BackgroundSickness absence has been shown to be a risk marker for severe future health outcomes, such as disability retirement and premature death. However, it is poorly understood how all-cause and diagnosis-specific sickness absence is reflected in subsequent physical and mental health functioning over time. The aim of this study was to examine the association of all-cause and diagnosis-specific sickness absence with subsequent changes in physical and mental health functioning among ageing municipal employees.MethodsProspective survey and register data from the Finnish Helsinki Health Study and the Social Insurance Institution of Finland were used. Register based records for medically certified all-cause and diagnostic-specific sickness absence spells (>14 consecutive calendar days) in 2004–2007 were examined in relation to subsequent physical and mental health functioning measured by Short-Form 36 questionnaire in 2007 and 2012. In total, 3079 respondents who were continuously employed over the sickness absence follow-up were included in the analyses. Repeated-measures analysis was used to examine the associations.ResultsDuring the 3-year follow-up, 30% of the participants had at least one spell of medically certified sickness absence. All-cause sickness absence was associated with lower subsequent physical and mental health functioning in a stepwise manner: the more absence days, the poorer the subsequent physical and mental health functioning. These differences remained but narrowed slightly during the follow-up. Furthermore, the adverse association for physical health functioning was strongest among those with sickness absence due to diseases of musculoskeletal or respiratory systems, and on mental functioning among those with sickness absence due to mental disorders.ConclusionsSickness absence showed a persistent adverse stepwise association with subsequent physical and mental health functioning. Evidence on health-related outcomes after long-term sickness absence may provide useful information for targeted interventions to promote health and workability.

BackgroundBoth smoking and obesity are separately associated with sickness absence. Unhealthy lifestyle habits and health conditions may occur concurrently yet studies focusing on their joint association are few. This study examined the joint associations of smoking and obesity with sickness absence (SA).MethodsA mail survey among employees of the City of Helsinki, Finland, during 2000–2002 included data on obesity, smoking and covariates (N = 8960, response rate 67%, 80% women). These data were prospectively linked with register data on self- (1–3 days) and medically certified (4 days or longer) SA among those consenting to the linkage (n = 6986). Pregnant, underweight and those with missing data on key variables were excluded (n = 138). The total number of participants included in the analyses was 6847. The follow-up time was 5 years. Poisson regression was used to calculate rate ratios (RR).ResultsAmong women and men smoking and obesity were associated with self-certified SA. Among women there was a joint association with self-certified SA (obese smokers RR 1.81, 95% CI 1.59–2.07).Among women and men smoking and obesity were jointly associated with medically certified SA (for obese smoking women RR 2.23, 95% CI 1.93–2.57, for obese smoking men RR 2.69, 95% CI 2.03–3.55). Associations remained after adjustments for socioeconomic position, working conditions, health behaviours and self-rated health.ConclusionBoth smoking and obesity are jointly associated with all lengths of sickness absence. Support measures for smoking cessation and prevention of obesity could likely to reduce SA.

BackgroundRetirement is a key life event, which is associated with changes in physical activity, however, there is limited evidence with regard to changes in physical activity that take place in post-retirement years. The aim of this study was to examine how leisure-time physical activity changes shortly after the transition to retirement and during the post-retirement years.MethodsThe phase 1 data were collected in 2000–2002 (n = 8960, response rate 67%) among 40–60-year-old employees of the City of Helsinki, Finland. Phase 2 was carried out in 2007 (n = 7332, response rate 83%) and phase 3 in 2012 (n = 6814, response rate 79%). Disability retirees and those under the age of 50 at baseline were excluded. This yielded 2902 participants. Most of the participants (79%) were women. The mean age of the participants was 54.4 in phase 1. Negative binomial models for repeated measurements with generalized estimating equations (GEE) were used to calculate the incidence rate ratios (IRR) and 95% confidence intervals (CI). These indicated the changes in time spent in self-reported leisure-time physical activity among the retired compared with the continuously employed.ResultsOf the participants, 851 retired on the grounds of old age during the first period (phases 1–2), and 948 during the second period (phases 2–3). Change in physical activity was positive among those who retired during the first (IRR = 1.10, 95% CI 1.04–1.17) and second (IRR = 1.10, 95% CI 1.04–1.16) periods compared to the continuously employed. During the second period, there was little difference between those who had retired during the first one (IRR = 0.96, 95% CI 0.91–1.02) and the continuously employed.ConclusionsThe transition to statutory retirement was associated with an immediate increase in leisure-time physical activity, which nevertheless diminished during post-retirement years.

