invariant gender (for between-individual analysis).Results: Higher levels of psychological distress were consistently associated with SA, both within- and between-individuals. The within-individual association (incidence rate ratio (IRR) 1.68, 95% CI 1.61-1.75 for SA at high distress), however, was substantially smaller than the between-individual association (IRR 2.53, 95% CI 2.39-2.69). High levels of psychological distress had slightly stronger within-individual associations with SA among older (>45 years) than younger employees, lower than higher occupational class, and among men than women. None of the assessed work unit related factors (e.g. job demand, job control) were consistent moderators.Limitations: These findings may not be generalizable to other working sectors or cultures with different SA policies or study populations that are male dominated.Conclusions: Focus on within-individual variation over time provides more accurate estimates of the contribution of mental health to subsequent sickness absence.
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40.
  • Halonen, Jaana I, et al. (author)
  • Socioeconomic and health-related childhood and adolescence predictors of entry into paid employment
  • 2019
  • In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 29:3, s. 555-561
  • Journal article (peer-reviewed)abstract
    • BackgroundMost studies on prolonging working careers have explored later career, while less is known about social and particularly health-related determinants of entry into labour market. We examined social and health-related factors from childhood and adolescence as predictors of age at entry into paid employment and early occupational class, and whether own education moderates these associations.MethodsThe Northern Finland Birth Cohort 1986 was followed from birth until the end of 2015. We included 8542 participants (52% male) who had had a minimum of 6-month employment that was defined by registered earning periods. As socioeconomic predictors, we examined low parental education at age 7 and low household income at age 16. Behaviour- and health-related factors at age 16 included smoking, alcohol use, physical inactivity, overweight, length of sleep and not having breakfast, while mental health problems included symptoms of anxiety and depression, attention problems and social problems. The analyses for significant predictors were further stratified by register-based level of completed own education by age 28–29 (low/high).ResultsAfter adjustments, low parental education, smoking and having been drunk were significant predictors of early entry into paid employment (≤18 vs. ≥24 years), especially among those who later obtained high education. Low parental education and smoking were predictors of low or non-specified (vs. high) occupational class in the first job. Mental health problems were not associated with either outcome.ConclusionsSocioeconomic background and unhealthy lifestyle contribute to early entry into the labour market and low occupational status in the first job.
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41.
  • Halonen, Jaana, et al. (author)
  • Pathways from parental mental disorders to offspring's work disability due to depressive or anxiety disorders in early adulthood—The 1987 Finnish Birth Cohort
  • 2019
  • In: Depression and anxiety (Print). - : Hindawi Limited. - 1091-4269 .- 1520-6394. ; 36:4, s. 305-312
  • Journal article (peer-reviewed)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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42.
  • Halonen, Jaana, et al. (author)
  • Psychotropic medication before and after disability retirement by pre-retirement perceived work-related stress
  • 2020
  • In: European Journal of Public Health. - : Oxford University Press (OUP). - 1101-1262 .- 1464-360X. ; 30:1, s. 158-163
  • Journal article (peer-reviewed)abstract
    • Background: Retirement has been associated with improved mental health, but it is unclear how much this is due to the removal of work-related stressors. We examined rates of psychotropic medication use before and after the transition to disability retirement due to mental, musculoskeletal and other causes by pre-retirement levels of perceived work stress (effort-reward imbalance, ERI). Methods: Register-based date and diagnosis of disability retirement of 2766 participants of the Finnish Public Sector study cohort were linked to survey data on ERI, socialand health-related covariates, and to national records on prescribed reimbursed psychotropic medication, measured as defined daily doses (DDDs). Follow-up for DDDs was 2–5 years before and after disability retirement. We assessed differences in the levels of DDDs before and after retirement among those with high vs. low level of pre-retirement ERI with repeated measures regression. Results: Those with high (vs. low) levels of ERI used slightly more psychotropic medication before disability retirement due to mental disorders [rate ratio (RR) 1.14, 95% confidence intervals (CI) 0.94–1.37], but after retirement this difference attenuated (RR 0.94, 95% CI 0.80–1.10, P for interaction 0.02). Such a change was not observed for the other causes of disability retirement. Conclusions: The level of psychotropic medication use over the transition to disability retirement due to mental, but not musculoskeletal or other, causes was modified by pre-retirement perceived work-related stress. This suggests that among people retiring due to mental disorders those who had stressful jobs benefit from retirement more than those with low levels of work-related stress.
