Health At A Glance

본 과제는 노동부 국제협상팀에서 제112차 경제협력개발기구(OECD) 고용노동사회위원회(ILSAC) 정례회의 참석을 요청해 옴에 따라 회의의 주요 의제 자료인 ‘Sickness, Disability and Work : Breaking the Barriers, Vol. 2 호주, 룩셈부르크, 스페인, 영국’의 국가사례들을 요약 정리한 것이다. OECD의 분석에 따르면 최근 노동시장의 재구조화가 이루어지면서 핵심 일자리가 축소되고 노동 불안정성이 증가되는 부정적인 변화가 일어나고 있다고 한다. 이러한 변화는 ‘틈새직종(niche jobs)’의 상실과 엄격해진 근로조건, 근로 압력으로 인한 건강손상과 스트레스 증가, 병으로 인한 결근 휴직(sickness absence)의 증가 등의 2가지 경로를 통해 장애인구에 영향을 미친다고 한다.. 이러한 문제는 노동시장의 문제를 의료적인 관점으로 환원하는 ‘medicalization of labor market problems’라는 새로운 현상을 야기시키고 있다. 즉 평균적인 건강 상태는 더욱 향상되고 있다고 보고되나 왜 더 많은 생산가능 인구들이 노동시장을 떠나 건강과 관련한 소득 보장에 의존하는가하는 문제에 직면시키고 있다 하는데, 이에 대해 호주, 룩셈부르크, 스페인, 영국의 장애보상체계와 고용정책을 면밀히 분석하여 비교 분석함으로써 시사점을 제시하고 있다. 결국 병으로 인한 결근, 휴직(sickness absence)의 증가나 장애보상수급은 장애인들의 객관적 혹은 주관적 건강지표와 무관하며, 오히려 국가의 장애정책과 경제적 사회현상에 좌우되는 사안이라고 주장하고 있다. 이와 관련하여 한국의 장애보상체계에 대한 검토와 향후 장애연금 도입 전망에 대한 의견을 제시하였다.

[OECD 2007 장애정책 리뷰] Sickness, Disability and Work : Breaking the Barriers

Objectives To determine, using longitudinal analyses, if retirement is followed by a change in the risk of incident chronic diseases, depressive symptoms, and fatigue. Design Prospective study with repeat measures from 7 years before to 7 years after retirement. Setting Large French occupational cohort (the GAZEL study), 1989-2007. Participants 11 246 men and 2858 women. Main outcome measures Respiratory disease, diabetes, coronary heart disease and stroke, mental fatigue, and physical fatigue, measured annually by self report over the 15 year observation period; depressive symptoms measured at four time points. Results The average number of repeat measurements per participant was 12.1. Repeated measures logistic regression with generalised estimating equations showed that the cumulative prevalence of self reported respiratory disease, diabetes, and coronary heart disease and stroke increased with age, with no break in the trend around retirement. In contrast, retirement was associated with a substantial decrease in the prevalence of both mental fatigue (odds ratio for fatigue one year after versus one year before retirement 0.19, 95% confidence interval 0.18 to 0.21) and physical fatigue (0.27, 0.26 to 0.30). A major decrease was also observed in depressive symptoms (0.60, 0.53 to 0.67). The decrease in fatigue around retirement was more pronounced among people with a chronic disease before retirement. Conclusions Longitudinal modelling of repeat data showed that retirement did not change the risk of major chronic diseases but was associated with a substantial reduction in mental and physical fatigue and depressive symptoms, particularly among people with chronic diseases.

Effects of retirement on major chronic conditions and fatigue: the french gazel occupational cohort study

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. 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. 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. 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.

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From long-term sickness absence to disability retirement: diagnostic and occupational class differences within the working-age Finnish population

Work disability may originate early during work history and involve sickness absences (SA) and eventually permanent disability. We studied this process over 15 years. Questionnaire data collected in 1981 on health, working conditions, and lifestyle of Finnish municipal employees aged 44–58 years (n = 6257) were linked with registers on SA (≥10 workdays), disability pension, and death from the period 1986–1995. Trajectory analysis was used to assess development in SA (days/year) over 5 years (1981–1985). We analyzed determinants of the trajectories with multinomial regression, while trajectory membership was used as a predictor of disability pension (DP) during the subsequent 10 years in survival analysis. Three SA trajectories emerged: increasing (women: 6.8%; men: 10.2%), moderate (21.2%; 22.7%), and low. In a mutually adjusted model, the increasing trajectory in women was associated with baseline musculoskeletal (MSD), mental and respiratory disorders, injuries, obesity, sleep problems, and low exercise (effect sizes OR > 2), and in men with MSD, sleep problems, smoking, low exercise, and non-satisfaction with management. The moderate trajectory associated with MSD, ‘other somatic disorders’, sleep problems, and awkward work postures in both genders; in women, also overweight, cardiovascular and respiratory morbidity, and (inversely) knowledge-intensive work, and in men, smoking and mental disorders were thus associated. Ten-year risks of DP contrasting increasing vs. low SA were more than 10-fold in both genders and contrasting moderate vs. low SA 3-fold in women and 2-fold in men. These findings emphasize the need for early identification of workers with short-term problems of work ability and interventions regarding lifestyle, health, and working conditions, to help prevent permanent disability.

https://www.mdpi.com/1660-4601/18/5/2614/pdf

Process of Work Disability: From Determinants of Sickness Absence Trajectories to Disability Retirement in A Long-Term Follow-Up of Municipal Employees.

