Götz Simon, Wahrendorf Morten, Dragano Nico
Centre for Health and Society, Institut für Medizinische Soziologie, Universitätsklinikum Düsseldorf, Dusseldorf, Deutschland.
Gesundheitswesen. 2022 Feb;84(2):130-138. doi: 10.1055/a-1335-4339. Epub 2021 Apr 1.
Employees in a low socio-economic position (SEP) are more likely to leave the labour market after medical rehabilitation for health reasons than those in a better social position. So far, almost nothing is known about whether certain types of rehabilitative care can reduce this inequality in rehabilitation success. This paper examines whether certain types of care modify the SEP's influence on return-to-work (RTW).
The study is based on administrative data from the German statutory pension insurance on 266,413 medical rehabilitations of 253,311 persons fully integrated into working life. Poisson regression analyses were used to check whether there was a correlation between SEP (income, education, occupational position) and the probability of RTW in the year following the measure, and whether this correlation was lower in follow-up treatment (AHB), inpatient treatment or treatment with subsequent graded RTW compared to rehabilitation that did not meet these characteristics.
People with a low income, education or occupational position were at increased risk of incomplete return to work after medical rehabilitation. This correlation was comparatively lower for all 3 SEP indicators when the return to work was gradual. In the case of AHB and inpatient rehabilitation, this only applied to income.
Socio-economically disadvantaged population groups are comparatively more likely not to return fully to work after medical rehabilitation. These inequalities are less pronounced for certain types of rehabilitative care. This tends to be the case with an active structuring role of the care system. However, there is a need for further research on the modification of effects by the type of treatment. This should be further investigated using data collected for this purpose to exclude selection effects.
社会经济地位较低的员工因健康原因接受医学康复后，比社会地位较好的员工更有可能离开劳动力市场。到目前为止，几乎没有人知道某些类型的康复护理是否能减少康复成功率方面的这种不平等。本文研究某些类型的护理是否会改变社会经济地位对重返工作岗位的影响。
该研究基于德国法定养老保险的行政数据，涉及253,311名完全融入工作生活的人员的266,413次医学康复。采用泊松回归分析来检验社会经济地位（收入、教育程度、职业地位）与康复措施后一年重返工作岗位的概率之间是否存在相关性，以及与不符合这些特征的康复相比，后续治疗（AHB）、住院治疗或后续逐步重返工作岗位的治疗中这种相关性是否更低。
收入、教育程度或职业地位较低的人在医学康复后不完全重返工作岗位的风险增加。当重返工作是逐步进行时，所有三个社会经济地位指标的这种相关性相对较低。在AHB和住院康复的情况下，这仅适用于收入。
社会经济处于不利地位的人群在医学康复后相对更有可能无法完全重返工作岗位。对于某些类型的康复护理，这些不平等现象不太明显。在护理系统发挥积极构建作用的情况下往往如此。然而，需要进一步研究治疗类型对效果的改变。应该使用为此目的收集的数据进一步对此进行调查，以排除选择效应。