BackgroundMusculoskeletal diseases and mental disorders are major causes of long-term sickness absence in Western countries. Although sickness absence is generally more common in lower occupational classes, little is known about class differences in diagnostic-specific absence over time. Focusing on Finland during 2005–2014, we therefore set out to examine the magnitude of and changes in absolute and relative occupational class differences in long-term sickness absence due to major diagnostic causes.MethodsA 70-per-cent random sample of Finns aged 25–64 linked to register data on medically certified sickness absence (of over 10 working days) in 2005–2014 was retrieved from the Social Insurance Institution of Finland. Information on occupational class was obtained from Statistics Finland and linked to the data. The study focused on female (n = 658,148–694,142) and male (n = 604,715–642,922) upper and lower non-manual employees and manual workers. The age-standardised prevalence, the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII) were calculated for each study year to facilitate examination of the class differences.ResultsThe prevalence of each diagnostic cause of sickness absence declined during the study period, the most common causes being musculoskeletal diseases, mental disorders and injuries. The prevalence of other causes under scrutiny was less than 1 % annually. By far the largest absolute and relative differences were in musculoskeletal diseases among both women and men. Moreover, the absolute differences in both genders (p < 0.0001) and the relative differences in men (p < 0.0001) narrowed over time as the prevalence declined most among manual workers. Both genders showed modest and stable occupational class differences in mental disorders. In the case of injuries, no major changes occurred in absolute differences but relative differences narrowed over time in men (p < 0.0001) due to a strong decline in prevalence among manual workers. Class differences in the other studied diagnostic causes under scrutiny appeared negligible.ConclusionsBy far the largest occupational class differences in long-term sickness absence concerned musculoskeletal diseases, followed by injuries. The results highlight potential targets for preventive measures aimed at reducing sickness absence and narrowing class differences in the future.

BackgroundMental symptoms are prevalent among populations, but their associations with premature mortality are inadequately understood. We examined whether mental symptoms contribute to cause-specific mortality among midlife employees, while considering key covariates.MethodsBaseline mail survey data from 2000–02 included employees, aged 40–60, of the City of Helsinki, Finland (n = 8960, 80 % women, response rate 67 %). Mental symptoms were measured by the General Health Questionnaire 12-item version (GHQ-12) and the Short Form 36 mental component summary (MCS). Covariates included sex, marital status, social support, health behaviours, occupational social class and limiting long-standing illness. Causes of death by the end of 2013 were obtained from Statistics Finland (n = 242) and linked individually to survey data pending consent (n = 6605). Hazard ratios (HR) and 95 % confidence intervals (95 % CI) were calculated using Cox regression analysis.ResultsFor all-cause mortality, only MCS showed a weak association before adjustments. For natural mortality, no associations were found. For unnatural mortality (n = 21), there was a sex adjusted association with GHQ (HR = 1.96, 95 % CI = 1.45–2.64) and MCS (2.30, 95 % CI = 1.72–3.08). Among unnatural causes of death suicidal mortality (n = 11) was associated with both GHQ (2.20, 95 % CI = 1.47–3.29) and MCS (2.68, 95 % CI = 1.80–3.99). Of the covariates limiting long-standing illness modestly attenuated the associations.ConclusionsTwo established measures of mental symptoms, i.e. GHQ-12 and SF-36 MCS, were both associated with subsequent unnatural, i.e. accidental and violent, as well as suicidal mortality. No associations were found for natural mortality due to diseases. These findings need to be corroborated in further populations. Supporting mental health through workplace measures may help counteract subsequent suicidal and other unnatural mortality among midlife employees.

BackgroundBetween 1997 and 2010, the English government pursued an ambitious programme to reduce health inequalities, the explicit and sustained commitment of which was historically and internationally unique. Previous evaluations have produced mixed results. None of these evaluations have, however, compared the trends in health inequalities within England with those in other European countries. We carried out an innovative analysis to assess whether changes in trends in health inequalities observed in England after the implementation of its programme, have been more favourable than those in other countries without such a programme.MethodsData were obtained from nationally representative surveys carried out in England, Finland, the Netherlands and Italy for years around 1990, 2000 and 2010. A modified difference-in-difference approach was used to assess whether trends in health inequalities in 2000–2010 were more favourable as compared to the period 1990–2000 in England, and the changes in trends in inequalities after 2000 in England were then compared to those in the three comparison countries. Health outcomes were self-assessed health, long-standing health problems, smoking status and obesity. Education was used as indicator of socioeconomic position.ResultsAfter the implementation of the English strategy, more favourable trends in some health indicators were observed among low-educated people, but trends in health inequalities in 2000–2010 in England were not more favourable than those observed in the period 1990–2000. For most health indicators, changes in trends of health inequalities after 2000 in England were also not significantly different from those seen in the other countries.ConclusionsIn this rigorous analysis comparing trends in health inequalities in England both over time and between countries, we could not detect a favourable effect of the English strategy. Our analysis illustrates the usefulness of a modified difference-in-difference approach for assessing the impact of policies on population-level health inequalities.