The Complexity of Decreased Work Ability: Individuals’ Perceptions of Factors That Affect Returning to Work after Sickness Absence

Much of what has been written about decreased work ability is based on quantitative studies and has been written from the perspective of professionals, service providers or authorities. In our qualitative study, we sought to understand how affected individuals themselves perceive and experience the multifaceted factors that are related to their decreased work ability. Sixteen individuals in Finland with musculoskeletal diseases (MSD) participated in semi-structured interviews. The participants were potential clients of a multi-professional service pilot model, the TOIKE Work Ability Centre. Narrative and thematic analyses were utilised. The study found that individuals with decreased work ability have differing perspectives towards returning to work and often complex life situations. Five distinctive groups were identified based on self-assessed health, work ability and orientation towards work or pension: (1) the Successful; (2) the Persevering; (3) the Forward-looking; (4) the Stuck; and (5) the Pension-oriented. Health problems, unemployment, age discrimination, financial difficulties and skill deficits were the major challenges of the interviewees. Furthermore, they perceived the service and benefit systems as complicated. The TOIKE service proved useful to some of them. However, many had not utilised it due to a lack of understanding of its purpose. Identifying the distinctive groups and their needs may improve interventions. Ultimately, this may help to achieve Target 8.5 of the UN Sustainable Development Goals, which advocates the right to employment for all ages and for those with disabilities.

Stability of health-related quality of life and morbidity burden from 18 months after diagnosis of prostate cancer: results of a UK-wide population-based outcome cohort

Objective To evaluate the dynamic nature of self-reported health-related quality of life (HRQL) and morbidity burden in men diagnosed with prostate cancer, we performed a follow-up study of the Life After Prostate Cancer Diagnosis (LAPCD) study cohort 12 months after initial survey. Methods The LAPCD study collected information from 35,823 men across the UK who were 18–42 months post-diagnosis of prostate cancer. Men who were still alive 12 months later were resurveyed. Generic HRQL (EQ-5D-5L plus self-assessed health rating) and prostate cancer-specific outcomes (EPIC-26) were assessed. Treatment(s) received was self-reported. Previously defined clinically meaningful differences were used to evaluate changes in outcomes over time. Results A total of 28,450 men across all disease stages completed follow-up surveys (85.8% response). Of the 21,700 included in this study, 89.7% reported no additional treatments since the first survey. This group experienced stable urinary and bowel outcomes, with good function for most men at both time points. On-going poor (but stable) urinary issues were associated with previous surgery. Sexual function scores remained low (mean: 26.8/100). Self-assessed health ratings were stable over time. The largest declines in HRQL and functional outcomes were experienced by men reporting their first active treatment between surveys. Discussion The results suggest stability of HRQL and most specific morbidities by 18–42 months for men who report no further treatment in the subsequent 12 months. This is reassuring for those with good function and HRQL but re-enforces the need for early intervention and support for men who experience poor outcomes.

Mismatch Between Physical Health and Job Demands among Older Workers by Full Retirement Age

Gradual increases to the Social Security full retirement age (FRA) from 65 to 67 were justified by improvements in the health of the older population and a general shift toward less physically demanding jobs. These two trends have been studied independently, but it is important to consider the agreement of these two factors—job demands and health—to understand whether those expected to work longer to receive full benefits have compatible health and job characteristics to do so. Using data from the 1992-2018 waves of the Health and Retirement Study, I observe 19,383 working individuals with FRA ranging from 65-67 while they are approaching retirement (ages 51-60). I compare the prevalence of person-work mismatch—defined by the co-occurrence of physical health conditions and self-reported physical job demands—by FRA. I find that individuals with an older FRA are less likely to be employed in physically demanding jobs while having arthritis. However, they are more likely to be employed in physically demanding jobs while having pain or fair/poor self-assessed health and are more likely to be employed in jobs requiring frequent stooping, kneeling, or crouching while simultaneously having difficulty with these activities. The co-occurrence of physically demanding work while having multiple mobility limitations has remained stable across the FRA cohorts. These findings indicate that older workers expected to work longer to receive full benefits have not experienced substantial improvements in the compatibility between their physical health and job demands that would facilitate working longer, and by some measures compatibility has declined.

