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ObjectiveTo determine the prospective association between retrospectively assessed physical work environment during working life and prospectively assessed sickness absence and labour market exit among older workers.MethodsUsing Cox regression analyses we estimated the 4-year to 6-year prospective risk of register-based long-term sickness absence (LTSA), disability pension, early retirement and unemployment from exposure to different physical work environmental factors during working life among 5076 older workers (age 49–63 at baseline) from the Copenhagen Aging and Midlife Biobank cohort.ResultsVery hard physical work throughout working life was a risk factor for LTSA (HR 1.66,95% CI 1.32 to 2.07), disability pension (HR 2.21,95% CI 1.04 to 4.72) and early retirement (HR 1.57,95% CI 1.13 to 2.17). Both short-term (<10 years) and long-term (≥20 years) exposures to lifting or carrying of heavy burdens predicted the risk of LTSA (HRs 1.49–1.56) and disability pension (HRs 2.26–3.29). In contrast, exposure to dust was associated with LTSA and disability pension only following 20 or more exposure years.ConclusionsRetrospectively assessed hard physical work during working life and exposure to several factors in the physical work environment, especially heavy lifting, were important for labour market exit and sickness absence. This study underscores the importance of reducing physical work exposures throughout the working life course for preventing sickness absence and premature exit from the labour market.

Background Previous studies indicate that psychological, social, and organizational factors at work contribute to health, motivation, absence from work, and functional ability. The objective of the study was to assess the current state of knowledge of the contribution of psychological, social, and organizational factors to disability retirement by a systematic review and meta-analyses. Methods Data sources : A systematic literature search for studies of retirement due to disability in Medline, Embase, and PsychINFO was performed. Reference lists of relevant articles were hand-searched for additional studies. Data extraction : Internal validity was assessed independently by two referees with a detailed checklist for sources of bias. Conclusions were drawn based on studies with acceptable quality. Data synthesis : We calculated combined effect estimates by means of averaged associations (Risk ratios) across samples, weighting observed associations by the study’s sample size. Thirty-nine studies of accepted quality were found, 37 of which from the Nordic countries. Results There was moderate evidence for the role of low control (supported by weighted average RR = 1.40; 95% CI = 1.21-1.61) and moderate evidence for the combination of high demands and low control (although weighted average was RR = 1.45; 95% CI = 0.96-2.19) as predictors of disability retirement. There were no major systematic differences in findings between the highest rated and the lowest rated studies that passed the criterion for adequate quality. There was limited evidence for downsizing, organizational change, lack of employee development and supplementary training, repetitive work tasks, effort-reward imbalance to increase risk of disability pension. Very limited evidence was found for job demands, evening or night work, and low social support from ones superior. Conclusions Psychological and organizational factors at work contribute to disability retirement with the most robust evidence for the role of work control. We recommend the measurement of specific exposure factors in future studies.

The objective of this population-based register study was (1) to investigate the association between young adults diagnosed with attention-deficit/hyperactivity disorder (ADHD) and subsequent labour market marginalisation (LMM) in two comparison groups, i.e. matched young adults from the general population without ADHD and unaffected siblings to persons with ADHD and (2) to assess the role of comorbid disorders. This study included all young adults in Sweden, aged 19-29 years, with an incident diagnosis of ADHD 2006-2011 ( = 9718). Crude and multivariate sex-stratified hazard ratios (HRs) with 95% confidence intervals (CIs) were measured 5 years after the diagnosis of ADHD for the risk of disability pension, long-term sickness absence (SA) (>90 days), long-term unemployment (>180 days) and a combined measure of all three in young adults with ADHD compared to their siblings without ADHD and a matched comparison group. In the adjusted analyses young adults with ADHD had a 10-fold higher risk of disability pension (HR = 10.2; CI 9.3-11.2), a nearly three-fold higher risk of long-term SA (HR = 2.7; CI 2.5-2.8) and a 70% higher risk of long-term unemployment (HR = 1.7; CI 1.6-1.8) compared to the matched comparison group. The risk estimates were lower compared to siblings for disability pension (HR = 9.0; CI 6.6-12.3) and long-term SA (HR = 2.5; CI 2.1-3.1) but higher in the long-term unemployed (HR = 1.9; CI 1.6-2.1). Comorbid disorders explained about one-third of the association between ADHD and disability pension, but less regarding SA and long-term unemployment. Young adults with ADHD have a high risk for different measures of LMM and comorbidities explain only a small proportion of this relationship.

