Socio-economic determinants of sickness absence

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http://urn.fi/URN:ISBN:978-952-10-6600-9
Title: Socio-economic determinants of sickness absence
Author: Piha, Kustaa
Contributor: University of Helsinki, Faculty of Medicine, Hjelt Institute, Department of Public Health
Thesis level: Doctoral dissertation (article-based)
Belongs to series: Publications of Public Health - URN:ISSN:0355-7979
Abstract: Socio-economic inequalities in health are a remarkable public health issue. There is abundant evidence showing that low socio-economic position is associated with poor health. Sickness absence is a well-established health-related measure, which causes substantial direct and indirect costs. Sickness absence is associated with other health indicators, such as self-rated health, disability pension, and mortality. Low socio-economic position, as measured by education, occupational class, and income, is associated with higher sickness absence rates. Although socio-economic inequalities in other domains in health have increased for decades, there is a lack of studies on changes over time of socio-economic inequalities in sickness absence. Different socio-economic position measures form a pathway that produces ill health, but no studies have so far analysed these pathways in sickness absence. Also, occupational class differences in work injuries are large, but socio-economic inequalities in work injuries and related absence by other socio-economic position measures are unknown. Explanatory factors, such as family-related factors, physical working conditions, psychosocial working conditions, and health-related behaviours contribute to sickness absence and other health outcomes, but the results vary between studies. In addition, their effects on occupational class inequalities in sickness absence are less examined. Previous sickness absence research provides no established theoretical framework for the study of socio-economic determinants of sickness absence. Based on previous research, a conceptual model of the determinants of sickness absence is developed. The conceptual model is considered from structural, causal, and intervention perspectives. The aim of this study was to examine the socio-economic determinants of medically certified sickness absence. Specific aims were to analyse (1) time trends, (2) interrelationships between key socio-economic position determinants, (3) work injury absence as a contributor to socio-economic inequalities in sickness absence, and (4) explanatory factors of occupational class inequalities in sickness absence. The study is part of the Helsinki Health Study, a prospective cohort study. The data for this study include register data for 25-59-year-old employees of the City of Helsinki for years 1990-1999, 2001, 2003-2007, and 2011 for time series- and register-based analyses. The number of employees annually was 16.000 to 28.000 women and 5.000 to 7.000 men, depending on the analyses. Survey data from 2000 to 2002 from those employees who reached the age of 40, 45, 50, 55 or 60 each year were linked to register data and were used in analysing explanatory factors. These data included 5.470 women and 1.464 men. Four days or longer medically certified sickness absence was used as an outcome variable. Key socio-economic determinants, namely education, occupational class, and individual income, were used. Explanatory factors included work arrangements, physical working conditions, psychosocial working conditions, health-related behaviours, and family-related factors. Statistical analyses included Poisson regression. Large and consistent socio-economic gradients in sickness absence were found by all socio-economic position measures, showing that low education, occupational class, and individual income were all associated with higher sickness absence rates. Age-adjusted sickness absence rates increased from 1990 to 1999, and absolute socio-economic inequalities widened. Changes from 2001 to 2011 indicated that educational and occupational inequalities in sickness absence decreased. In both genders, education and occupational class practically explained the effect of income. Clear pathways through socio-economic position measures were found, indicating that socio-economic position develops during a longer