Jenni Blomgren

Kela - The Social Insurance Institution of Finland · Research Department

Objectives More knowledge of the associations between over-indebtedness and health is needed. This study is the first longitudinal register-based study analysing long-term health consequences of severe over-indebtedness. Methods Adult Finnish persons, identified in 2010 as having been over-indebted for at least 15 years, were compared with matched...

Objectives: The aim was to describe sickness allowance histories before disability retirement due to mental disorders and to examine whether receiving sickness allowance due to mental disorders and somatic conditions predicts future disability retirement. Method: Pre-retirement sickness allowance histories were traced backwards for 7 years among...

A prime objective of welfare state activities is to take action to enhance population health and to decrease mortality risks. For several centuries, poverty has been seen as a key social risk factor in these respects. Consequently, the fight against poverty has historically been at the forefront of public health and social policy. The relationship...

Little is known about the effects of long-term marital history on mortality, and the relative importance of using marital history instead of baseline marital status in mortality analyses. No previous comparative studies on the associations of marital history and mortality exist. Longitudinal data from England & Wales and from Finland were used to a...

The aim of this study is to assess to what extent selected characteristics of functional regions affect alcohol-related mortality among men in Finland after adjusting for individual-level characteristics. The study was conducted as a multilevel Poisson regression analysis, with individuals (n = 1.1 million) as the first level and functional regions...

Background Sickness absence (SA) due to mental disorders has strongly increased in Finland during recent years while sickness absence due to somatic diagnoses has continued to decrease. Research is lacking on recent trends in SA by occupational class, especially during years of increasing mental disorders. The aim of the study is to analyze these t...

Aims Large differences exist in the risk of disability retirement between Finnish municipalities. This study examined whether individual-level and municipality-level characteristics explain these differences and which municipality-level characteristics are particularly important for the risk of disability retirement. Methods Individual-level regis...

Objectives This study followed the labour market pathways of unemployed persons who started a sickness absence (SA) spell. We aimed to unravel subgroups based on altering labour market states and to identify covariates of these subgroups. Design Register-based longitudinal study, with nine labour market states and 36-month units. Setting and part...

A thorough understanding of the use of services in the population is important in order to comprehend the varying service needs of different groups. This explorative study aimed to find distinct user profiles in a working-age population based on individuals’ annual use of healthcare, social and employment services and to explore socio-demographic a...

Objectives The use of part-time sickness absence (pSA) enables return to part-time work from full sickness absence. However, subsequent labour market outcomes of pSA users depend on various individual and work-related characteristics. We investigated labour market paths of private and public sector employees after having a pSA spell. Moreover, we e...

Background The onset of unemployment may entail adverse health effects and, thus, increase the need for healthcare services. On the other hand, the onset of unemployment may weaken access to the healthcare services, which may as such decrease the overall use of healthcare services. The aim was to examine the use of outpatient healthcare services in...

Background In 2012, new sickness allowance checkpoints after 30, 60 and 90 sickness absence days were introduced in Finland to improve earlier detection of long-term work disability and to fasten return to work after illness. We examined whether the reform affected participation in rehabilitation and employment outcomes one year after the start of...

Background Understanding the population's overall use of healthcare, social and employment services is important for comprehending service needs and improving the coordination of services. The aim of this exploratory study was to find separate groups in a working-age population based on individuals’ use of various healthcare, social and employment...

Background Understanding how the combination of unemployment and work disability affects future labour market pathways is important. We followed labour market pathways among those who were unemployed at the start of a sickness allowance spell. Methods Register data covered disability pensions (DP), rehabilitation spells, sickness allowance spells,...

OBJECTIVES: In 2012, new checkpoints were introduced in the Finnish sickness absence system to improve early detection of long-term work disability and hasten return to work after illness. We examined whether the reform affected participation in rehabilitation and labor market outcomes over a one-year period. METHODS: We used interrupted time serie...

Aims The aim was to examine the use of outpatient healthcare services in different sectors of healthcare before and after the onset of unemployment and to study whether job loss affected the use of these services. Methods Longitudinal individual-level register-based data was utilized on all individuals living in the City of Oulu, Finland, who beca...