Objective This study aimed to examine the risk of being granted a disability pension (DP) among incident cancer patients up to five years after diagnosis compared to a match control group, before and after the structural reform of the Danish Disability Pension Act in 2013. Methods All 20-60-year-old incident cancer-diagnosed individuals from 2000 to 2015 were identified in the Danish Cancer Registry. A control group, not previously diagnosed with cancer, was identified in Statistics Denmark matched by gender, age, education, and household income. Risk differences (RD) in cumulative incidence proportions of being granted a DP between cancer patients and controls were analyzed before and after the reform. Results In total, 111 773 incident cancer patients and 506 904 controls were included in the study. Before reform 10 561 cancer patients and 11 231 controls were granted DP; and 2570 cancer patients and 2646 controls were granted DP after the reform. The adjusted RD of being granted DP was significantly higher for cancer patients versus controls at all time points before the reform. The RD increased the most during the first (RD 3.6, 95% CI 3.5-3.7) and second (RD 7.2, 95% CI 7.0-7.4) follow-up year and levelled off the remaining three years. After the reform, the adjusted RD were lower for all 1-5 follow-up years compared to before the reform (RD range 2.8-7.7, 95% CI 2.6-8.1). Conclusion The 2013 reform of the Disability Pension Act reduced the risk of cancer patients being granted DP. The impact on a personal level should be further explored.

BackgroundThe aim was to elucidate if the risk of labour market marginalisation (LMM), measured as long-term unemployment, long-term sickness absence, disability pension and a combined measure of these three measures, differed between refugees and non-refugee migrants with different regions of birth compared with native Swedes.MethodsAll non-pensioned individuals aged 19–60 years who were resident in Sweden on 31 December 2009 were included (n=4 441 813, whereof 216 930 refugees). HRs with 95% CIs were computed by Cox regression models with competing risks and time-dependent covariates with a follow-up period of 2010–2013.ResultsRefugees had in general a doubled risk (HR: 2.0, 95% CI 1.9 to 2.0) and non-refugee migrants had 70% increased risk (HR: 1.7, 95% CI 1.7 to 1.7) of the combined measure of LMM compared with native Swedes. Refugees from Somalia (HR: 2.7, 95% CI 2.6 to 2.8) and Syria (HR: 2.5, 95% CI 2.5 to 2.6) had especially high risk estimates of LMM, mostly due to high risk estimates of long-term unemployment (HR: 3.4, 95% CI 3.3 to 3.5 and HR: 3.2, 95% CI 3.1 to 3.2). African (HR: 0.7, 95% CI 0.6 to 0.7) and Asian (HR: 1.0, 95% CI 1.0 to 1.1) refugees had relatively low risk estimates of long-term sickness absence compared with other refugee groups. Refugees from Europe had the highest risk estimates of disability pension (HR: 1.9, 95% CI 1.8 to 2.0) compared with native Swedes.ConclusionRefugees had in general a higher risk of all measures of LMM compared with native Swedes. There were, however, large differences in risk estimates of LMM between subgroups of refugees and with regard to type of LMM. Actions addressing differences between subgroups of refugees is therefore crucial in order to ensure that refugees can obtain as well as retain a position on the labour market.

PurposeThis feasibility study focusses on the implementation and use of a decision aid, which supports vocational rehabilitation (VR) professionals in helping clients with a disability pension return to work in practice. The decision aid shows an overview of the clients’ return to work barriers and suggests suitable VR interventions based on these barriers.MethodsThe study population consisted of VR professionals working at the Dutch Social Security Institute and their clients receiving a (partial) work disability pension. The feasibility was measured with concepts of the Linnan and Steckler framework and the attitude, social norm and self-efficacy model. Data were collected using questionnaires, checklists and qualitative interviews.ResultsTen professionals participated in this study. Fifty-four clients were asked to fill in the questionnaire of the decision aid and 32 clients received VR care based on the decision aid. In general, VR professionals and clients were satisfied with the decision aid and perceived a few barriers for using the decision aid.ConclusionsThis study showed that it is feasible to implement and use the decision aid. To improve the implementation of this decision aid, it should be implemented in digital systems used by professionals to improve efficiency of working with the decision aid.

