Aims: Most high mortality-risk occupations are manual occupations. We examined to what extent high mortality of such occupations could be explained by education, income, unemployment or industry and whether there were differences in these effects among different manual occupations. Methods: We used longitudinal individual-level register-based data, the study population consisting of employees aged 30–64 at the end of the year 2000 with the follow-up period 2001–2015. We used Cox proportional hazard regression models in 31 male and 11 female occupations with high mortality. Results: There were considerable differences between manual occupations in how much adjusting for education, income, unemployment and industry explained the excess mortality. The variation was especially large among men: controlling for these variables explained over 50% of the excess mortality in 23 occupations. However, in some occupations the excess mortality even increased in relation to unadjusted mortality. Among women, these variables explained a varying proportion of the excess mortality in every occupation. After adjustment of all variables, mortality was no more statistically significantly higher than average in 14 occupations among men and 2 occupations among women. Conclusions: The high mortality in manual occupations was mainly explained by education, income, unemployment and industry. However, the degree of explanation varied widely between occupations, and considerable variation in mortality existed between manual occupations after controlling for these variables. More research is needed on other determinants of mortality in specific high-risk occupations.
Background The aim was to identify specific manual occupations with high mortality and to examine whether there are differences in the role of alcohol in explaining the excess mortality among manual occupations with high all-cause mortality. Methods A register-based study of employees aged 30–64 years, followed for mortality 2001–15. Age standardized mortality ratios (SMRs) were calculated to compare the mortality rates of manual occupations. The contribution of alcohol-related mortality to excess mortality was obtained by comparing the excess mortality in all deaths and deaths not related to alcohol. Results Men had 31 and women 11 manual occupations with SMR statistically significantly over 120 compared with all employees. Mortality rates were highest among building construction labourers (SMR 180) among men and building caretakers (SMR 155) among women. With few exceptions, high mortality was a combination of high alcohol-related and high non-alcohol-related mortality. Among men, the contribution of alcohol-related mortality to the excess all-cause mortality compared with all employees was over 10% in half of the high-mortality occupations. The contribution was highest among welders and flame cutters (50%) and lowest among farmer’s locums (−50%). Among women the contribution was highest among building caretakers (15%). Conclusions High-mortality occupations had high mortality even without alcohol-related deaths. However, alcohol-related mortality was generally higher than mortality for other causes; therefore, alcohol-related mortality increased further the excess mortality. Diminishing the alcohol-related mortality would level excess mortality of these occupations but not eliminate it.
Background The aim of this study was to examine how the use of outpatient and inpatient health services differs by occupational groups, and whether the differences are explained by sociodemographic factors and health status. Methods We used register-based data on 25–64-year-old employees living in the city of Oulu, Finland, in 2018 (N = 61,848). Use of outpatient health care services (public, private and occupational health care) among men and women was analysed with negative binomial regression models, and use of inpatient health care with logistic regression models, using two occupational classifications: occupational group (1-digit level) and more detailed occupation (2-digit level). Adjusted covariates were age, education, income, marital status, special reimbursement entitlements for medicines, and sickness absence. Results Examined at the level of larger occupational groups, the use of outpatient and inpatient health care was less common than average among managers, professionals and skilled agricultural, forestry and fishery workers; in women also among craft and related trades workers. Controlling for covariates explained only part of the differences, more among women than among men. Analysed at the level of more detailed occupations, the adjusted use of outpatient and inpatient care was more common among health associate professionals and stationary plant and machine operators, both among men and women. Furthermore, the use of outpatient care was common among male personal care workers, protective service workers and metal, machinery and related trades workers as well as among labourers in mining, construction, manufacturing and transport, and female customer services clerks and sales workers. Conclusion The use of health care services differs by occupation, and the differences are not fully explained by sociodemographic factors and health status. High occupational risks, attitudes and knowledge may explain the more frequent use of health services. Furthermore, explanations may be sought from lack of access to occupational health care or healthier working conditions and behavior.
