Educational inequalities in self-rated health and emotional exhaustion among workers during the COVID-19 pandemic: a longitudinal study.

OBJECTIVE: This study aimed to investigate trends in educational inequalities in poor health and emotional exhaustion during the pandemic among workers, and differences in trends between men and women. METHODS: Five waves (2019-2021) from the longitudinal study 'the Netherlands Working Conditions Survey COVID-19 study' were used (response rates: 32-38%). Generalized logistic mixed models were used to estimate the changes in absolute and relative educational inequalities in poor health and emotional exhaustion for all workers (n = 12,479) and for men and women, separately. RESULTS: Low and intermediate educated workers reported more often poor health (OR 2.54; 95% CI 1.71-3.77 and OR 2.09; 95% CI 1.68-2.61, respectively) than high educated workers. Intermediate educated women (OR 0.49; 95% CI 0.37-0.64) reported less emotional exhaustion than high educated women, but no differences were observed among men. The prevalence of poor health first decreased across all educational levels until March 2021, and bounced back in November 2021. A similar pattern was found for emotional exhaustion, but for low and intermediate educated workers only. Relative educational inequalities in poor health reduced among men during the pandemic, and absolute differences decreased among men and women by 2.4-2.6%. Relative educational inequalities in emotional exhaustion widened among men only. Absolute differences in emotional exhaustion first increased among both men and women, but narrowed between the last two waves. DISCUSSION: Socioeconomic inequalities for poor self-rated health remained but narrowed in relative and absolute terms during the pandemic. With regard to emotional exhaustion, socioeconomic inequalities returned to pre-COVID-19 levels at the end of 2021.

Employers' attitude, intention, skills and barriers in relation to employment of vulnerable workers.

BACKGROUND: Little is known why some organizations employ vulnerable workers and others do not. OBJECTIVE: To explore the relationships between the attitude, intention, skills and barriers of employers and employment of vulnerable workers. METHODS: We included 5,601 inclusive organizations (≥1% of employees had a disability, was long-term unemployed or a school dropout) and 6,236 non-inclusive organizations of the Netherlands Employers Work Survey 2014-2019. We operationalized employer factors based on the Integrative Model of Behavioral Prediction as attitude (negative impact), intention (mission statement regarding social inclusion), skills (human resources policies and practices), and barriers (economic conditions and type of work). We used multivariate-adjusted logistic regression models. RESULTS: Compared to non-inclusive organizations, inclusive organizations had a more negative attitude (OR:0.81) and a stronger intention to employ vulnerable workers (OR:6.09). Regarding skills, inclusive organizations had more inclusive human resources practices (OR:4.83) and initiated more supporting human resources actions (OR:4.45). Also, they adapted more work conditions towards the needs of employees (OR:1.52), negotiated about work times and absenteeism (OR:1.49), and had general human resources practices on, for example, employability (OR:1.78). Inclusive organizations had less barriers reflected by better financial results (OR:1.32), more employment opportunities (OR:1.33) and more appropriate work tasks (OR:1.40). CONCLUSIONS: Overall, inclusive organizations reported more positive results on the employer factors of the Integrative Model of Behavioral Prediction, except for a more negative attitude. The more negative attitude might reflect a more realistic view on the efforts to employ vulnerable groups, and suggests that other unmeasured emotions and beliefs are more positive.

Trajectories of metabolic risk factors and biochemical markers prior to the onset of type 2 diabetes: the population-based longitudinal Doetinchem study.

BACKGROUND: Risk factors often develop at young age and are maintained over time, but it is not fully understood how risk factors develop over time preceding type 2 diabetes. We examined how levels and trajectories of metabolic risk factors and biochemical markers prior to diagnosis differ between persons with and without type 2 diabetes over 15-20 years. METHODS: A total of 355 incident type 2 diabetes cases (285 self-reported, 70 with random glucose ⩾11.1 mmol l-1) and 2130 controls were identified in a prospective cohort between 1987-2012. Risk factors were measured at 5-year intervals. Trajectories preceding case ascertainment were analysed using generalised estimating equations. RESULTS: Among participants with a 21-year follow-up period, those with type 2 diabetes had higher levels of metabolic risk factors and biochemical markers 15-20 years before case ascertainment. Subsequent trajectories were more unfavourable in participants with type 2 diabetes for body mass index (BMI), HDL cholesterol and glucose (P<0.01), and to a lesser extent for waist circumference, diastolic and systolic blood pressure, triglycerides, alanine aminotransferase, gamma glutamyltransferase, C-reactive protein, uric acid and estimated glomerular filtration rate compared with participants without type 2 diabetes. Among persons with type 2 diabetes, BMI increased by 5-8% over 15 years, whereas the increase among persons without type 2 diabetes was 0-2% (P<0.01). The observed differences in trajectories of metabolic risk factors and biochemical markers were largely attenuated after inclusion of BMI in the models. Results were similar for men and women. CONCLUSIONS: Participants with diabetes had more unfavourable levels of metabolic risk factors and biochemical markers already 15-20 years before diagnosis and worse subsequent trajectories than others. Our results highlight the need, in particular, for maintenance of a healthy weight from young adulthood onwards for diabetes prevention.