Background Return-to-work (RTW) process often includes many phases. Still, multi-state analyses that follow relevant labour market states after a long-term sickness absence (LTSA), and include a comprehensive set of covariates, are scarce. The goal of this study was to follow employment, unemployment, sickness absence, rehabilitation, and disabilit...

Nuoren kuntoutusrahaa maksetaan 16–19-vuotiaille, joiden työ- tai opiskelukyky tai ammatin valitsemisen mahdollisuudet ovat olennaisesti heikentyneet ja joilla on tarve tehostetulle kuntoutukselle eli erityisille tukitoimille. Nuoren kuntoutusrahaa maksetaan opiskelun tai muun työelämään tähtäävän kuntoutuksen ajalta. Tutkimuksen tavoitteena oli ku...

Background The aim of this study was to examine how the use of outpatient and inpatient health services differs by occupational groups, and whether the differences are explained by sociodemographic factors and health status. Methods We used register-based data on 25–64-year-old employees living in the city of Oulu, Finland, in 2018 ( N = 61,848)....

The objective of the study was to follow the health care and rehabilitation use before, during and after long-term sickness absence (LTSA), and to compare the use by post-LTSA labour market situation in terms of disability pension and employment. Individuals aged 18–58 with a ≥30-day LTSA spell in 2015 (N = 2427) were included from the total popula...

Kuntoutukseen osallistumisen sosioekonomisista eroista on vain vähän tietoa. Tavoitteena oli selvittää, millaisia eroja kuntoutukseen osallistumisessa on ylipäätään ja eri osajärjestelmissä koulutuksen, ammattiaseman ja tulojen mukaan sekä selittyvätkö kunkin sosioekonomisen aseman mittarin mukaiset erot muilla sosioekonomisen aseman mittareilla, s...

Objectives The objective of the study was to examine outpatient healthcare use before and during a long-term sickness absence (LTSA), and to compare the development of healthcare use between groups defined through LTSA lengths and disability pension (DP) transition. Design Register-based longitudinal study with five 6-month periods before and afte...

Studies have usually addressed the utilization of either medical or dental services, and less is known about how medical and dentist visits are associated. As oral health is linked to systemic health, knowledge on care coordination between dental and medical services is important to gain understanding of the overall functioning of health care. Regi...

Dental care utilization is known to have a strong socioeconomic gradient, with lower socioeconomic groups utilizing less of these services despite having poorer dental health. However, less is known about the utilization of dental services in the population concurrently in the public and private sectors in different socioeconomic groups. Additional...

To enhance understanding of the interplay between unemployment and sickness absence and disability retirement, the aim of this study was to examine how changes in area-level unemployment rates are associated with changes in sickness absence and disability retirement rates in a longitudinal setting. Municipality-level time-series data were collected...

Objectives Frequent attenders (FAs) impose a significant burden on service capacity and public health funding. Although the characteristics of the group and their risk for sickness absences (SA) have been studied, an understanding of FAs in different health care schemes is lacking. The aim of the study was to investigate FAs and their SA risk in th...

PurposePsychotropic drug consumption as a proxy measure of mental health problems during a disability pension process has only been studied among awarded applicants. This study examined psychotropic drug purchase trajectories among awarded and rejected disability pension applicants. Analyses were conducted in different diagnostic and sociodemograph...

Aims Mental disorders are among the key public health challenges and cause a significant share of sickness absence. The aim of this study was to examine gender and age-specific trends in sickness absence in Finland among non-retired persons aged 16–67 years during 2005–2019 by main diagnostic groups. Special focus was put on the development of sick...

Tutkittu tieto sairauspäivärahan enimmäisajan jälkeisestä toimeentulosta on puuttunut Suomessa. Tutkimme työkyvyttömyyseläkkeelle siirtymistä, ansiotyö- ja työttömyysjaksoja, ammatillista kuntoutusta sekä uusia sairauspäivärahakausia kahden vuoden seurannassa henkilöillä, joiden sairauspäivärahan enimmäisaika oli tullut täyteen 2012. Tarkastelimme...

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 st...

Tiivistelmä Tieto kuntoutuksen kentän kokonaisuudesta ja erilaisten kuntoutuspalveluiden käytöstä samoilla ihmisillä on varsin hajanaista ja puutteellista. Tutkimuksen tavoitteena on selvittää kuntoutukseen osallistumisen yleisyyttä ja päällekkäisyyttä eri osajärjestelmissä Oulun asukkailla vuonna 2018 laajalla rekisteriaineistolla (N = 192 844). T...

