Occupational Class Inequalities in Physical Health and Work Disability : Causes and Consequences
Year: 2020
Type: dissertation
Study design: Observational Study
Abstract: Socioeconomic position has been consistently found to be connected to health, with those in lower socioeconomic positions having worse health. Inequalities are observed in mortality, individual illnesses, self-rated health, and functioning. While socioeconomic inequalities have been studied extensively over the last decades, there are still gaps in our knowledge. Previous studies have indicated a widening of socioeconomic differences in physical health in late middle-age, but our understanding on the causes of this widening is lacking. Some ageing employees are confronted with work disability and disability retirement, while most eventually transition to mandatory retirement. We also lack knowledge on how different retirement pathways affect the trajectories of physical health in different socioconomic positions. Work ability may also be affected differently in socioeconomic positions after occurrence of serious ill-health. Studies comparing a wide range of causes of inequalities in work disability are scarce. Studying all these different aspects of health and work disability across socioeconomic positions provides a fuller understanding of health and ill-health in different socioeconomic positions, and may provide justification and targets for interventions aiming to reduce the inequalities. The aim of this study was to examine occupational class inequalities in physical health and work disability, assess the major explanations of these inequalities, and examine occupational class inequalities in consequences of ill-health on work disability. The evidence of this study provides material for designing focused interventions to tackle socioeconomic inequalities in physical health and work disability. This study was conducted among the Helsinki Health Study cohort of employees of City of Helsinki, Finland, using both questionnaire survey data and register based data of City of Helsinki employees. The baseline survey data were collected in 2000-2002 (N=8960, response rate 67%), and the follow-up surveys in 2007 (N=7332, response rate 83%) and 2012 (N=6816, response rate 79%). In one sub-study the baseline questionnaire was linked to the retirement register from Finnish Centre for Pensions. In another sub-study the personnel register of all City of Helsinki employees from 1990 to 2013 (N=170510) were linked to national retirement and hospital discharge registers. Information on occupational class was based on job title, and categorized to professionals, semi-professionals, routine non-manual workers and manual workers. Physical health was measured by the physical component summary of the Short Form 36 (SF-36) questionnaire, summarizing different aspects of physical health. The data were analysed using Bayesian hierarchical linear random effects models, mixed effects growth curve models, Cox proportional hazards regression models, and competing risks regression models. Overall the findings of this study indicate the existence of clear occupational class inequalities in physical health among late middle-aged employees, and inequalities are also observed in how health changes over age. The health inequalities also manifest as inequalities in subsequent work disability and as inequalities in consequences of ill-health on work disability. The occupational class differences are likely to be related to differences in accumulation of exposures, particularly physical exposures related to work, and possibly to opportunities to deal with the exposures. .
Source: Työväentutkimus Vuosikirja
Author: Olli Pietiläinen
Language: English
Subfield: Demography
Field: Social Sciences
Domain: Social Sciences
Open Access status: green
OpenAlex ID: W3007294171