Kuntoutukseen osallistumisen sosioekonomisista eroista on vain vähän tietoa. Tavoitteena oli selvittää, millaisia eroja kuntoutukseen osallistumisessa on ylipäätään ja eri osajärjestelmissä koulutuksen, ammattiaseman ja tulojen mukaan sekä selittyvätkö kunkin sosioekonomisen aseman mittarin mukaiset erot muilla sosioekonomisen aseman mittareilla, siviilisäädyllä ja sairastavuudella. Aineistona oli rekisteriaineisto Oulussa vuonna 2018 asuneista 25–64-vuotiaista (N=99569) sekä heidän sosiaali- ja terveyspalveluiden ja etuuksien käytöstään. Kuntoutukseen osallistuneiksi määrittelimme kaikki julkisen terveyspalvelujärjestelmän, Kelan tai työeläkelaitosten kuntoutukseen tai työterveyshuollon tai yksityiseen fysioterapiaan vuoden 2018 aikana osallistuneet. Menetelminä käytimme ristiintaulukointia ja logistista regressioanalyysia. Kuntoutukseen osallistuminen oli keskimääräistä harvinaisempaa perusasteen koulutuksen saaneilla, yrittäjillä ja työttömillä sekä alimmassa tuloneljänneksessä, kun ikä ja sukupuoli oli huomioitu. Siviilisäädyn, muiden sosioekonomisten ja sairastavuuteen liittyvien taustatekijöiden vakioiminen ei juuri muuttanut tuloksia. Julkisen terveyspalvelujärjestelmän järjestämään kuntoutukseen osallistuivat todennäköisimmin työelämän ulkopuolella olevat ja pienituloiset. Kelan kuntoutukseen osallistuneiden profiili oli samankaltainen, mutta lisäksi Kelan kuntoutukseen osallistuivat todennäköisimmin korkeasti koulutetut ja ylemmät toimihenkilöt. Työeläkekuntoutukseen osallistuivat todennäköisimmin keskiasteen suorittaneet, opiskelijat ja muut työelämän ulkopuolella olevat sekä keskituloiset. Työterveyshuollon fysioterapiaan ja yksityiseen fysioterapiaan osallistuivat todennäköisimmin korkeasti koulutetut, palkansaajat sekä hyvätuloiset; yksityiseen fysioterapiaan usein myös yrittäjät. Matalimmassa sosioekonomisessa asemassa olevilla on muita pienempi todennäköisyys osallistua kuntoutukseen. Kohdentuessaan hyväosaisille kuntoutus saattaa osin ylläpitää väestön sosioekonomisia terveyseroja. Kuntoutuksen sosioekonomisista eroista saatavaan kuvaan vaikuttaa kuitenkin se, mikä kaikki kuntoutus tutkimuksessa on mahdollista huomioida.
Vocational rehabilitation may affect the frequency of health care use by improving the access or reducing the need for health care. We examined whether participation in rehabilitation effects the healthcare services use. Register-based data was utilized on all individuals aged 15–60 living in the city of Oulu, Finland, who started vocational rehabilitation in 2014–2015 (N = 784). We examined the use of outpatient health care services from 1.5 years before to 1.5 years after the start of rehabilitation and 1.5 years after the end of rehabilitation, and compared it to the propensity score matched controls. Rehabilitees had on average 1.5 visits to outpatient health care services in the 6th quarter before the start of rehabilitation. In the 4th quarter before the start of rehabilitation, that number increased to 1.8. After the rehabilitation period, the quarterly number of visits returned to the same level as at the beginning of the follow-up. The biggest changes were in the use of occupational health services. Compared to the propensity score matched controls, vocational rehabilitation did not appear to affect the use of health care services. Vocational rehabilitation seems to replace need for other services but not to affect the need to receive treatment for the underlying disease.
Tutkimuksessa tarkasteltiin toisen ja korkea-asteen opiskelijoiden sosioekonomisen perhetaustan (vanhempien koulutustaustan ja pääasiallisen toiminnan sekä lapsuudenperheen tulotason) yhteyttä opiskeluaikaiseen Kelan mielenterveyssyistä myönnettyyn kuntoutuspsykoterapiaan ja koulutuksena järjestettyyn ammatilliseen kuntoutukseen osallistumiseen. Lisäksi tarkasteltiin, millainen sosioekonomisen perhetaustan ja kuntoutukseen osallistumisen välinen yhteys on, kun perheeseen ja koulutukseen liittyvät tekijät on otettu huomioon.Tutkimusväestö sisälsi vuosina 1989–1991 syntyneet toisen ja korkea-asteen opiskelijat. Aineisto koostettiin Tilastokeskuksen, Opetushallituksen sekä Kelan rekisteritiedoista. Menetelminä käytettiin ristiintaulukointia ja logistista regressioanalyysiä. Tilastollisia merkitsevyyksiä tarkasteltiin laskemalla tuloksille 95 prosentin luottamusvälit.Kuntoutusmuodot kytkeytyivät selvästi sosioekonomiseen perhetaustaan. Toisella asteella koulutuksena toteutettuun ammatilliseen kuntoutukseen osallistuvista valtaosa oli miehiä ja tuli matalammasta sosioekonomisesta perhetaustasta. Kun sosioekonomisen perhetaustan yhteyttä kyseiseen kuntoutukseen osallistumiseen tarkasteltiin ottaen huomioon perheeseen ja koulutukseen liittyvät tekijät, havaittiin, että osallistuminen oli yleisempää korkeatuloisesta taustasta tulevilla, niillä, joiden vanhemmilla oli korkeakoulutus sekä niillä, joiden vanhemmat olivat työvoiman ulkopuolella. Korkea-asteella osallistuminen ammatilliseen kuntoutukseen oli harvinaista.Kuntoutuspsykoterapiaan osallistuivat korkeasta sosioekonomisesta taustasta tulevat. Suurin osa kuntoutupsykoterapiaan osallistuneista oli naisia, ja tämä kuntoutusmuoto oli yleisempi korkea-asteella. Kuntoutuspsykoterapiaan osallistuminen oli yhteydessä lapsuudenperheen korkeampaan tulotasoon, naisopiskelijoilla myös vanhempien olemiseen työelämän ulkopuolella. Opiskelijat, joiden vanhemmilla oli korkea-asteen koulutus, osallistuivat kuntoutuspsykoterapiaan useammin kuin ne, joiden vanhemmilla oli keskiasteen koulutus. Kun muut sosioekonomiset perhetaustatekijät vakioitiin, vanhempien korkea koulutus oli yhteydessä kuntoutuspsykoterapiaan osallistumiseen vain toisen asteen naisopiskelijoilla. Lisäksi lapsuudenperheen