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43.
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44.
  • Heikkila, Katriina, et al. (author)
  • Job Strain and Alcohol Intake : A Collaborative Meta-Analysis of Individual-Participant Data from 140 000 Men and Women
  • 2012
  • In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 7:7, s. Art. no. e40101-
  • Journal article (peer-reviewed)abstract
    • Background: The relationship between work-related stress and alcohol intake is uncertain. In order to add to the thus far inconsistent evidence from relatively small studies, we conducted individual-participant meta-analyses of the association between work-related stress (operationalised as self-reported job strain) and alcohol intake. Methodology and Principal Findings: We analysed cross-sectional data from 12 European studies (n = 142 140) and longitudinal data from four studies (n = 48 646). Job strain and alcohol intake were self-reported. Job strain was analysed as a binary variable (strain vs. no strain). Alcohol intake was harmonised into the following categories: none, moderate (women: 1-14, men: 1-21 drinks/week), intermediate (women: 15-20, men: 22-27 drinks/week) and heavy (women: > 20, men: > 27 drinks/week). Cross-sectional associations were modelled using logistic regression and the results pooled in random effects meta-analyses. Longitudinal associations were examined using mixed effects logistic and modified Poisson regression. Compared to moderate drinkers, non-drinkers and (random effects odds ratio (OR): 1.10, 95% CI: 1.05, 1.14) and heavy drinkers (OR: 1.12, 95% CI: 1.00, 1.26) had higher odds of job strain. Intermediate drinkers, on the other hand, had lower odds of job strain (OR: 0.92, 95% CI: 0.86, 0.99). We found no clear evidence for longitudinal associations between job strain and alcohol intake. Conclusions: Our findings suggest that compared to moderate drinkers, non-drinkers and heavy drinkers are more likely and intermediate drinkers less likely to report work-related stress.
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45.
  • Heikkila, Katriina, et al. (author)
  • Job strain and the risk of inflammatory bowel diseases : individual-participant meta-analysis of 95 000 men and women
  • 2014
  • In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:2, s. e88711-
  • Journal article (peer-reviewed)abstract
    • Background and Aims: Many clinicians, patients and patient advocacy groups believe stress to have a causal role in inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. However, this is not corroborated by clear epidemiological research evidence. We investigated the association between work-related stress and incident Crohn's disease and ulcerative colitis using individual-level data from 95 000 European adults. Methods: We conducted individual-participant data meta-analyses in a set of pooled data from 11 prospective European studies. All studies are a part of the IPD-Work Consortium. Work-related psychosocial stress was operationalised as job strain (a combination of high demands and low control at work) and was self-reported at baseline. Crohn's disease and ulcerative colitis were ascertained from national hospitalisation and drug reimbursement registers. The associations between job strain and inflammatory bowel disease outcomes were modelled using Cox proportional hazards regression. The study-specific results were combined in random effects meta-analyses. Results: Of the 95 379 participants who were free of inflammatory bowel disease at baseline, 111 men and women developed Crohn's disease and 414 developed ulcerative colitis during follow-up. Job strain at baseline was not associated with incident Crohn's disease (multivariable-adjusted random effects hazard ratio: 0.83, 95% confidence interval: 0.48, 1.43) or ulcerative colitis (hazard ratio: 1.06, 95% CI: 0.76, 1.48). There was negligible heterogeneity among the study-specific associations. Conclusions: Our findings suggest that job strain, an indicator of work-related stress, is not a major risk factor for Crohn's disease or ulcerative colitis.
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46.
