Lifestyle‐related risk factors and trajectories of work disability over 5 years in employees with diabetes: findings from two prospective cohort studies

Abstract

AimsTo examine work disability trajectories among employees with and without diabetes and identify lifestyle‐related factors associated with these trajectories.MethodsWe assessed work disability using records of sickness absence and disability pension among participants with diabetes and age‐ sex‐, socio‐economic status‐ and marital status‐matched controls in the Finnish Public Sector Study (1102 cases; 2204 controls) and the French GAZEL study (500 cases; 1000 controls), followed up for 5 years. Obesity, physical activity, smoking and alcohol consumption were assessed at baseline and the data analysed using group‐based trajectory modelling.ResultsFive trajectories described work disability: ‘no/very low disability’ (41.1% among cases and 48.0% among controls); ‘low–steady’ (35.4 and 34.7%, respectively); ‘high–steady’ (13.6 and 12.1%, respectively); and two ‘high–increasing’ trajectories (10.0 and 5.2%, respectively). Diabetes was associated with a ‘high–increasing’ trajectory only (odds ratio 1.90, 95% CI 1.47–2.46). Obesity and low physical activity were similarly associated with high work disability in people with and without diabetes. Smoking was associated with ‘high–increasing’ trajectory in employees with diabetes (odds ratio 1.88, 95% CI 1.21–2.93) but not in those without diabetes (odds ratio 1.32, 95% CI 0.87–2.00). Diabetes was associated with having multiple ( ≥ 2) risk factors (21.1 vs. 11.4%) but the association between multiple risk factors and the ‘high–increasing’ trajectory was similar in both groups.ConclusionsThe majority of employees with diabetes have low disability rates, although 10% are on a high and increasing disability trajectory. Lifestyle‐related risk factors have similar associations with disability among employees with and without diabetes, except smoking which was only associated with poorer prognosis in diabetes.

Trajectories of Work-Related Functional Impairment prior to Suicide

“…We found that a large proportion of the individuals either showed stable high levels (30.4%) or increasing number (16.1%) of annual SA/DP months preceding suicide. This is in contrast to much lower levels or lower proportions of high/increasing work disability in individuals prior to multiple sclerosis and first diagnosis of diabetes in recent studies based on a Swedish cohort (<23%) [ 29 ], and a Finnish (<29%) and a French (<13%) occupational cohort [ 16 ]. High levels of SA/DP seem to be associated with the type and severity of the underlying diagnoses of SA/DP [ 30 , 31 ].…”

“…Work-related functional impairment has been demonstrated to have different trajectories before diagnosing of chronic diseases, e.g. diabetes [ 16 ]. Knowledge on work-related trajectories may be beneficial for early identifying patients at higher risk.…”

Common mental disorders and trajectories of work disability among midlife public sector employees – A 10-year follow-up study

“…The current study is relatively novel in its application of the GBTA method. A French-Finnish study analysed work disability trajectories using the annual number of work disability days, not months, as a repeated end-point among employees with and without diabetes (Virtanen et al, 2015). Despite the differences in the study designs and the length of the follow-up periods, some similarities are evident.…”

“…Previous studies have investigated the association between mental ill-health and work disability by focusing on either frequential (SA) or dichotomous (DR) end-points (Ahola et al, 2011;Knudsen et al, 2013;Lahelma et al, 2015;Mauramo et al, 2018) but less research has considered heterogeneity in the development of work disabilities over time using a trajectory modelling approach (Farrants et al, 2018;Feldt et al, 2009;Laaksonen et al, 2016;Virtanen et al, 2015). A study analysing disability benefit records of all Finnish residents aged 30 to 64 found that DR awards follow heterogeneous SA trajectories, and that these trajectories were associated with the diagnostic reason of the DR award (Laaksonen et al, 2016).…”

“…Despite efforts to integrate group-based trajectory analysis (GBTA) into the research on work disability (Bjorkenstam et al, 2015;Feldt et al, 2009;Ferdiana et al, 2014;Haukka et al, 2017;Virtanen et al, 2015), the existing studies employing GBTA focus on relatively short or medium length follow-ups that cover only a small part of the working life span, and typically utilise either only survey or register-based data, although some exceptions exist (Virtanen et al, 2015). Furthermore, we are unaware of previous studies focusing on work disability trajectories through age, not time, among initially midlife employees with and without mental-ill health indicated by common mental disorders (CMD).…”