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  • Lallukka, Tea; Sivertsen, Borge; Kronholm, Erkki; Bin, Yu Sun; Overland, Simon; Glozier, Nick (2018)
    Objectives: We aimed to evaluate the interaction of two key determinants of sleep health, quantity and quality, with physical, emotional, and social functioning, in the general population. Design: Nationally-representative Australian cross-sectional study. Setting: General population. Participants: 14,571 people aged 15 or older in Household, Income and Labor Dynamics in Australia (HILDA) in 2013. Measurements: The associations of sleep quality (good/poor) in combination with mid-range (6-8 hours), short (8) sleep duration with functioning, determined from the SF-36, were evaluated using logistic regression adjusting for sociodemographic, relationships, health behaviors, obesity, pain, and mental and physical illness confounders. Results: After adjusting for gender, and age, poor sleep quality in combination with short, mid-range and long sleep was associated with worse physical, emotional and social functioning. Pain and comorbid illness explained much of these associations, while attenuation from other covariates was minor. The associations of poor sleep quality with worse functioning remained after full adjustment regardless of sleep duration, while among people with good quality sleep, only those with long sleep duration reported poorer functioning. Conclusions: Poor sleep quality has robust associations with worse functioning regardless of total duration in the general population. There appears to be a substantial number of functional short sleepers with good quality sleep. (c) 2017 National Sleep Foundation. Published by Elsevier Inc. All rights reserved.
  • Lallukka, Tea; Pietiläinen, Olli; Jäppinen, Sauli; Laaksonen, Mikko; Lahti, Jouni; Rahkonen, Ossi (2020)
    Background: Declining response rates are a common challenge to epidemiological research. Response rates further are particularly low among young people. We thus aimed to identify factors associated with health survey response among young employees using different data collection methods. Methods: We included fully register-based data to identify key socioeconomic, workplace and health-related factors associated with response to a health survey collected via online and mailed questionnaires. Additionally, telephone interviews were conducted for those who had not responded via online or to the mailed survey. The survey data collection was done in autumn 2017 among young employees of the City of Helsinki, Finland (18-39 years, target population n=11,459). Results: The overall response to the survey was 51.5% (n=5898). The overall findings suggest that differences in the distributions of socioeconomic, workplace and health-related factors between respondents in the online or mailed surveys, or telephone interviews, are relatively minor. Telephone interview respondents were of lower socioeconomic position, which helped improve representativeness of the entire cohort. Despite the general broad representativeness of the data, some socioeconomic and health-related factors contributed to response. Thus, non-respondents were more often men, manual workers, from the lowest income quartile, had part-time jobs, and had more long sickness absence spells. In turn, job contract (permanent or temporary) and employment sector did not affect survey response. Conclusions: Despite a general representativeness of data of the target population, socioeconomically more disadvantaged and those with long sickness absence, are slightly overrepresented among non-respondents. This suggests that when studying the associations between social factors and health, the associations can be weaker than if complete data were available representing all socioeconomic groups.
  • Virtanen, Marianna; Oksanen, Tuula; Pentti, Jaana; Ervasti, Jenni; Head, Jenny; Stenholm, Sari; Vahtera, Jussi; Kivimaki, Mika (2017)
    Objectives The aim of this study was to examine occupational class differences in working more than six months beyond the mandatory retirement age and factors that may contribute to these differences. Methods The study comprised a prospective cohort study of a total of 5331 Finnish municipal employees (73% women) who were not on work disability pension and reached the age eligible for old-age pension in 2005-2011. Occupational class included four categories: managers and professionals, lower grade non-manual, skilled manual, and elementary occupations. Survey responses while at work were linked to national health and pension registers. Results A total of 921 participants (17.3%) worked beyond the pensionable age. Compared with elementary workers, skilled manual workers had a similar probability [gender-adjusted risk ratio (RR) 0.95, 95% confidence interval (95% CI) 0.72-1.23] while lower grade non-manual workers had a 2.03-fold (95% CI 1.59-2.58), and managers and professionals had a 1.79-fold (95% CI 1.41-2.27) probability of working beyond the pensionable age. Adjustment for physical workload (32.0% in lower non-manual, 36.7% in managers and professionals), work time control (20.4% and 11.4%) and perceived work ability (16.5% and 29.1%) contributed to the largest attenuation for these associations. Analyses using a counterfactual approach suggested greater mediated effects for physical workload and work time control than those observed in traditional mediation analyses. Conclusions Employees with higher occupational classes are two times more likely to continue working beyond the retirement age compared to those with lower occupational classes. A large proportion of these differences were explained by having physically light job, better work time control, and better self-rated work ability among employees with high occupational class.