  • Heikkila, Katriina, et al. (author)
  • Job Strain and Tobacco Smoking : An Individual-Participant Data Meta-Analysis of 166 130 Adults in 15 European Studies
  • 2012
  • In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 7:7
  • Journal article (peer-reviewed)abstract
    • Background: Tobacco smoking is a major contributor to the public health burden and healthcare costs worldwide, but the determinants of smoking behaviours are poorly understood. We conducted a large individual-participant meta-analysis to examine the extent to which work-related stress, operationalised as job strain, is associated with tobacco smoking in working adults. Methodology and Principal Findings: We analysed cross-sectional data from 15 European studies comprising 166 130 participants. Longitudinal data from six studies were used. Job strain and smoking were self-reported. Smoking was harmonised into three categories never, ex- and current. We modelled the cross-sectional associations using logistic regression and the results pooled in random effects meta-analyses. Mixed effects logistic regression was used to examine longitudinal associations. Of the 166 130 participants, 17% reported job strain, 42% were never smokers, 33% ex-smokers and 25% current smokers. In the analyses of the cross-sectional data, current smokers had higher odds of job strain than never-smokers (age, sex and socioeconomic position-adjusted odds ratio: 1.11, 95% confidence interval: 1.03, 1.18). Current smokers with job strain smoked, on average, three cigarettes per week more than current smokers without job strain. In the analyses of longitudinal data (1 to 9 years of follow-up), there was no clear evidence for longitudinal associations between job strain and taking up or quitting smoking. Conclusions: Our findings show that smokers are slightly more likely than non-smokers to report work-related stress. In addition, smokers who reported work stress smoked, on average, slightly more cigarettes than stress-free smokers.
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47.
  • Heikkila, Katriina, et al. (author)
  • Long working hours and cancer risk : a multi-cohort study
  • 2016
  • In: British Journal of Cancer. - : Springer Science and Business Media LLC. - 0007-0920 .- 1532-1827. ; 114, s. 813-818
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Working longer than the maximum recommended hours is associated with an increased risk of cardiovascular disease, but the relationship of excess working hours with incident cancer is unclear.METHODS: This multi-cohort study examined the association between working hours and cancer risk in 116 462 men and women who were free of cancer at baseline. Incident cancers were ascertained from national cancer, hospitalisation and death registers; weekly working hours were self-reported.RESULTS: During median follow-up of 10.8 years, 4371 participants developed cancer (n colorectal cancer: 393; n lung cancer: 247; n breast cancer: 833; and n prostate cancer: 534). We found no clear evidence for an association between working hours and the overall cancer risk. Working hours were also unrelated the risk of incident colorectal, lung or prostate cancers. Working ⩾55 h per week was associated with 1.60-fold (95% confidence interval 1.12-2.29) increase in female breast cancer risk independently of age, socioeconomic position, shift- and night-time work and lifestyle factors, but this observation may have been influenced by residual confounding from parity.CONCLUSIONS: Our findings suggest that working long hours is unrelated to the overall cancer risk or the risk of lung, colorectal or prostate cancers. The observed association with breast cancer would warrant further research.
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48.
  • Heikkilä, Katriina, et al. (author)
  • Job strain and COPD exacerbations: an individual-participant meta-analysis
  • 2014
  • In: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 44:1, s. 247-251
  • Journal article (peer-reviewed)abstract
    • To the Editor:Chronic obstructive pulmonary disease (COPD) is a major cause of mortality and disability worldwide (1). The clinical course of COPD is characterised by exacerbations, which can be minor and manageable at home or in primary care, or severe, leading to hospitalisation or even death. Known causes of exacerbations include tobacco smoke, air pollution, dusts and fumes, and respiratory infections (1, 2). One less well understood risk factor is stress, which could plausibly lead to COPD exacerbations as it can trigger inflammation (3, 4) and is associated with increased smoking (5), which are both implicated in COPD pathology (2). Work is an important source of stress in the age groups in which COPD is typically diagnosed (1, 6). However, we are not aware of previous investigations of work-related stress and the risk of COPD exacerbations.In this study, we examined the associations between job strain (the most widely studied conceptualisation of work-related stress) and severe COPD exacerbations using individual-level data from 10 prospective cohort studies from the Individual Participant Data Meta-analysis in Working Populations (IPD-Work) Consortium (7). Job strain is defined as a combination of high demands (excessive amounts of work) and low control (having little influence on what tasks to.
