Socioeconomic Differences in Occupational Health Service Utilization and Sickness Absence Due to Mental Disorders: A Register-Based Retrospective Cohort Study

Abstract

Occupational health service (OHS) is the main provider of primary care services for the working population in Finland. We investigated whether socioeconomic differences in the utilization of OHS predict sickness absence (SA) due to mental disorders. We used register linkage data covering the employees of the City of Helsinki aged 18–34 years (N = 6545) and 35–54 years (N = 15,296) from 2009 to 2014. The outcome was medically certified long-term (over 11 days) SA due to mental disorders. Cox regression analyses were performed to obtain hazard ratios (HR) and their 95% confidence intervals (CIs). Employees with low socioeconomic position (SEP) used OHS more frequently. The number of OHS visits independently predicted SA due to mental disorders. HRs were 1.59 (95% CI 1.35, 1.86) for those with frequent visits and 1.73 (95% CI 1.30, 2.29) for those with a clustered visit pattern among 18–34 year old employees; and 1.46 (95% CI 1.18, 1.81) and 1.41 (95% CI 1.14, 1.74) among 35–54 year old employees, respectively. In both age groups, lower education and routine non-manual worker position indicated the highest probability of SA. Low SEP predicts both high OHS utilization and subsequent SA due to mental disorders. Medical records may be used to accurately predict future SA, and the results indicate that preventive measures should be targeted particularly to younger employees with lower SEP.

Frequent attenders of three outpatient health care schemes in Finland: characteristics and association with long-term sickness absences, 2016–2018

“…In the OHS scheme, frequent attendance was most common among lower non-manual and manual employees. Among employees, those with a lower socioeconomic position are most likely to use OHS, especially when adjusting for age and chronic disease [ 17 , 26 ]. This generally higher attendance rate may be reflected in the higher proportion of FAs as well.…”

“…Indeed, frequent health care attendance tends to accumulate in distinct demographic and more vulnerable socioeconomic groups. FAs are more often women [ 6 , 9 , 11 , 15 , 16 ], older [ 5 , 6 , 11 , 12 , 15 ], without work [ 9 , 14 , 16 ], and have a lower occupational class [ 12 , 16 – 18 ], and lower education [ 8 , 14 , 17 – 19 ]. Lower socioeconomic status may be associated with frequent attendance in primary care or general practice settings especially [ 8 , 9 , 16 , 18 , 19 ].…”

“…Lower socioeconomic status may be associated with frequent attendance in primary care or general practice settings especially [ 8 , 9 , 16 , 18 , 19 ]. However, also among the employed, working in a manual field can increase the probability of frequent attendance of occupational health services (OHS) [ 3 , 4 , 17 ].…”

“…A study by Bergh et al [ 7 ] showed similar results in Norwegian primary health care, as FAs had a three-fold probability of long-term sickness absence during a five-year follow-up compared to other attenders. In a study by Harkko et al [ 17 ] on Helsinki city employees, a higher number of OHS visits predicted a higher risk for long sick leaves. As long sickness absence spells are a major predictor of permanent disability [ 21 – 24 ], understanding the association between frequent attendance and sickness absence is crucial.…”

“…Frequent attenders have mainly been studied in primary care and general practice settings, and to a lesser extent in OHS [ 12 , 17 , 20 , 25 ]. There is a clear lack of studies comparing health care schemes.…”