  • Lallukka, Tea; Mänty, Minna; Cooper, Cyrus; Fleischmann, Maria; Kouvonen, Anne; Walker-Bone, Karen E.; Head, Jenny; Halonen, Jaana I. (2018)
    Objectives To examine the impact of recurrent, as compared with single, reports of back pain on exit from paid employment over decades of follow-up. Methods The study sample was from the British Whitehall II Study cohort (n=8665, 69% men, aged 35-55 at baseline), who had provided information about their reports of back pain between 1985 and 1994. Data about exit from paid employment (health-related and non-health related exit, unemployment and other exit) were collected between 1995 and 2013. Repeated measures logistic regression models were fitted to examine the associations, and adjust for covariates. Results Recurrent pain was reported by 18% of participants, while 26% reported pain on an occasion and 56% did not report pain. Report of back pain on an occasion was not associated with health-related job exit, whereas recurrent pain was associated with such an exit (OR 1.51; 95% CI 1.15 to 1.99), when compared with those who did not report pain. These associations were somewhat stronger among middle-grade and lower-grade employees, while these associations were not seen among higher-grade employees. Differences in associations by age and psychosocial working conditions were small. Conclusions These results highlight the need for early detection of recurrent back pain to prevent exit out of paid employment for health reasons. As the risk varies by occupational grade, this emphasises the importance of identification of high-risk groups and finding ways to address their modifiable risk factors.
  • Salonsalmi, Aino; Rahkonen, Ossi; Lahelma, Eero; Laaksonen, Mikko (2017)
    Objectives Alcohol drinking is associated with ill health but less is known about its contribution to overall functioning. We aimed to examine whether alcohol drinking predicts self-reported mental and physical functioning 5-7 years later. Design A prospective cohort study. Setting Helsinki, Finland. Participants 40-year-old to 60-year-old employees of the City of Helsinki (5301 women and 1230 men) who participated in a postal survey in 2000-2002 and a follow-up survey in 2007. Primary and secondary outcome measures Mental and physical functioning measured by the Short Form 36 Health Survey. Results Alcohol drinking was differently associated with mental and physical functioning. Heavy average drinking, binge drinking and problem drinking were all associated with subsequent poor mental functioning except for heavy average drinking among men, whereas only problem drinking was associated with poor physical functioning. Also, non-drinking was associated with poor physical functioning. Problem drinking was the drinking habit showing most widespread and strongest associations with health functioning. The associations between problem drinking and poor mental functioning and with poor physical functioning among women remained after adjusting for baseline mental functioning, sociodemographic factors, working conditions and other health behaviours. Conclusions Alcohol drinking is associated especially with poor mental functioning. Problem drinking was the drinking habit strongest associated with poor health functioning. The results call for early recognition and prevention of alcohol problems in order to improve health functioning among employees.
  • Neupane, Subas; Lallukka, Tea; Pietiläinen, Olli; Rahkonen, Ossi; Leino-Arjas, Päivi (2020)
    Objectives We examined developmental trajectories of multisite musculoskeletal pain in midlife, and their associations with mental well-being. Methods Midlife municipal employees at baseline aged 40, 45, 50, 55 or 60 years (80% women) from the City of Helsinki, Finland, responded to a baseline questionnaire in 2000-02 (N = 8,960; response rate 67%) and follow-ups in 2007 (N = 7,332; 83%) and 2012 (N = 6,809; 78%). Trajectories of the number of pain sites (0-4) were modelled using latent class growth analysis (n = 6,527). Common mental disorders were assessed by the General Health Questionnaire (GHQ) 12-item version (trichotomized to low, intermediate or high). Information on health-related behaviour, comorbidity and socioeconomic position was obtained from the questionnaire. Associations of baseline factors with pain trajectories were assessed by multinomial logistic regression. Results We identified four distinct pain trajectories: high (15%), increasing (24%), decreasing (20%) and low (41%). After an initial increase, the high and increasing trajectories stabilized at around 2.5 and 1.5 pain sites respectively. In a multivariable model, high, increasing and decreasing trajectories of pain sites were associated with higher baseline GHQ scores. The association was strongest for the high trajectory (low GHQ: OR 3.7, 95% CI 2.8-4.9; high GHQ: OR 5.4, 95% 4.4-6.6). Trajectory membership also associated with unhealthy behaviours, musculoskeletal comorbidities and a low socioeconomic position at baseline. Average GHQ was consistently highest for the high pain trajectory and decreased in the decreasing trajectory over the follow-up. Conclusions Multisite musculoskeletal pain shows variable developmental patterns among midlife employees. The trajectories are associated with the level of common mental disorders. Significance Four developmental trajectories of multisite pain in midlife were described over 10-12 years of follow-up: low (41% of the sample), increasing (24%), high (15%) and decreasing (20%). Common mental disorders strongly associated with these. Belonging to the highest tertile of mental disorders at baseline increased the risk of membership in the high trajectory more than fivefold. On the other hand, together with a decrease in mental disorders, the number of pain sites decreased to zero.
