Occupational and behavioural factors in the explanation of social inequalities in premature and total mortality: A 12.5-year follow-up in the Lorhandicap study

INSERM, U1018, CESP Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health Team, Villejuif, France.
European Journal of Epidemiology (Impact Factor: 5.34). 01/2011; 26(1):1-12. DOI: 10.1007/s10654-010-9506-9
Source: PubMed


The respective contribution of occupational and behavioural factors to social disparities in all-cause mortality has been studied very seldom. The objective of this study was to evaluate the role of occupational and behavioural factors in explaining social inequalities in premature and total mortality in the French working population. The study population consisted of a sample of 2,189 and 1,929 French working men and women, who responded to a self-administered questionnaire in mid-1996, and were followed up until the end of 2008. Mortality was derived from register-based information and linked to the baseline data. Socioeconomic status was measured using occupation. Occupational factors included biomechanical and physical exposures, temporary contract, psychological demands, and social support, and behavioural factors, smoking, alcohol abuse, and body mass index. Significant social differences were observed for premature and total mortality. Occupational factors reduced the hazard ratios of mortality for manual workers compared to managers/professionals by 72 and 41%, from 1.88 (95% CI: 1.17-3.01) to 1.25 (95% CI: 0.74-2.12) for premature mortality, and from 1.71 (95% CI: 1.18-2.47) to 1.42 (95% CI: 0.95-2.13) for total mortality. The biggest contributions were found for biomechanical and physical exposures, and job insecurity. The role of behavioural factors was very low. Occupational factors played a substantial role in explaining social disparities in mortality, especially for premature mortality and men. Improving working conditions amongst the lowest social groups may help to reduce social inequalities in mortality.

Download full-text


Available from: Nearkasen Chau
  • Source
    • "s SEP increases , whereas for women , job strain - attributable de - pression did not vary consistently by SEP [ LaMontagne et al . , 2008 ] . Work organization factors and job insecurity explained a larger proportion of socioeconomic inequal - ities in health among men than women in three studies [ Borrell et al . , 2004 ; Sekine et al . , 2009 ; Niedhammer et al . , 2011 ] . In one of these studies , material well - being at home and amount of household labor played a larger role in women ' s class differences in health [ Borrell et al . , 2004 ] Thus , further research is needed on the moderating role of gender in assessing the role of work organization hazards in socioeconomic inequalities in health ."
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Changes in employment conditions in the global economy over the past 30 years have led to increased job insecurity and other work organization hazards. These hazards may play a role in creating and sustaining occupational health disparities by socioeconomic position, gender, race, ethnicity, and immigration status. Methods: A conceptual model was developed to guide the review of 103 relevant articles or chapters on the role of work organization and occupational health disparities identified through a comprehensive search conducted by NIOSH. A second review was conducted of employment and workplace policies and programs designed to reduce the health and safety risks due to job insecurity and other work organization hazards. Results: There is consistent evidence that workers in lower socioeconomic or social class positions are exposed to greater job insecurity and other work organization hazards than workers in higher socioeconomic positions. Likewise, racial and ethnic minorities and immigrants are exposed to greater job insecurity. Limited research examining the effects of interventions targeting work organization hazards on disparities has been conducted; nonetheless, intervention strategies are available and evidence suggests they are effective. Conclusions: Job insecurity and work organization hazards play a role in creating and sustaining occupational health disparities. Employment and workplace policies and programs have the potential to reduce these hazards, and to reduce disparities.
    Full-text · Article · May 2014 · American Journal of Industrial Medicine
  • Source
    • "Furthermore, because stroke and associated disabilities affect capacity to work, many survivors have to leave their jobs (to retire or become unemployed), which may result in low socioeconomic resources. These issues are likely to be more pronounced among those individuals in lower socioeconomic groups, those with a lower educational level and income, and possibly those with more severe stroke and comorbidity [13,14]. The individuals in lower socioeconomic groups or with a lower educational level may have reduced awareness of the benefits of prevention. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Quality of life (QoL) assessment is important when monitoring over time the recovery of stroke-survivors living at home. This study explores the associations between QoL and socioeconomic factors, functional impairments and self-reported dissatisfaction with received information and home-care services among survivors two years after stroke onset. This problem remains partially addressed though optimal information and services may improve survivors' QoL. Stroke-survivors admitted to all hospitals in Luxembourg 18 months or more previously were identified using the only care-expenditure-reimbursement national system database. The clinical diagnosis was confirmed. Ninety four patients aged 65 years and living at home were interviewed to gather socioeconomic characteristics, functional impairments, dissatisfaction with information and home-care services, and QoL (using the Newcastle Stroke-Specific QoL, newsqol) assessing 11 domains. Data were analyzed using multiple linear regression models. About 50% of survivors had low education and lower income. Functional impairments were common: sensory (45%), motor (35%), memory (32%), language (31%), and vision (20%). Survivors with education (<12th grade) or lower income had low values for most newsqol domains (sex-age-adjusted regression coefficient saRC, i.e. mean difference, between -23 and -8). Patients who were working had better values for pain, mental feelings and sleep domains than did retired people (saRC between -3.9 and 4.2). Various functional impairments were associated with markedly low values of nearly all domains (saRC between -33.5 and -7.5) and motor, language, memory and sensory impairments had the highest impact. The survivors' perceived QoL was markedly low, especially for the domains of interpersonal relationship, sleep, cognition, mental feelings, and pain. Various QoL domains were strongly related to dissatisfaction with information about stroke and its consequences/changes over time, accuracy of information obtained, help received, coordination between services, and the possibility of receiving help when necessary (saRC reaching -30). Stroke-survivors had major alterations in QoL that reflected depressive symptoms, which should be appropriately treated. These findings may help with the development of public policies aiming at improving QoL among stroke survivors. The newsqol could be used routinely to measure the recovery of survivors over time and their needs in terms of information, help and care services.
    Full-text · Article · Apr 2014 · BMC Neurology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We investigated the 28-year development trajectories of work ability among initially middle-aged male and female municipal employees and the association of perceived mental and physical work strain in midlife by work ability trajectory groups. The baseline data of the Finnish longitudinal study of municipal employees (FLAME) were collected in 1981 (N=6257) with follow-ups in 1985, 1992, 1997, and 2009. Work ability was assessed in all the waves as present perceived work ability relative to lifetime best. Altogether, N=2690 had work ability data in 1981 and 2009, and at least for one wave in between these years, and were included in group-based semi-parametric mixture modeling trajectory analyses. Baseline differences in mental and physical work strain according to the work ability trajectories were assessed with MANCOVA (multivariate analysis of covariance). A five-group work ability trajectory model was identified for men and a four-group model for women. For the majority, a linear decline from excellent to moderate or moderate to poor work ability was observed while non-linear trajectories with sudden collapse and, in some cases, modest subsequent recovery of work ability were also observed. Individuals who maintained their work ability on an excellent-to-moderate level throughout the follow-up more often reported low mental and physical work strain in midlife. A substantial proportion of individuals seem to maintain their work ability on a moderate level from midlife to old age. Work strain may have far-reaching negative effects on individuals' work ability from midlife to old age, warranting vigilance in maintaining and promoting work ability throughout the lifespan.
    Full-text · Article · Jun 2011 · Scandinavian Journal of Work, Environment & Health
Show more