Objectives Despite the stable incidence of mental disorders in Finland and Europe, mental health-related occupational disability has been increasing. We unveiled the paths to permanent psychiatric disability, recovery, or death, by analysing sequences of labour market participation. Methods The RETIRE register database includes information regardi...

Background: 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...

Työpaperissa tarkastellaan Kelan kuntoutuksen ratkaisuja sekä niiden hylkäysosuutta vuodet 2005–2017 kattavaan rekisteriaineistoon perustuen. Kuntoutusta tarkastellaan kuntoutusmuodon lakiperusteen mukaan jaoteltuna ammatilliseen, lääkinnälliseen ja harkinnanvaraiseen kuntoutukseen sekä vuodesta 2011 alkaen kuntoutuspsykoterapiaan. Hylkäysosuuksien...

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 re...

A weakening work ability may lead to a higher risk of gradual exclusion from working life, which may be manifested in increasing levels of unemployment. This study examined development of unemployment prior to disability retirement by educational level and occupational class in different diagnostic groups. The study population comprised 70% of Finn...

Introduction: Depression is a highly prevalent condition with typical onset in early adulthood. Internet-delivered cognitive behavioural therapy (iCBT) is a promising cost-effective and more widely available alternative to face-to-face CBT. However, it is not known whether it can reduce sickness absence in employees showing depressive symptoms. Th...

Background Early exit from paid employment is a notable public health and societal challenge. Previous research has largely focused on the relationships among variables instead of the relationships among individuals with different work participation history. Person-oriented methods enable to identify latent groups of individuals who are likely to f...

Background Receipt of sickness allowance (SA), which in the Finnish benefit system functions as compensation for loss of income due to over 10-days-long sickness absence, is more prevalent in lower socioeconomic groups. As SA is an earnings-related benefit and higher occupational classes have on average higher previous income, their share of SA exp...

Purpose Trajectories of psychotropic drug purchases around disability pension process have only been studies among awarded applicants. The aim was to follow and compare psychotropic drug purchases between awarded and rejected applicants before and after the application ruling, and to analyse whether such differences are affected by diagnostic group...

Background: Early exit from paid employment is a notable public health and societal challenge. Previous research has largely focused on the relationships among variables instead of the relationships among individuals with different work participation history. Person-oriented methods enable to identify latent groups of individuals who are likely to...

Breast cancer is the most common cancer among women in Western countries with clear socioeconomic differences. Higher occupational class is associated with higher breast cancer incidence but with better survival from the disease, whereas lower occupational class is associated with higher risk of sickness absence. We are not aware of previous studie...

Omaishoitajan psyykkisen terveydentilan ja kuormittuneisuuden indikaattorina voidaan pitää hänen psyykenlääkkeiden käyttöään. Aiheesta ei ole julkaistu suomalaista tutkimustietoa. Tavoitteenamme oli selvittää, erosivatko psyykenlääkkeitä kalenterivuoden aikana ostaneiden osuudet omaishoitajien ja muun saman ikäisen väestön välillä. Lisäksi kuvailem...

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. Methods: Finnish residents aged 18–58 years with a first rejected disability pension application in 2010 (N = 3683) were followed for 48 months with re...

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...

Objectives The objective of the study was to examine diagnosis-specific sickness absences of different lengths as predictors of disability retirement in different occupational classes. Design Register-based prospective cohort study up to 8 years of follow-up. Participants A 70% random sample of the non-retired Finnish population aged 25–62 at the...

Objectives Those in lower occupational classes have an increased risk of sickness absence due to musculoskeletal diseases (MSDs), but studies examining the associations simultaneously across specified diagnostic groups within MSDs are lacking. We examined occupational class differences in the occurrence and length of long-term sickness absence due...

Abstract Background Musculoskeletal diseases and mental disorders are major causes of long-term sickness absence in Western countries. Although sickness absence is generally more common in lower occupational classes, little is known about class differences in diagnostic-specific absence over time. Focusing on Finland during 2005–2014, we therefore...