  • Hiilamo, Aapo; Butterworth, Peter; Shiri, Rahman; Ropponen, Annina; Pietiläinen, Olli; Mänty, Minna; Kouvonen, Anne; Lahelma, Eero; Rahkonen, Ossi; Lallukka, Tea (2019)
    Objectives Pain is linked to an increased risk of sickness absence (SA); however, the extent to which unmeasured time-invariant differences explain this association is yet unknown. Therefore, we determined the within-individual associations between pain and short-term (in the survey year) and long-term (2 years following the survey years) SA risk in high and low occupational classes while controlling for the potential bias due to unobservable time-invariant characteristics. Methods The Helsinki Health Study data consisting of midlife public sector employees with mailed surveys from up to four time points, and SA record linkage were used (3983 persons). The within-individual estimates were calculated using hybrid negative binomial regression models. Results Acute/subacute pain was associated with a 13% increase in the rate of short-term SA days (incidence rate ratio 1.13 [95% CI 1.01 to 1.27]), while the association was somewhat stronger for chronic pain (1.32 [1.19-1.47]). For the employees in the low occupational class, these associations were robust (1.29 [1.10-1.50] for acute/subacute and 1.43 [1.23-1.66] for chronic pain), whereas only chronic pain was associated with SA among those in the high occupational class (1.25 [1.08-1.46]). Chronic pain was also associated with SA days in the long term without occupational class differences. Similar results were obtained for multisite pain (pain in several locations). Conclusions These results indicate that particularly chronic and multisite pain have a within-individual link to SA but ignoring unobservable differences between those reporting pain and those not might yield overstated effect sizes. Pain might have a different relation to SA in low and high occupational classes.
  • Lallukka, Tea; Kronholm, Erkki; Pekkala, Johanna; Jäppinen, Sauli; Blomgren, Jenni; Pietiläinen, Olli; Lahelma, Eero; Rahkonen, Ossi (2019)
    Background: Early exit from paid employment is a notable public health and societal challenge. Previous research has largely focused on the relationships among variables instead of the relationships among individuals with different work participation history. Person-oriented methods enable to identify latent groups of individuals who are likely to follow similar development in their work participation over time. We thus aimed to identify work participation trajectories during early and midlife careers and their social determinants using large nationally representative data comprising over 1 million initially employed individuals and a 10-year follow-up for their work participation. A further aim was to determine the cumulative incidence of sickness absence due to key diagnostic groups, mental disorders and musculoskeletal diseases within the trajectories. Methods: Young (25-38 years at baseline, n = 495,663) and midlife (39-52 years at baseline, n = 603,085) Finnish people, all working in 2004, were followed up through 2013, with registers of the Social Insurance Institution, and the Statistics Finland. The registers provided data for work participation and its determinants, as well as for computing the cumulative incidence of sickness absence. Latent class growth analysis was used to identify trajectories. Results: Three distinctive trajectories were identified: temporary exit, permanent exit, and continuously employed people. As compared to the other trajectories, those belonging to the permanent exit trajectory were more likely men, manual workers and had a lower income. The cumulative incidence of sickness absence due to mental disorders was highest in the permanent exit trajectory group. For musculoskeletal diseases, the cumulative incidence of sickness absence increased in the permanent exit trajectory mainly in the older age groups. Conclusion: Distinct group-based trajectories of early work exit can be identified in a representative cohort of initially employed people. Focusing on the determinants of premature exit and early intervention to tackle increasing sickness absence may promote work participation particularly in the most vulnerable groups.
  • Lallukka, Tea; Kaila-Kangas, Leena; Mänty, Minna; Koskinen, Seppo; Haukka, Eija; Kausto, Johanna; Leino-Arjas, Päivi; Kaikkonen, Risto; Halonen, Jaana I.; Shiri, Rahman (2019)
    The contribution of physically demanding work to the developmental trajectories of sickness absence (SA) has seldom been examined. We analyzed the associations of 12 physical work exposures, individually and in combination, with SA trajectories among the occupationally active in the Finnish nationally representative Health 2000 survey. We included 3814 participants aged 30-59 years at baseline, when exposure history to work-related factors was reported. The survey and interview responses were linked with the annual number of medically confirmed SA spells through 2002-2008 from national registries. Trajectory analyses identified three SA subgroups: 1 = low (54.6%), 2 = slowly increasing (33.7%), and 3 = high (11.7%). After adjustments, sitting or use of keyboard >1 year was inversely associated with the high SA trajectory (odds ratio, OR, 0.57; 95% 95% confidence interval, CI, 0.43-0.77). The odds of belonging to the trajectory of high SA increased with an increasing number of risk factors, and was highest for those with >= 4 physical workload factors (OR 2.71; 95% CI 1.99-3.69). In conclusion, these findings highlight the need to find ways to better maintain the work ability of those in physically loading work, particularly when there occurs exposure to several workload factors.