Macro-organizational factors,the incidence of work disability,and work ability among the total workforce of home care workers in Sweden

Abstract

Aims: To investigate the importance of macro-organizational factors, i.e. organizational sociodemographic and socioeconomic preconditions, of the municipal incidence of long-term sick leave, disability pension, and prevalence of workers with long-term work ability among home care workers. Methods: In an ecological study design, data from national databases were combined by record linkage. Descriptive and analytical statistics were used to estimate and interpret macro-organizational factors (economic resources, region, unemployment, employment, occupational rehabilitation, return to work, age structures of inhabitants and home care workers). Results: The incidence of long-term sick leave among female home care workers was twice as high as that of male home care workers, and incidence of disability pension was about four times as high for the women. A great variation in municipal incidence of long-term sick leave, disability pension, and long-term work ability (101—264, 0.6—19.6, and 913—1,279 per 1,000 full-time equivalent workers and year) was also found. The strongest single factor for long-term work ability was a high proportion of part-time or hourly paid employees, which explained 35% of the municipal variation. Macro-organizational factors explained long-term work ability (47—62% explained variance) better than long-term sick leave (33% explained variance). There was a low rehabilitation activity; only 2% received occupational rehabilitation and 5% of those on sick leave longer than 2 weeks returned to work within 30 days. Conclusions: The differences in the municipal proportion of work ability incidence indicate a preventive potential, especially related to employment and return to work after sick leave.

Keywords

Cohort health personnel home-care service home health aides incidence occupational diseases retirement sick leave social environment socioeconomic factors

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References

Thorlacius S. , Stefánsson S. , Olafsson S. , Rafnsson V.

Changes in the prevalence of disability pension in Iceland 1976—1996. Scand

J Public Health 2002;30:244—8.

Knutsson A. , Goine H. Occupation and unemployment rates as predictors of long term sickness absence in two Swedish counties. Soc Sci Med 1998;47:25—31.

Swedish Council on Technology Assessment in Health Care, Sjukskrivning — orsaker, konsekvenser och praxis. En systematisk litteraturöversikt [Sickness absence — causes, consequences and practice]. Stockholm : SBU, 2003.

Alexandersson K. , Leijon M. , Åkerlind I. , Rydh H. , Bjurulf P. Epidemiology of sickness absence in a Swedish county in 1985, 1986 and 1987. Scand J Soc Med 1994;22:27—34.

Gjesdal S. , Bratberg E. The role of gender in long-term sickness absence and transition to permanent disability benefits: Results from a multiregister based, prospective study in Norway 1990—1995. Eur J Public Health 2002;12:180—6.

Szucs S. , Hemström Ö. , Marklund S. Organisatoriska faktorers betydelse för långa sjukskrivningar i kommuner [The importance of organisational factors for spells of long— term sickness in municipalities]. Stockholm: National Institute for Working Life, 2003.

Vahtera J. , Kivimäki M. , Pentti J. , Theorell T.

Effect of change in the psychosocial work environment on sickness absence: A seven year follow up of initially healthy employees. J Epidemiolol

Community Health 2000;54:484—93.

Lund T. Associations between health and work disability. Doctoral thesis. Copenhagen: National Institute of Occupational Health , 2001.

Tuomi K. , Illmarinen J. , Seitsamo J. , Huuhtanen P. , Martikainen R. , Nygård C-H. , Klockars M. Summary of the Finnish research project (1981—1992) to promote the health and work ability of ageing workers. Scand J Work Environ Health 1997;23(suppl 1):66—71.

10.

Yen I. , Syme S. The social environment and health: A discussion of the epidemiologic literature. Ann Rev Public Health 1999;20:287—308.

11.

Rugulies R. , Aust B. , Syme S. The epidemiology of health and illness: A socio-psycho-physiological perspective . In: Sutton S , Baum A , Johnston M , editors. The Sage handbook of health psychology. London: Sage Publications, 2004.

12.

Diez-Roux AV Bringing context back into epidemiology: Variables and fallacies in multilevel analysis. Am J Public Health 1998;88:216—22.

13.

Hagberg M. , Cristiani D. , Courtney TK , Halperin W. , Leamon TB , Smith TJ Consensus report: Broadening the view of exposure assessment. Scand J Work Environ Health 2001 ;27:354—7.

14.

Pickett KE , Pearl M. Multilevel analyses of neighbourhood socioeconomic context and health outcomes: A critical review. J Epidemiol Community Health 2001;55:111—22.

15.

Diez-Roux A. Investigating neighborhood and area effects on health. Am J Public Health 2001;91:1783—9.

16.

Benavides F. , Benach J. , Diez-Roux A. , Roman C. How do types of employment relate to health indicators? Findings from the Second European Survey on Working Conditions . J Epidemiol Community Health 2000;54:494—501.

17.

Voss M. , Floderus B. , Didrichsen F.

Changes in sickness absenteeism following the introduction of a qualifying day for sickness benefit — findings from Sweden Post. Scand

J Public Health 2001;29:166—74.

18.

Hagen K. , Holte H. , Tambs K. , Bjerkedal T. Socioeconomic factors and disability retirement from back pain: A 1983— 1993 population-based prospective study in Norway. Spine 2000;25:2480—7.

19.

Wagstaff A. , van Doorslaer E.

Income inequality and health: What does the literature tell us?

Ann Rev Public Health 2000;21:546—67.

20.

Pohjonen T. Perceived work ability of home care workers in relation to individual and work-related factors in different age groups . Occup Med 2001;51:209—17.

21.

Dellve L. , Lagerström M. , Hagberg M. Work system risk factors for permanent work disability among home care workers: A case-control study . Int Arch Occup Environ Health 2003;76:216—24.

22.

Eriksen W. , Bruusgard D. , Knardahl S. Work factors as predictors of sickness absence: A three month prospective study of nurses' aides. Occup Environ Health 2003;60:271—8.

23.

Dellve L. Explaining occupational disorders and work ability among home care workers. Doctoral thesis. Göteborg: Göteborg University, 2003.

24.

Dellve L. , Herloff B. , Karlberg K. , Hagberg M. , Lagerström M. , Allebeck P. Socioeconomic determinants of occupational injuries and diseases among the total work force of home care workers in Sweden: An eco-epidemiological study. Safety Science Monitor 2003;7(IV-I). Available at: http://www.ipso.asn.au/vol7.

25.

Dellve L. , Lagerström M. , Hagberg M. Rehabilitation of home care workers. Supportive factors and obstacles prior to disability pension due to musculoskeletal disorders . J Occup Rehab 2002;12:55—64.

26.

Virtanen M. , Kivimäki M. , Elovainen M. , Vahtera J. , Cooper C. Contingent employment, health and sickness absence. Scand J Work Environ Health 2001;27:365—72.

27.

Lynch J. , Davey Smith G , Hillemeier M. , Shaw M. , Raghunathan T. , Kaplan G. Income inequality, the psychosocial environment, and health: Comparisons of wealthy nations. Lancet 2001;358:194—200.

28.

Ahlgren C. , Hammarström A. Back to work? Gender experiences of rehabilitation . Scand J Public Health 2000;28:88—94.

29.

Hensing G. , Alexanderson K. , Allebeck P. , Bjurulf P. How to measure sickness absence? Literature review and suggestion of five basic measures . Scand J Soc Med 1998;6:133—44.

30.

Frohlich N. , Carriere K. , Potvin L. , Black C.

Assessing socioeconomic effects on different sized populations: To weight or not to weight?

J Epidemiol Community Health 2001;55:913—20.