Association between socioeconomic position and occupational health service utilisation trajectories among young municipal employees in Finland

Abstract

ObjectivesTo identify groups of municipal employees between the ages of 20 and 34 years with distinct utilisation trajectories of primary care services provided by occupational health service (OHS), measured as the annual number of OHS visits, and to identify demographic and socioeconomic risk factors that distinguish employees in the high utilisation trajectory group(s).MethodsThe present study is a retrospective register-based cohort study. All municipal employees of the City of Helsinki, Finland, aged 20–34 in the Helsinki Health Study, recruited from 2004 to 2013, with follow-up data for 4 years were included in the study (n=9762). The outcome measure was group-based trajectories of OHS utilisation, identified with a group-based trajectory analysis. The demographic and socioeconomic variables used to predict the outcome were age, first language, educational level and occupational class. The analyses were stratified by gender.ResultsA large proportion of the young employees do not use OHS. Trajectory groups of ‘No visits’ (50%), ‘Low/increasing’ (18%), ‘Low/decreasing’ (22%) and ‘High/recurrent’ (10%) use were identified. We found occupational class differences in OHS utilisation patterns showing that lower occupational classes had a higher propensity for ‘High/recurrent’ OHS utilisation for both genders.ConclusionsPreventive measures should be targeted particularly to the trajectory groups of ‘Low/increasing’ and ‘High/recurrent’ in order to intervene early. In addition, OHS utilisation should be closely monitored among the two lowest occupational classes. More research with longitudinal OHS data is needed.

Frequent attenders of three outpatient health care schemes in Finland: characteristics and association with long-term sickness absences, 2016–2018

“…As in previous studies [ 6 , 8 , 9 , 11 , 12 , 15 – 19 ], frequent attendance was most characteristic for females, older age groups, and those with a lower socioeconomic status. However, especially the socioeconomic characteristics of FAs depended on health care scheme, reflecting the different roles of the schemes in the Finnish health care system.…”

“…Moreover, frequent health care attendance may often not be functional or as such meet clients’ needs. This is indicated by the high frequency of medically unexplained symptoms, health anxiety, negative life events and social problems among FAs [ 3 , 5 – 10 ], and above all by the resilient nature of frequent attendance [ 3 , 5 , 6 , 11 , 12 ]. Foster et al [ 13 ] and Vedsted and Olesen [ 14 ] have shown that frequent use of general practice health care is partly independent of the clients’ medical conditions.…”

“…Indeed, frequent health care attendance tends to accumulate in distinct demographic and more vulnerable socioeconomic groups. FAs are more often women [ 6 , 9 , 11 , 15 , 16 ], older [ 5 , 6 , 11 , 12 , 15 ], without work [ 9 , 14 , 16 ], and have a lower occupational class [ 12 , 16 – 18 ], and lower education [ 8 , 14 , 17 – 19 ]. Lower socioeconomic status may be associated with frequent attendance in primary care or general practice settings especially [ 8 , 9 , 16 , 18 , 19 ].…”

“…Frequent attenders have mainly been studied in primary care and general practice settings, and to a lesser extent in OHS [ 12 , 17 , 20 , 25 ]. There is a clear lack of studies comparing health care schemes.…”

Outpatient healthcare use before and during a long-term sickness absence spell: a register-based follow-up study comparing healthcare use by the length of sickness absence and transition to disability pension in Finland

“…Both disability benefit spells and publicly reimbursed healthcare use cause enormous public expenses. 1 2 As markers of ill health and occupational disability, they both have mainly been treated in research literature as risk outcomes [3][4][5][6][7][8][9][10][11][12] or as predictors of disability pensioning (DP). [13][14][15][16] The association between long-term sickness absence (LTSA) and healthcare use is also evident.…”