korkea tulotaso ei enää ollut yhteydessä kuntoutusterapiaan osallistumiseen korkea-asteen naisopiskelijoilla.Tulosten perusteella koulutuksena toteutettu ammatillinen kuntoutus ja kuntoutuspsykoterapia kohdentuvat sosioekonomisen taustansa suhteen erilaisille nuorille. Tulevaisuudessa olisi tärkeää selvittää tarkemmin havaittuja eroja selittäviä yksilöllisiä sekä järjestelmätason kuten kuntoutukseen ohjaamiseen liittyviä tekijöitä sekä tunnistaa keinoja puuttua tutkimuksessa havaittuihin sosioekonomisiin eroihin. Abstract Socioeconomic background and use of Kela’s rehabilitative mental health services among secondary and tertiary education students We studied how socioeconomic background (parents’ educational level, employment situation and childhood family’s income class) is related to use of mental health related rehabilitative psychotherapy and vocational rehabilitation arranged as education, provided by Finland’s Social Insurance Institution (Kela) during studies. In addition, we explored these relationships when familial background and educational factors were standardized.Research population included students in secondary and tertiary education born between 1989 and 1991. Data on population, education, rehabilitation and disability retirement was extracted from the Statistics Finland, the Finnish National Agency for Education and Kela. Methods included crosstabulation and logistic regression. Statistical significances were observed by calculating 95 percent confidence intervals.Participation in vocational rehabilitation arranged as education and rehabilitative psychotherapy was strongly associated with students’ socioeconomic background. Vocational rehabilitation was more commonly used by male students in secondary education, the majority coming from lower socioeconomic background. When the relationship between socioeconomic background and rehabilitation, standardized by familial background and educational factors, was examined, participation in rehabilitation was more common among students coming from high-income backgrounds, having higher educated parents or whose parents were outside the workforce. Vocational rehabilitation was rarely used in tertiary education.Use of rehabilitative psychotherapy was more common among students from higher socioeconomic background, the majority of participants being female and students in tertiary education. Use of rehabilitative psychotherapy was higher among students whose family belonged to the highest income quartile and female students whose parents were outside the workforce. Students whose parents had a degree from tertiary education were more likely to participate in psychotherapy than students whose parents had secondary degree. When other socioeconomic factors were taken into account, parents’ higher education was associated with participation in rehabilitation psychotherapy only among female secondary school students. In addition, family’s high income-level was no more associated with participation in rehabilitation psychotherapy among female students in tertiary education.The results show that use of vocational rehabilitation and rehabilitative psychotherapy are associated with students’ socioeconomical background. In future, it is important to study in more detail the individual and systemic factors explaining the differences observed, as well as to identify ways to address the socio-economic differences shown in the study. Keywords: mental health, students, young adults, secondary education, higher education, rehabilitative psychotherapy, vocational rehabilitation, socioeconomic background, familial background
Background Because vocational rehabilitation is a separate service from other health services, there may be interruptions at their interface. We examined whether the use of health services changes before and after rehabilitation. Methods Longitudinal individual-level register-based data was utilized on all individuals aged 15-60 living in the city of Oulu, Finland and starting vocational rehabilitation in 2014-2015 (N = 792). We compared their use of outpatient health care services in 3-month periods from 1.5 years before to 1.5 after the rehabilitation period to the total population of the same age and to the propensity score matched controls. Several socio-demographic factors and sickness and employment histories were used for matching. Results According to the preliminary results, rehabilitees had on average 1.5 visits to outpatient health care services in the 6th quarter before the start of rehabilitation, twice that of the total population. In the 4th quarter before the start of rehabilitation, the number increased to 1.8. After the rehabilitation period, the quarterly number of visits were at the same level as in the beginning of the follow-up. The biggest changes took place in the use of occupational health services. Changes were modest in public health care services. In other services changes were minimal. Compared to the propensity score matched controls, vocational rehabilitation did not appear to have an effect on the use of health care services. Conclusions The use of health care services is more common before vocational rehabilitation than after it. The effect of rehabilitation on the use of health care needs further analysis. Key messages • The pattern of the use of health care services changes in the course of vocational rehabilitation. The changes are mainly due to visits in occupational health care services. • The use of health care services is most common before rehabilitation. However, vocational rehabilitation does not appear to have an effect on the use of outpatient and inpatient health care services.
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