There is little knowledge on socioeconomic differences in use of health care organized by different care schemes and on exclusive and concurrent use of health care at different schemes in different socioeconomic groups. In Finland, public, occupational and private schemes offer parallel outpatient primary health care services. Each scheme mainly reaches different population groups because of differences in availability, costs and gatekeeping. This study aimed to analyse how the probability of using health care organized by the three schemes differed by socioeconomic status in a working-age population. Individual-level register-based data on use of public, occupational and private outpatient primary health care during 2013 as well as data on sociodemographic covariates were linked for the total population aged 25-64 of the city of Oulu, Finland. Data were analysed with descriptive methods and multinomial logistic regression models. Those in the study population most often used only occupational care or only public care, or did not use any of the studied health care schemes at all. The lower the socioeconomic status, the higher was the probability of not using care or using only public care. The higher the socioeconomic status, the higher was the probability of using occupational care-either only occupational care or occupational care in combination with private care. Education, occupational class and income were all associated with care use also when adjusted for sociodemographic covariates and chronic disease, but income proved to be the strongest predictor of the three. The results reflect the design of the Finnish health care system, with a strong occupational health care scheme for the employed population contributing to inequality in use of health care and potentially to health inequality between socioeconomic groups.

Socioeconomic differences in use of public, occupational and private health care: A register-linkage study of a working-age population in Finland.

Aims: Examining the non-medical determinants of applying for and being awarded disability pension is important for assessing the functionality of the disability pension system. We examined how demographic and socioeconomic factors as well as factors related to the disability process associate with the probability of applying for disability pension and the probability of applicants being awarded pension in 2009 and 2014. Methods: 70% random samples of Finnish non-retired residents aged 18-64 in 2009 (n = 2,076,881) and in 2014 (n = 2,097,790) were analysed with logistic regression analysis. The application rates were 0.9% in 2009 and 0.7% in 2014, and the rates of awarded pensions were 80.6% in 2009 and 72.2% in 2014. Results: Being an upper-level non-manual employee and having more employment during the preceding four calendar years decreased the odds of applying for disability pension but increased the odds of being awarded one. Older age increased the odds of both applying for and being awarded pension. Compared to applications based on mental disorders, those applying due to neoplasms and diseases of the circulatory system had increased odds of being awarded pension whereas those applying due to musculoskeletal diseases or injuries had decreased odds. Only minor temporal changes were found in the determinants of applying for or being awarded disability pension. Conclusions: With a greater probability of disability pension applications but also a lower probability of being awarded pension, the occupational disability process involves a comprehensive disadvantage for lower socioeconomic status groups.

Determinants of disability pension applications and awarded disability pensions in Finland, 2009 and 2014:

Purpose: To identify different income trajectories after a rejected disability pension application and to analyze socio-demographic and disability process related determinants of these trajectories...

Sources of income following a rejected disability pension application: a sequence analysis study.

Socioeconomic differences in sickness absence are well known, but previous studies have tended to focus on wage earners only. This study examined incidence and length of sickness absence comparing the employee groups of upper and lower non-manual employees and manual workers, but also entrepreneurs, the unemployed and other non-wage-earners. The study utilized register data on a nationally representative 70% sample of Finns aged 25–62 at the end of year 2012 (N = 1,615,352). Sickness absence spells compensated by sickness allowance and initiated during 2013 were retrieved from the register of the Social Insurance Institution of Finland (SIIF) and followed until the end of each episode and linked to socio-demographic covariates collected from the registers of the SIIF and of Statistics Finland. Zero-inflated negative binomial regression was used in multivariate models. After adjusting for age, marital status, region and income, there were clear differences in the occurrence and length of sickness absence across socioeconomic groups. Compared to upper non-manual employees, lower non-manual employees and especially manual workers had higher cumulative annual incidence of sickness absence among both men and women, but the entrepreneurs, the unemployed and other non-wage-earners had a clearly higher expected number of sickness absence days. Results varied by diagnostic group. The results highlight the importance of different types of preventive measures for reducing the occurrence of sickness absence and for preventing prolongations of sickness absence spells in different socioeconomic groups.

Jenni Blomgren

Papers

Socioeconomic differences in use of public, occupational and private health care: A register-linkage study of a working-age population in Finland.

From long-term sickness absence to disability retirement: diagnostic and occupational class differences within the working-age Finnish population

Determinants of disability pension applications and awarded disability pensions in Finland, 2009 and 2014:

Sources of income following a rejected disability pension application: a sequence analysis study.

Incidence and Length of Sickness Absence among Hierarchical Occupational Classes and Non-Wage-Earners: A Register Study of 1.6 Million Finns.