time period throughout the life course and affects sickness absence. Socio-economic inequalities in work injury absence were equally consistent and larger than sickness absence owed to other causes. Work injury absence, however, accounted for only a minor part of the overall socio-economic inequalities in sickness absence. Physical working conditions and health-related behaviours were the strongest explanatory factors for the occupational class inequalities in sickness absence. The effects of work arrangements, psychosocial working conditions, and family-related factors were negligible. This study provided new and important evidence on the pathway of the effects of sickness absence through education, occupational class, and individual income. The results for socio-economic inequalities in sickness absence supported previous research. In all, the explanatory factors accounted for 40 to 60% of the occupational class differences in sickness absence. The results from this study empirically supported the developed conceptual model of the determinants of sickness absence. Further research could focus on earlier socio-economic determinants and pathways to sickness absence. The results indicated that work injuries remain a minor but avoidable source of socio-economic inequalities in sickness absence. Possible targets in sickness absence prevention include improving physical working conditions and health promotion designed to enhance health-related behaviours.Sosioekonomiset terveyserot ovat merkittävä kansanterveysongelma. On laajalti osoitettu, että matala sosioekonominen asema on yhteydessä huonoon terveyteen ja korkeampiin sairauspoissaolotasoihin. Sairauspoissaolot aiheuttavat merkittäviä suoria ja epäsuoria kustannuksia. Sairauspoissaolot ovat yhteydessä muihin terveydentilan mittareihin, kuten koettuun terveyteen, työkyvyttömyyseläkkeelle jäämiseen ja kuolleisuuteen. Sosioekonomisen aseman mittarien yhteyttä työtapaturmasta aiheutuneisiin poissaoloihin ja eriarvoisuuteen niissä ei tunneta. Perhetilanne, fyysiset työolot, psykososiaaliset työolot ja terveyskäyttäytyminen ovat yhteydessä sairauspoissaoloihin, mutta tulokset vaihtelevat tutkimuksesta toiseen. Tutkimuksen tarkoituksena oli selvittää lääkärintodistusta vaativien sairauspoissaolojen sosioekonomisia syytekijöitä, sekä niitä selittäviä tekijöitä. Tutkimus on osa Helsinki Health Studya, joka on työssä olevia koskeva etenevä kohorttitutkimus. Tutkimuksen rekisteriaineisto kattoi 25-59 -vuotiaat Helsingin kaupungin työntekijät vuosien 1990 ja 2011 välillä. Rekisteriaineistossa oli vuosittain 16.000-28.000 naista ja 5.000-7.000 miestä. Vuosina 2000-2002 kerätyssä kyselyaineistossa oli 5.470 naista ja 1.464 miestä. Sosioekonomiset erot olivat suuria ja johdonmukaisia siten, että matala koulutus, ammattiasema ja henkilökohtaiset tulot olivat yhteydessä korkeisiin sairauspoissaolotasoihin. Ikävakioidut sairauspoissaolot lisääntyivät ja sosioekonomiset erot sairauspoissaoloissa kasvoivat vuosien 1990 ja 1999 välillä ja vähenivät vuosien 2001 ja 2011 välillä. Tutkimuksessa löydettiin selkeitä polkuja sosioekonomisen aseman eri mittarien välillä, joka viittaa siihen, että sosioekonominen asema muotoutuu pidemmän ajan kuluessa elämänkaaren eri vaiheissa ja vaikuttaa myöhempiin sairauspoissaoloihin. Sosioekonomiset erot työtapaturmista aiheutuneissa poissaoloissa olivat johdonmukaisia ja suurempia kuin muissa sairauspoissaoloissa. Tutkimuksen tulokset osoittavat, että työtapaturmat ovat pieni, mutta ehkäistävissä oleva sairauspoissaolojen sosioekonomisten erojen lähde. Fyysiset työolot ja terveyskäyttäytyminen selittivät eniten ammattiaseman mukaisia eroja sairauspoissaoloissa. Työaika ja työsuhde, psykososiaaliset työolot ja perhetilanne eivät juurikaan selittäneet eroja. Tutkitut tekijät selittivät kaikkiaan 40-60 % sairauspoissaolojen ammattiaseman mukaisista eroista. Mahdollisia kohteita sairauspoissaolojen vähentämiseksi ovat fyysisten työolojen kohentaminen sekä terveyden edistäminen terveyskäyttäytymiseen vaikuttamalla.
URI: URN:ISBN:978-952-10-6600-9
http://hdl.handle.net/10138/41671
Date: 2013-11-22
Subject: kansanterveystiede
Rights: This publication is copyrighted. You may download, display and print it for Your own personal use. Commercial use is prohibited.


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