The present study aims to investigate the association between exposure to precarious employment three years after graduation and the risk of labor market marginalization (LMM) ten years later. A registered-linked cohort study based on the Swedish Work, Illness, and Labor-market Participation (SWIP) cohort was conducted among all individuals born between 1973 and 1976, who were registered in Sweden the year they turned 27 years old (N=365 702). Information on the exposure of labor market establishment three years after graduating from school and outcome of LMM ten years after graduating was collected from nationwide registers. Relative risk ratios (RRR) with 95% confidence intervals (CI) were obtained by multinominal logistic regression. After considering important covariates, young adults in precarious employment three years after graduation were at an increased risk of future long-term unemployment (RRR 2.31), later precarious employment (RRR 2.85), and long-term sickness absence/disability pension (RRR 1.43) compared to individuals who had obtained standard employment arrangements within three years of graduating. Young precariously employed men had a slightly strong association compared to females with regards to all outcomes. The result of this study suggests that both young men and women in precarious employment three years after graduation are more likely to have a weaker attachment to the labor force later in life compared to individuals of the same age in standard employment. This is important as the prevalence of precarious employment is increasing globally, and young adults appear to be especially vulnerable.

There is a lack of large-scale studies exploring labor market marginalization (LMM) among individuals diagnosed with bipolar disorder (BD). We aimed to investigate the association of BD with subsequent LMM in Sweden, and the effect of sex on LMM in BD. Individuals aged 19-60 years living in Sweden with a first-time BD diagnosis between 2007 and 2016 ( = 25 231) were followed from the date of diagnosis for a maximum of 14 years. Risk of disability pension (DP), long-term sickness absence (SA) (>90 days), and long-term unemployment (>180 days) was compared to a matched comparison group from the general population, matched 1:5 on sex and birth year ( = 126 155), and unaffected full siblings ( = 24 098), using sex-stratified Cox regression analysis, yielding hazard ratios (HRs) with 95% confidence intervals (CIs). After adjusting for socioeconomic factors, baseline labor market status, and comorbid disorders, individuals with BD had a significantly higher risk of DP compared to the general population (HR = 16.67, 95% CI 15.33-18.13) and their unaffected siblings (HR = 5.54, 95% CI 4.96-6.18). Individuals with BD were also more likely to experience long-term SA compared to the general population (HR = 3.19, 95% CI 3.09-3.30) and their unaffected siblings (HR = 2.83, 95% CI 2.70-2.97). Moreover, individuals diagnosed with BD had an elevated risk of long-term unemployment relative to both comparison groups (HR range: 1.75-1.78). Men with BD had a higher relative risk of SA and unemployment than women. No difference was found in DP. Individuals with BD face elevated risks of LMM compared to both the general population and unaffected siblings.

Introduction In Sweden, many people with multiple sclerosis (PwMS) remain employed due to flexible work and social insurance support. However, as MS progresses, work income declines while reliance on sickness absence (SA) and disability pension (DP) increases. Self-rated health, a holistic measure of physical and mental well-being, is informative in the work context. This study aims to explore factors associated with combined categorical indicators that integrate employment status and self-rated health and examines factors associated with different employment-health states. Methods This population-based study included survey responses from 4329 PwMS linked to national register data. We categorized participants into four employment–health groups based on self-rated health (high vs. low EQ-VAS) and employment status (working vs. receiving SA/DP). Groups comparisons were conducted to describe differences in sociodemographic, clinical, mental health, and work-related characteristics. Multinomial logistic regression was then used to examine factors associated with group membership. Results Women, older individuals, and those with progressive MS or more visible symptoms were more likely to be receiving SA/DP. Depressive symptoms were more common among participants reporting low self-rated health, regardless of employment status, while disability, fatigue, and reduced work ability were associated with poorer health and reduced labor market participation. Fatigue emerged as a prevalent symptom across all groups, including those still working. Participants working despite low health reported insufficient or absent workplace adjustments, suggesting unmet support needs. Career and educational decisions were also influenced by MS, with many participants reducing working hours or avoiding job changes. Conclusions Employment status among PwMS did not perfectly reflect individual’s overall well-being, particularly regarding mental health and fatigue. Nevertheless, clear group-level differences between those who were employed and those who were receiving part-time SA/DP underscore the importance of early, tailored interventions.