Relationship between self-assessed health and life satisfaction in older adults: the moderating role of ego-resiliency

The present study was focused on the relationship between the subjective assessment of physical health and satisfaction with life (SWL) in older adults. The relationship itself was found in previous studies, but we postulated that it is moderated by ego-resiliency (ER). To verify this hypothesis, 124 Polish participants aged between 60 and 89 (mean = 71.72, standard deviation = 7.08) were asked to complete questionnaire measures of: self-assessed health (SAH; measured with seven items from the World Health Organization Quality of Life WHOQOL-BREF assessment), SWL (measured with the Satisfaction with Life Scale) and ER (measured with the Ego-Resiliency Scale ER89). The results confirmed the moderating role of ER by showing that the relationship between SAH and SWL was statistically significant only when ER was high or moderate, while there was no relationship for participants with low ER. To interpret these results, we postulate that ego-resilient older adults are more accurate in the assessment of health, i.e. their SAH reflects the objective condition more closely, which strengthens the relationship between SAH and wellbeing. ER is thus conceived as an important psychological resource that promotes the accuracy of SAH and, consequently, makes it a more robust predictor of SWL. We hypothesise that this is based on the positive relationship between ER and wisdom in older adults.

Does Self-Assessed Health Reflect the True Health State?

Self-assessed health (SAH) is a widely used tool to estimate population health. However, the debate continues as to what exactly this ubiquitous measure of social science research means for policy conclusions. This study is aimed at understanding the tenability of the construct of SAH by simultaneously modelling SAH and clinical morbidity. Using data from 17 waves (2001–2017) of the Russian Longitudinal Monitoring Survey, which captures repeated response for SAH and frequently updates information on clinical morbidity, we operationalise a recursive semi-ordered probit model. Our approach allows for the estimation of the distributional effect of clinical morbidity on perceived health. This study establishes the superiority of inferences from the recursive model. We illustrated the model use for examining the endogeneity problem of perceived health for SAH, contributing to population health research and public policy development, in particular, towards the organisation of health systems.

An Objective Metric of Individual Health And Aging For Population Surveys

Background: Generalized, biomarker-based metrics of health status have numerous applications in fields ranging from sociology and economics to clinical research. We recently proposed a novel metric of health status based on physiological dysregulation measured as a Mahalanobis distance (DM) among clinical biomarkers. While DM was not particularly sensitive to the choice of biomarkers, it required calibration when used in different populations, making it difficult to compare findings across studies. To facilitate its use, here we aimed to identify and validate a standard version of DM that would be highly stable across populations, while using fewer biomarkers drawn exclusively from common blood panels. Methods: Using three datasets, we identified nine-biomarker (DM9) and seventeen-biomarker (DM17) versions of DM, choosing biomarkers based on their consistent levels across populations. We validated them in a fourth dataset. We assessed DM stability within and across populations by looking at correlations of DM versions calibrated using different populations or their demographic subsets. We used regression models to compare these standard DM versions to allostatic load and self-assessed health in their association with diverse health outcomes. Results: DM9 and DM17 were highly stable across population subsets (mean r = 0.96 and 0.95, respectively) and across populations (mean r = 0.94 for both). Performance predicting health outcomes was competitive with allostatic load and self-assessed health, though performance of these markers were somewhat variable for different health outcomes. Conclusions: Both DM9 and DM17 are highly stable within and across populations, supporting their use as objective metrics of health status. DM17 performs slightly better than DM9 and at least as well as other comparable metrics, but requires more biomarkers. The metrics we propose here are easy to measure with data that are available in a wide array of panel, cohort, and clinical studies.

