Disability retirement causes a significant burden on the society and affects the well-being of in... more Disability retirement causes a significant burden on the society and affects the well-being of individuals. Early health problems as determinants of disability retirement have received little attention. The objective was to study, whether interrupting compulsory military service is an early indicator of disability retirement among Finnish men and whether seeking medical advice during military service increases the risk of all-cause disability retirement and disability retirement due to mental disorders and musculoskeletal diseases. We also looked at secular trends in these associations. We examined a nationally representative sample of 2069 men, who had entered military service during 1967-1996. We linked military service health records with cause-specific register data on disability retirement from 1968 to 2008. Secular trends were explored in three service time strata. We used the Cox regression model to estimate proportional hazard ratios and their 95% confidence intervals. During the follow-up time altogether 140 (6.8%) men retired due to disability, mental disorders being the most common cause. The men who interrupted service had a remarkably higher cumulative incidence of disability retirement (18.9%). The associations between seeking medical advice during military service and all-cause disability retirement were similar across the three service time cohorts (overall hazard ratio 1.40 per one standard deviation of the number of visits; 95% confidence interval 1.26-1.56). Visits due to mental problems predicted disability retirement due to mental disorders in the men who served between 1987 and 1996 and a tendency for a similar cause-specific association was seen for musculoskeletal diseases in the men who served in 1967-1976. In conclusion, health problems-in particular mental problems-during late adolescence are strong determinants of disability retirement. Call-up examinations and military service provide access to the entire age cohort of men, where persons at risk for work disability can be identified and early preventive measures initiated.
The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a s... more The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental...
Mental symptoms are prevalent among populations, but their associations with premature mortality ... more Mental symptoms are prevalent among populations, but their associations with premature mortality are inadequately understood. We examined whether mental symptoms contribute to cause-specific mortality among midlife employees, while considering key covariates. Baseline mail survey data from 2000-02 included employees, aged 40-60, of the City of Helsinki, Finland (n = 8960, 80 % women, response rate 67 %). Mental symptoms were measured by the General Health Questionnaire 12-item version (GHQ-12) and the Short Form 36 mental component summary (MCS). Covariates included sex, marital status, social support, health behaviours, occupational social class and limiting long-standing illness. Causes of death by the end of 2013 were obtained from Statistics Finland (n = 242) and linked individually to survey data pending consent (n = 6605). Hazard ratios (HR) and 95 % confidence intervals (95 % CI) were calculated using Cox regression analysis. For all-cause mortality, only MCS showed a weak as...
Both smoking and obesity increase mortality, however, only few studies have considered premature... more Both smoking and obesity increase mortality, however, only few studies have considered premature death. The joint effect of smoking and obesity is less studied. The aim of this study was to examine the joint associations of smoking and obesity with all-cause and cancer mortality among midlife employees. METHODS: : Baseline mail surveys among employees of the City of Helsinki, Finland, during 2000-2002 include data on smoking (never-, ex-, moderate and heavy), BMI (non-obese, obese), and covariates (N = 8960, response rate 67%). Data were linked with register data on mortality until 2013. The final sample included 6437 employees. Cox proportional hazard models were used. Finally synergistic interaction effect was examined. RESULTS: : Adjusting for age and gender, non-obese heavy smokers had an elevated risk of all-cause mortality (HR 2.98, 95% CI 2.05-4.32). The joint association of obesity and smoking with all-cause mortality was stronger (HR 3.46, 95% CI 1.87-6.40), but there was no synergistic interaction (Synergy Index 0.9). Non-obese heavy smokers had an elevated cancer mortality (HR 2.94, 95% CI 1.79-4.82). The joint association of obesity and smoking with cancer mortality was stronger (HR 4.57, 95% CI 2.14-9.76) suggesting a synergistic interaction (Synergy Index 1.6, NS). Ex-smokers' risk of death was not elevated irrespective of their weight status. CONCLUSIONS: : Smoking increases the risk of death, and obesity strengthens this association. Quitting smoking, especially among obese people, may reduce premature mortality.
To quantify the association between long working hours and alcohol use. Systematic review and met... more To quantify the association between long working hours and alcohol use. Systematic review and meta-analysis of published studies and unpublished individual participant data. A systematic search of PubMed and Embase databases in April 2014 for published studies, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies. The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression. Cross sectional analysis was based on 61 studies representing 333 693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100 602 participants from nine countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1.20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours and ≥55 hours a week were 1.13 (1.02 to 1.26; adjusted difference in incidence 0.8 percentage points) and 1.12 (1.01 to 1.25; adjusted difference in incidence 0.7 percentage points), respectively, compared with working standard 35-40 hours (incidence of new onset risky alcohol use 6.2%). There was no difference in these associations between men and women or by age or socioeconomic groups, geographical regions, sample type (population based v occupational cohort), prevalence of risky alcohol use in the cohort, or sample attrition rate. Individuals whose working hours exceed standard recommendations are more likely to increase their alcohol use to levels that pose a health risk.
