Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany.
Senior Professorship on Work Stress Research, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany.
Eur J Public Health. 2020 Jun 1;30(3):498-503. doi: 10.1093/eurpub/ckaa024.
Given limited knowledge on the extent of social inequalities in longer-term work ability of people with a chronic disease, this study analyzes social inequalities of three consecutive indicators of work ability following medical rehabilitation in a large sample of insured employees.
Based on data from the German statutory pension insurance, a representative 20% random sample of all employed persons undergoing medical rehabilitation between 2006 and 2008 was included in a longitudinal analysis (n=219 584 persons). Three measures of consecutive work-related outcomes (physicians' assessment of work ability at discharge; return to work in the year thereafter; disability pension during follow-up) and socioeconomic position (SEP) (education, occupational position and income) were assessed. Adjusted relative risks (RRs) for each outcome were calculated according to SEP, applying Poisson regression analysis.
The measures of SEP were associated with all three outcomes of work ability in the fully adjusted models. Relatively strongest relationships were observed for education as SEP measure, and they were particularly pronounced for 'low work ability' (RR=2.38 for lower secondary education compared to tertiary education; 95% CI: 2.26-2.51). Based on average marginal effects, absolute differences of work ability by SEP indicate a socially graded pattern, with only few exceptions.
Despite Germany's universal access to medical and vocational rehabilitation social inequalities in longer-term work ability following chronic disease persist, thus calling for targeted programmes of prevention and occupational health promotion.
鉴于对慢性病患者长期工作能力的社会不平等程度的了解有限，本研究分析了医疗保险员工中经过医学康复后三个连续工作能力指标的社会不平等。
基于德国法定养老金保险的数据，在 2006 年至 2008 年期间接受医学康复的所有受雇人员中，选择了一个具有代表性的 20%随机样本，纳入了一项纵向分析（n=219584 人）。评估了三个连续与工作相关的结果指标（医生在出院时评估的工作能力；此后一年内重返工作岗位；随访期间的残疾养老金）和社会经济地位（SEP）（教育程度、职业地位和收入）。根据 SEP，应用泊松回归分析，计算每个结果的调整相对风险（RR）。
在完全调整的模型中，SEP 的测量值与所有三个工作能力结果均相关。以教育作为 SEP 衡量标准，观察到的关系最强，对于“低工作能力”尤为明显（与高等教育相比，中学以下教育的 RR=2.38；95%CI：2.26-2.51）。基于平均边际效应，SEP 指示的工作能力的绝对差异表明存在社会等级模式，仅有少数例外。
尽管德国普遍获得了医疗和职业康复，但慢性病患者长期工作能力的社会不平等仍然存在，因此需要有针对性的预防和职业健康促进计划。