  •  
49.
  • Heikkilä, Katriina, et al. (author)
  • Job Strain as a Risk Factor for Peripheral Artery Disease : A Multi-Cohort Study
  • 2020
  • In: Journal of the American Heart Association. - : Wiley-Blackwell. - 2047-9980. ; 9:9
  • Journal article (peer-reviewed)abstract
    • Background Job strain is implicated in many atherosclerotic diseases, but its role in peripheral artery disease (PAD) is unclear. We investigated the association of job strain with hospital records of PAD, using individual-level data from 11 prospective cohort studies from Finland, Sweden, Denmark, and the United Kingdom. Methods and Results Job strain (high demands and low control at work) was self-reported at baseline (1985-2008). PAD records were ascertained from national hospitalization data. We used Cox regression to examine the associations of job strain with PAD in each study, and combined the study-specific estimates in random effects meta-analyses. We used τ2, I2, and subgroup analyses to examine heterogeneity. Of the 139 132 participants with no previous hospitalization with PAD, 32 489 (23.4%) reported job strain at baseline. During 1 718 132 person-years at risk (mean follow-up 12.8 years), 667 individuals had a hospital record of PAD (3.88 per 10 000 person-years). Job strain was associated with a 1.41-fold (95% CI, 1.11-1.80) increased average risk of hospitalization with PAD. The study-specific estimates were moderately heterogeneous (τ2=0.0427, I2: 26.9%). Despite variation in their magnitude, the estimates were consistent in both sexes, across the socioeconomic hierarchy and by baseline smoking status. Additional adjustment for baseline diabetes mellitus did not change the direction or magnitude of the observed associations. Conclusions Job strain was associated with small but consistent increase in the risk of hospitalization with PAD, with the relative risks on par with those for coronary heart disease and ischemic stroke.
  •  
50.
  • Heikkilä, Katriina, et al. (author)
  • Work stress and risk of cancer: meta-analysis of 5700 incident cancer events in 116 000 European men and women
  • 2013
  • In: The BMJ. - : BMJ. - 1756-1833. ; 345:f165
  • Journal article (peer-reviewed)abstract
    • Objective To investigate whether work related stress, measured and defined as job strain, is associated with the overall risk of cancer and the risk of colorectal, lung, breast, or prostate cancers.Design Meta-analysis of pooled prospective individual participant data from 12 European cohort studies including 116 056 men and women aged 17-70 who were free from cancer at study baseline and were followed-up for a median of 12 years. Work stress was measured and defined as job strain, which was self reported at baseline. Incident cancers (all n=5765, colorectal cancer n=522, lung cancer n=374, breast cancer n=1010, prostate cancer n=865) were ascertained from cancer, hospital admission, and death registers. Data were analysed in each study with Cox regression and the study specific estimates pooled in meta-analyses. Models were adjusted for age, sex, socioeconomic position, body mass index (BMI), smoking, and alcohol intakeResults A harmonised measure of work stress, high job strain, was not associated with overall risk of cancer (hazard ratio 0.97, 95% confidence interval 0.90 to 1.04) in the multivariable adjusted analyses. Similarly, no association was observed between job strain and the risk of colorectal (1.16, 0.90 to 1.48), lung (1.17, 0.88 to 1.54), breast (0.97, 0.82 to 1.14), or prostate (0.86, 0.68 to 1.09) cancers. There was no clear evidence for an association between the categories of job strain and the risk of cancer.Conclusions These findings suggest that work related stress, measured and defined as job strain, at baseline is unlikely to be an important risk factor for colorectal, lung, breast, or prostate cancers.
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