Joint Authority of Karkkila and Vihti for Public Health and Social Services, Occupational Health Care Unit of Nummela, Nummenselkä 2, 03100 Nummela, Finland.
Scand J Work Environ Health. 2018 Sep 1;44(5):485-495. doi: 10.5271/sjweh.3736. Epub 2018 May 2.
Objectives The aim of this study was to examine the association between co-occurring work stressors and risk of disability pension. Methods The work stressors job strain, effort-reward imbalance (ERI), and organizational injustice were measured by a survey in 2008 of 41 862 employees linked to national records of all-cause and cause-specific disability pensions until 2011. Co-occurring work stressors were examined as risk factors of work disability using Cox regression marginal models. Results Work stressors were clustered: 50.8% had no work stressors [observed-to-expected ratio (O/E)=1.2], 27.4% were exposed to one stressor (O/E=0.61-0.81), 17.7% to two stressors (O/E=0.91-1.73) and 6.4% to all three stressors (O/E=2.59). During a mean follow-up of 3.1 years, 976 disability pensions were granted. Compared to employees with no work stressors, those with (i) co-occurring strain and ERI or (ii) strain, ERI and injustice had a 1.9-2.1-fold [95% confidence interval (CI) 1.7-2.6] increased risk of disability retirement. The corresponding hazard ratios were 1.2 and 1.5 (95% CI 1.0-1.8) for strain and ERI alone. Risk of disability pension from depressive disorders was 4.4-4.7-fold (95% CI 2.4-8.0) for combinations of strain+ERI and strain+ERI+injustice, and 1.9-2.5-fold (95% CI 1.1-4.0) for strain and ERI alone. For musculoskeletal disorders, disability risk was 1.6-1.9-fold (95% CI 1.3-2.3) for strain+ERI and ERI+injustice combinations, and 1.3-fold (95% CI 1.0-1.7) for strain alone. Supplementary analyses with work stressors determined using work-unit aggregates supported these findings. Conclusions Work stressors tend to cluster in the same individuals. The highest risk of disability pension was observed among those with work stressor combinations strain+ERI or strain+ERI+injustice, rather than for those with single stressors.
本研究旨在探讨工作压力源的共同存在与残疾养老金风险之间的关系。
通过对 2008 年 41862 名员工进行的一项调查，评估了工作压力源（工作紧张、努力-回报失衡（ERI）和组织不公正），并将这些数据与所有原因和特定原因残疾养老金的国家记录相关联，直至 2011 年。使用 Cox 回归边缘模型，将共同存在的工作压力源作为工作残疾的风险因素进行了研究。
工作压力源呈聚类存在：50.8%的员工没有工作压力源（观察到的与预期的比值（O/E）=1.2），27.4%的员工仅暴露于一种压力源（O/E=0.61-0.81），17.7%的员工暴露于两种压力源（O/E=0.91-1.73），6.4%的员工暴露于三种压力源（O/E=2.59）。在平均 3.1 年的随访期间，有 976 人获得了残疾养老金。与没有工作压力源的员工相比，同时存在（i）紧张和 ERI 或（ii）紧张、ERI 和不公正的员工，残疾退休的风险增加了 1.9-2.1 倍（95%置信区间[CI]1.7-2.6）。相应的风险比为 1.2 和 1.5（95%CI 1.0-1.8），分别对应于紧张和 ERI 单独存在的情况。抑郁障碍导致残疾养老金的风险对于紧张+ERI 和紧张+ERI+不公正的组合为 4.4-4.7 倍（95%CI 2.4-8.0），对于紧张和 ERI 单独存在的情况为 1.9-2.5 倍（95%CI 1.1-4.0）。对于肌肉骨骼疾病，紧张+ERI 和 ERI+不公正组合导致残疾风险为 1.6-1.9 倍（95%CI 1.3-2.3），紧张单独存在的情况为 1.3 倍（95%CI 1.0-1.7）。使用工作单位汇总数据确定工作压力源的补充分析支持了这些发现。
工作压力源往往在同一人群中聚集存在。残疾养老金风险最高的是那些同时存在工作压力源紧张+ERI 或紧张+ERI+不公正的人群，而不是那些仅存在单一压力源的人群。