Background Unemployment is known to be associated with poor health and disability. The aim of this study was to examine the risk of disability retirement by past unemployment in different socioeconomic groups. Method Disability retirees aged 25–64 years were drawn from the years 2011–2015 (n=74.460) to trace back their unemployment histories durin...

Introduction Timely access to healthcare is crucial in order to tackle problems of work ability in the workforce. However, studies have shown that in many countries, e.g. in Finland, use of healthcare is unequally distributed across the socio-economic groups. Primary healthcare in Finland is organised at three different sectors (free occupational h...

Objectives Sickness absence is consistently higher in lower occupational classes, but attempts to analyse changes over time in socioeconomic differences are scarce. We examined trends in medically certified sickness absence by occupational class in Finland from 1996 to 2013 and assessed the magnitude and changes in absolute and relative occupationa...

While over-indebtedness has emerged as a new social risk among Europeans as a consequence of economic recessions, its associations with health and disability are poorly understood. This study utilises longitudinal, register-based data to assess the associations of over-indebtedness with disability retirement. Severely over-indebted people were iden...

Objectives: To identify subgroups of disability retirees with different pre-retirement sickness allowance histories and to examine whether the diagnosis of disability pension and socio-demographic variables discriminate these subgroups. Methods: The data included all Finnish residents aged 30-64 years who were granted a full disability pension i...

Associations between retirement and changes in health care use have not been shown in a longitudinal setting. In the Finnish universal health care system, transition into retirement from employment entails loss of access to occupational health care that provides easily accessible primary health care services, which may cause changes in utilization...

In all countries, there are differences in health between socio-economic groups. In Finland those health differences are comparatively large. Why there is such wide cross-national variation in relative health differences between socio-economic groups remains an unanswered question. One brand of explanations links health outcomes to income inequalit...

Objectives: We aimed to examine the cross-national and cross-temporal association between poverty and mortality, in particular differentiating the impact of absolute and relative poverty. Methods: We employed pooled cross-sectional time series analysis. Our measure of relative poverty was based upon the standard 60% of median income. The measure...

Background To ease the burden of public health care, use of private health care that is deemed medically necessary is partly reimbursed (about 20–30% of costs) by social insurance in Finland. Private health care includes doctor and dentist care as well as examinations and treatments prescribed by doctors. However, little is known about how the co...

Background According to OECD comparisons, Finland is among the most unequal countries in terms of doctor visits. One reason behind this is that while universal public services are not always easily accessible, private services, partly reimbursed from the social insurance system (22% of costs in 2012), can be used by those who can trade off high c...

Future increases in need of old-age care warrant research on receipt of informal care among older people in different policy and cultural contexts. Separating informal care into help provided by spouse and by children may shed more light on dynamics of informal help, important in alleviating the demands on the formal sector. Using nationally repres...

Little is known about the effects of long-term marital history on mortality, and the relative importance of using marital history instead of baseline marital status in mortality analyses. No previous comparative studies on the associations of marital history and mortality exist. Methods: Longitudinal data from England & Wales and from Finland were...

Työkyvyttömyyseläkkeelle siirtyneiden työttömyys-ja sairaustausta eri eläkejärjestelmissä Nettityöpapereita 26/2011 Kelan tutkimusosasto

Knowledge of the determinants of use of formal home-based services among older people is of particular importance for predicting the need for and cost of care in the future. The aim of this study was to estimate the frequency of formal and informal help among community-dwelling older people and to assess the determinants of home-based formal help,...

The article studies to what extent regional socioeconomic and cultural characteristics explain spatial patterns in the Second Demographic Transition in Finland. The country’s 75 functional regions are used as area units. A summary indicator of the transition based on divorce and cohabitation is used as the dependent variable. The results show that...

We studied whether migration influences the relationship between area socioeconomic structure and mortality. We used data on Finns aged 25-64 that are linked to information on proportions of manual workers in 85 functional regions in 1987 and 1997, and on deaths in 1998-2004. Participants aged 25-44 moving to areas with a lower proportion of manual...

To estimate changes in the total and independent effects of education and occupational social class on mortality over 30 years, and to assess the causes of changes in the independent effects. Census records linked with death records for 1971-2000 for all Finns aged 30-59 years were studied. The total and independent effects of education and social...