Department of Public Health, University of Helsinki, P. O. Box 20, FIN-00014, Helsinki, Finland.
Finnish Institute of Occupational Health, Helsinki and Turku, Finland.
BMC Public Health. 2019 Oct 30;19(1):1418. doi: 10.1186/s12889-019-7753-6.
Early exit from paid employment is a notable public health and societal challenge. Previous research has largely focused on the relationships among variables instead of the relationships among individuals with different work participation history. Person-oriented methods enable to identify latent groups of individuals who are likely to follow similar development in their work participation over time. We thus aimed to identify work participation trajectories during early and midlife careers and their social determinants using large nationally representative data comprising over 1 million initially employed individuals and a 10-year follow-up for their work participation. A further aim was to determine the cumulative incidence of sickness absence due to key diagnostic groups, mental disorders and musculoskeletal diseases within the trajectories.
Young (25-38 years at baseline, n = 495,663) and midlife (39-52 years at baseline, n = 603,085) Finnish people, all working in 2004, were followed up through 2013, with registers of the Social Insurance Institution, and the Statistics Finland. The registers provided data for work participation and its determinants, as well as for computing the cumulative incidence of sickness absence. Latent class growth analysis was used to identify trajectories.
Three distinctive trajectories were identified: temporary exit, permanent exit, and continuously employed people. As compared to the other trajectories, those belonging to the permanent exit trajectory were more likely men, manual workers and had a lower income. The cumulative incidence of sickness absence due to mental disorders was highest in the permanent exit trajectory group. For musculoskeletal diseases, the cumulative incidence of sickness absence increased in the permanent exit trajectory mainly in the older age groups.
Distinct group-based trajectories of early work exit can be identified in a representative cohort of initially employed people. Focusing on the determinants of premature exit and early intervention to tackle increasing sickness absence may promote work participation particularly in the most vulnerable groups.
提前退出有薪工作是一个显著的公共卫生和社会挑战。先前的研究主要集中在变量之间的关系上，而不是具有不同工作参与历史的个体之间的关系。面向个体的方法可以识别出具有相似工作参与发展趋势的潜在个体群体。因此，我们旨在使用大型全国代表性数据，对超过 100 万最初就业的个体及其 10 年的工作参与情况进行随访，确定早中年职业期间的工作参与轨迹及其社会决定因素。进一步的目的是确定轨迹内由于主要诊断组、精神障碍和肌肉骨骼疾病导致的病假累积发生率。
在基线时年龄为 25-38 岁（n=495663）和中年（39-52 岁，n=603085）的芬兰年轻人和中年人，均于 2004 年就业，通过社会保险机构和芬兰统计局的登记数据进行随访，直至 2013 年。登记数据提供了工作参与及其决定因素的数据，以及计算病假累积发生率的数据。采用潜在类别增长分析来识别轨迹。
确定了三种独特的轨迹：临时退出、永久退出和持续就业的人。与其他轨迹相比，属于永久退出轨迹的人更可能是男性、体力劳动者，收入较低。永久退出轨迹组中精神障碍导致的病假累积发生率最高。对于肌肉骨骼疾病，永久退出轨迹组中的病假累积发生率在年龄较大的群体中增加。
在代表性的初始就业队列中，可以确定早期工作退出的基于群体的不同轨迹。关注过早退出的决定因素和早期干预以应对不断增加的病假缺勤率，可能会促进工作参与，特别是在最脆弱的群体中。
