从长期病假到残疾退休：芬兰工作年龄人群中的诊断和职业类别差异。
From long-term sickness absence to disability retirement: diagnostic and occupational class differences within the working-age Finnish population.
机构信息
Department of Social Research, University of Turku, Turku, Finland.
The Social Insurance Institution of Finland, Helsinki, Finland.
出版信息
BMC Public Health. 2020 Jul 8;20(1):1078. doi: 10.1186/s12889-020-09158-7.
BACKGROUND
It is well documented that sickness absence is strongly associated with disability retirement. A long-term sickness absence (LTSA) in particular increases the risk of disability retirement, but little is known about the variation of this risk across diagnostic causes. Further, as occupational classes differ in their diagnostic profiles, it is likely that the role of diagnosis in the pathway from LTSA to disability retirement varies between occupational classes. We examined how LTSA of different diagnostic causes predicts all-cause disability retirement and disability retirement due to the same diagnostic group or due to some other diagnostic group than that which caused the LTSA spell in different occupational classes.
METHODS
Cox proportional hazards models were used to analyse a 70% random sample of all employed Finns aged 25-62 Finns in 2006 (N = 1,458,288). Disability retirement was followed from 2007 to 2014. The risk of disability retirement was compared between occupational classes with at least one LTSA spell due to musculoskeletal diseases, mental disorders, respiratory diseases, or circulatory diseases and those who had no LTSA spells due to these diagnostic groups during 2005.
RESULTS
Those who had LTSA due to musculoskeletal diseases or mental disorders transferred more often to disability retirement due to same diagnostic group, whereas those who had LTSA due to respiratory or circulatory diseases transferred more often to disability retirement due to some other diagnostic group. The largest occupational class differences in all-cause disability retirement were found among those with LTSA due to mental disorders. For men, the hazard ratios (HR) varied from HR 5.70 (95% confidence interval (CI) 5.00-6.52) in upper non-manual employees to 2.70 (95% CI 2.50-2.92) in manual workers. For women, the corresponding HRs were 3.74 (95% CI 3.37-4.14) in upper non-manual employees and 2.32 (95% 2.17-2.50) in manual workers.
CONCLUSIONS
The association between LTSA and disability retirement varies between diagnostic groups, and the strength of this association further depends on the person's occupational class and gender.
背景
大量文献证明，病假与提前退休之间存在很强的关联。长期病假（LTSA）尤其会增加提前退休的风险，但对于这种风险在不同诊断病因中的变化知之甚少。此外，由于职业类别在诊断特征上存在差异，因此 LTSA 与提前退休之间的关系在不同职业类别中可能因诊断病因的不同而有所不同。我们研究了不同诊断病因的 LTSA 如何预测所有原因的提前退休以及由于同一诊断群体或由于与导致 LTSA 发作的诊断群体不同的其他诊断群体而导致的提前退休，在不同职业类别中。
方法
使用 Cox 比例风险模型分析了 2006 年芬兰所有 25-62 岁就业人群的 70%随机样本（N=1,458,288）。从 2007 年到 2014 年，我们对提前退休情况进行了随访。将至少有一次因肌肉骨骼疾病、精神障碍、呼吸疾病或循环系统疾病而导致 LTSA 的职业类别与在 2005 年期间没有因这些诊断组而发生任何 LTSA 发作的职业类别进行了比较。
结果
那些因肌肉骨骼疾病或精神障碍而导致 LTSA 的人更有可能因同一诊断组而转为提前退休，而那些因呼吸或循环系统疾病而导致 LTSA 的人更有可能因其他诊断组而转为提前退休。在所有原因的提前退休中，最大的职业类别差异发生在那些因精神障碍而导致 LTSA 的人当中。对于男性，风险比（HR）从非体力劳动者的 HR5.70（95%置信区间（CI）5.00-6.52）到体力劳动者的 HR2.70（95%CI2.50-2.92）不等。对于女性，相应的 HR 分别是非体力劳动者的 HR3.74（95% CI 3.37-4.14）和体力劳动者的 HR2.32（95%CI2.17-2.50）。
结论
LTSA 与提前退休之间的关联因诊断病因而异，这种关联的强度还取决于个人的职业类别和性别。
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