Disability retirement causes a significant burden on the society and affects the well-being of in... more Disability retirement causes a significant burden on the society and affects the well-being of individuals. Early health problems as determinants of disability retirement have received little attention. The objective was to study, whether interrupting compulsory military service is an early indicator of disability retirement among Finnish men and whether seeking medical advice during military service increases the risk of all-cause disability retirement and disability retirement due to mental disorders and musculoskeletal diseases. We also looked at secular trends in these associations. We examined a nationally representative sample of 2069 men, who had entered military service during 1967-1996. We linked military service health records with cause-specific register data on disability retirement from 1968 to 2008. Secular trends were explored in three service time strata. We used the Cox regression model to estimate proportional hazard ratios and their 95% confidence intervals. During the follow-up time altogether 140 (6.8%) men retired due to disability, mental disorders being the most common cause. The men who interrupted service had a remarkably higher cumulative incidence of disability retirement (18.9%). The associations between seeking medical advice during military service and all-cause disability retirement were similar across the three service time cohorts (overall hazard ratio 1.40 per one standard deviation of the number of visits; 95% confidence interval 1.26-1.56). Visits due to mental problems predicted disability retirement due to mental disorders in the men who served between 1987 and 1996 and a tendency for a similar cause-specific association was seen for musculoskeletal diseases in the men who served in 1967-1976. In conclusion, health problems-in particular mental problems-during late adolescence are strong determinants of disability retirement. Call-up examinations and military service provide access to the entire age cohort of men, where persons at risk for work disability can be identified and early preventive measures initiated.
The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a s... more The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental...
Mental symptoms are prevalent among populations, but their associations with premature mortality ... more Mental symptoms are prevalent among populations, but their associations with premature mortality are inadequately understood. We examined whether mental symptoms contribute to cause-specific mortality among midlife employees, while considering key covariates. Baseline mail survey data from 2000-02 included employees, aged 40-60, of the City of Helsinki, Finland (n = 8960, 80 % women, response rate 67 %). Mental symptoms were measured by the General Health Questionnaire 12-item version (GHQ-12) and the Short Form 36 mental component summary (MCS). Covariates included sex, marital status, social support, health behaviours, occupational social class and limiting long-standing illness. Causes of death by the end of 2013 were obtained from Statistics Finland (n = 242) and linked individually to survey data pending consent (n = 6605). Hazard ratios (HR) and 95 % confidence intervals (95 % CI) were calculated using Cox regression analysis. For all-cause mortality, only MCS showed a weak as...
Both smoking and obesity increase mortality, however, only few studies have considered premature... more Both smoking and obesity increase mortality, however, only few studies have considered premature death. The joint effect of smoking and obesity is less studied. The aim of this study was to examine the joint associations of smoking and obesity with all-cause and cancer mortality among midlife employees. METHODS: : Baseline mail surveys among employees of the City of Helsinki, Finland, during 2000-2002 include data on smoking (never-, ex-, moderate and heavy), BMI (non-obese, obese), and covariates (N = 8960, response rate 67%). Data were linked with register data on mortality until 2013. The final sample included 6437 employees. Cox proportional hazard models were used. Finally synergistic interaction effect was examined. RESULTS: : Adjusting for age and gender, non-obese heavy smokers had an elevated risk of all-cause mortality (HR 2.98, 95% CI 2.05-4.32). The joint association of obesity and smoking with all-cause mortality was stronger (HR 3.46, 95% CI 1.87-6.40), but there was no synergistic interaction (Synergy Index 0.9). Non-obese heavy smokers had an elevated cancer mortality (HR 2.94, 95% CI 1.79-4.82). The joint association of obesity and smoking with cancer mortality was stronger (HR 4.57, 95% CI 2.14-9.76) suggesting a synergistic interaction (Synergy Index 1.6, NS). Ex-smokers' risk of death was not elevated irrespective of their weight status. CONCLUSIONS: : Smoking increases the risk of death, and obesity strengthens this association. Quitting smoking, especially among obese people, may reduce premature mortality.
To quantify the association between long working hours and alcohol use. Systematic review and met... more To quantify the association between long working hours and alcohol use. Systematic review and meta-analysis of published studies and unpublished individual participant data. A systematic search of PubMed and Embase databases in April 2014 for published studies, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies. The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression. Cross sectional analysis was based on 61 studies representing 333 693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100 602 participants from nine countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1.20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours and ≥55 hours a week were 1.13 (1.02 to 1.26; adjusted difference in incidence 0.8 percentage points) and 1.12 (1.01 to 1.25; adjusted difference in incidence 0.7 percentage points), respectively, compared with working standard 35-40 hours (incidence of new onset risky alcohol use 6.2%). There was no difference in these associations between men and women or by age or socioeconomic groups, geographical regions, sample type (population based v occupational cohort), prevalence of risky alcohol use in the cohort, or sample attrition rate. Individuals whose working hours exceed standard recommendations are more likely to increase their alcohol use to levels that pose a health risk.
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