Socioeconomic inequalities in health: the role of daily hassles and the importance of health

A low socioeconomic position (SEP) adversely affects health outcomes and is associated with a lower perceived importance of health. It has been suggested that people with a low SEP disproportionately face daily hassles, as a result of which health may be perceived as less important for those with a low SEP compared to those with a high SEP. A lower perceived importance of health likely influences health-related behaviours that affect health outcomes. This study examines whether socioeconomic inequalities in self-assessed health are mediated by daily hassles and/or the perceived importance of health, and whether there is sequential mediation of daily hassles and perceived importance of health. A cross-sectional survey was conducted in 2019 among N = 1,334 Dutch adults. Participants rated the extent of eleven commonly experienced daily hassles (e.g., financial hassles, legal issues), and indicated the perceived importance of two health-related domains (not being ill, living a long life). Inequalities in self-assessed health according to SEP (indicated by income and education) were examined using structural equation modelling, with daily hassles and perceived importance of not being ill or living long a life either as single or sequential mediators. Daily hassles and perceived importance of health individually mediated the relationship between SEP and self-assessed health, but importance of health did not mediate the association between by daily hassles self-assessed health. Socioeconomic inequalities in self-assessed health were explained by the experience of daily hassles, and by differences in the perceived importance of health individually, but the perceived importance of health did not explain the influence of the experience of daily hassles. Addressing the challenging circumstances (e.g., financial or housing hassles) associated with a low SEP, may contribute to improving self-assessed health. Further research should examine how daily hassles affect health. Key messages Daily hassles and the perceived importance of health mediated the relationship between socioeconomic position and health. There was no association between daily hassles and the perceived importance of health.

The Gender Life Satisfaction/Depression Paradox

According to the gender life satisfaction/depression paradox women are significantly more likely to report higher levels of life satisfaction than men after controlling for all relevant socio-demographic factors, but also significantly more likely to declare they are depressed. We find that the paradox holds in the cross-country sample of the European Social Survey and is stable across age, education, self-assessed health, macroregion and survey round splits. We find support for the affect intensity rationale showing that women are relatively more affected in their satisfaction about life by the good or bad events or achievements occurring during their existence and less resilient (less likely to revert to their standard levels of happiness after a shock). We as well discuss biological, genetic, cultural, personality rationales advocated in the literature that can explain our findings.

Socioeconomic inequalities in health behaviors: exploring mediation pathways through material conditions and time orientation

Background Socioeconomic inequalities in health behaviors have been attributed to both structural and individual factors, but untangling the complex, dynamic pathways through which these factors influence inequalities requires more empirical research. This study examined whether and how two factors, material conditions and time orientation, sequentially impact socioeconomic inequalities in health behaviors. Methods Dutch adults 25 and older self-reported highest attained educational level, a measure of socioeconomic position (SEP); material conditions (financial strain, housing tenure, income); time orientation; health behaviors including smoking and sports participation; and health behavior-related outcomes including body mass index (BMI) and self-assessed health in three surveys (2004, 2011, 2014) of the longitudinal GLOBE (Dutch acronym for “Health and Living Conditions of the Population of Eindhoven and surroundings”) study. Two hypothesized pathways were investigated during a ten-year time period using sequential mediation analysis, an approach that enabled correct temporal ordering and control for confounders such as baseline health behavior. Results Educational level was negatively associated with BMI, positively associated with sports participation and self-assessed health, and not associated with smoking in the mediation models. For smoking, sports participation, and self-assessed health, a pathway from educational level to the outcome mediated by time orientation followed by material conditions was observed. Conclusions Time orientation followed by material conditions may play a role in determining socioeconomic inequalities in certain health behavior-related outcomes, providing empirical support for the interplay between structural and individual factors in socioeconomic inequalities in health behavior. Smoking may be determined by prior smoking behavior regardless of SEP, potentially due to its addictive nature. While intervening on time orientation in adulthood may be challenging, the results from this study suggest that policy interventions targeted at material conditions may be more effective in reducing socioeconomic inequalities in certain health behaviors when they account for time orientation.

The measurement of health inequalities: does status matter?

Approaches to measuring health inequalities are often problematic because they use methods that are inappropriate for categorical data. In this paper we focus on “pure” or univariate health inequality (rather than income-related or bivariate health inequality) and use a concept of individual status that allows a consistent treatment of such data. We take alternative versions of the status concept and apply methods for treating categorical data to examine self-assessed health inequality for the countries included in the World Health Survey. We also use regression analysis on the apparent determinants of these health inequality estimates. We show that the status concept that is used will affect health-inequality rankings across countries and the way health inequality is related to countries’ median health, income, demographics and governance.