Associations between depressive symptoms and 5-year subsequent work nonparticipation due to long-term sickness absence, unemployment and early retirement in a cohort of 2,413 employees in Germany.

BACKGROUND: We examined the association of depressive symptoms with subsequent events - and duration thereof - of work nonparticipation (long-term sickness absence, unemployment and early retirement). METHODS: We employed a 5-year cohort from the Study on Mental Health at Work (S-MGA), based on a random sample of employees subject to social contributions aged 31-60 years in 2012 (N = 2413). Depressive symptoms were assessed at baseline through questionnaires, while work nonparticipation was recorded in follow-up interviews. Associations of depressive symptoms with subsequent events of work nonparticipation were examined in two-part models, with events analysed by logistic regressions and their duration by generalized linear models. RESULTS: Medium to severe depressive symptoms were associated with events of work nonparticipation (males Odds Ratio [OR] = 3.22; 95% CI = 1.90-5.45; females OR = 1.92; 95% CI = 1.29-2.87), especially with events of long-term sickness absence in both genders and events of unemployment in males. Mild depressive symptoms were also associated with events of work nonparticipation (males OR = 1.59; 95% CI = 1.19-2.11; females OR = 1.42; 95% CI = 1.10-1.84). Among those experiencing one or more events, the duration of total work nonparticipation was twice as high among males [Exp(ß) = 2.06; 95% CI = 1.53-2.78] and about one third higher [Exp(ß) = 1.38; 95% CI = 1.05-1.83] among females with medium to severe depressive symptoms. CONCLUSIONS: The present study focuses on both events and duration of work nonparticipation, which are both critical for examining societal consequences of depressive symptoms. It is key to regard also mild depressive symptoms as a possible risk factor and to include different types of work nonparticipation.

Working conditions as risk factors for early exit from work-in a cohort of 2351 employees in Germany.

OBJECTIVES: We would assess the possible impact of a range of physical and psychosocial working conditions on early exit from paid employment (i.e., before retirement age) in a representative employee population in Germany. METHODS: We analysed a cohort from the German Study on Mental Health at Work (S-MGA) with a baseline of 2351 employees in 2011/12, sampled randomly from the register of integrated employment biographies (IEB) at the Institute for Employment Research (IAB). Follow-up ended mid-2015. Early Exit comprised episodes of either pensioning, long-term sickness absence or unemployment ≥ 18 months. Total follow-up years were 8.422. Working conditions were partly assessed by the Copenhagen Psychosocial Questionnaire (COPSOQ). Through Cox regressions, associations of baseline working conditions with time to event of exit were estimated-adjusting for baseline age, gender, poverty, fixed-term contract and socioeconomic position. RESULTS: In multiple regressions, awkward body postures (HR = 1.24; 95% CI = 1.07-1.44), heavy lifting (1.17; 1.00-1.37) and high work pace (1.41; 1.16-1.72) were associated with exit. The estimated attributable fraction of exit for being exposed to less than optimal work environment was 25%. Regarding specific exit routes, repetitive movements (1.25; 1.03-1.53) increased the risk for the long-term sickness absence; work pace (1.86; 1.22-2.86) and role clarity (0.55; 0.31-1.00) were associated to unemployment; and control over working time (0.72; 0.56-0.95) decreased the risk of the early retirement. CONCLUSIONS: Work environment seems to be important for subsequent early exit from work. Physical and psychosocial demands seem to be associated to exit to a stronger extent than resources at work.

Effects of occupational exposure to respirable quartz dust on acute myocardial infarction.

OBJECTIVES: The aim of this study is to investigate the effects of occupational exposure to respirable quartz (RQ) on first acute myocardial infarction (AMI). RQ causes pulmonary diseases like silicosis and has also been linked to cardiovascular diseases. Inflammation is hypothesised as the underlying pathway. METHODS: We performed a 1:3 matched case-control study nested in a cohort of male uranium miners. We included cases (identified from hospital records and validated according to WHO criteria) who had suffered their first AMI while still employed and <65 years of age. Controls were matched by date of birth and Wismut recruitment era. RQ exposure was derived from a job-exposure matrix. We performed a conditional logistic regression adjusted for smoking, metabolic syndrome and baseline erythrocyte sedimentation rate. Subgroups by date of birth and Wismut recruitment era were analysed to minimise the impact of pre-exposures. RESULTS: The study base comprised 292 matched sets. The cumulative exposure ranged from 0 to 38.9 mg/m3-years RQ. The adjusted OR of the highest RQ tertile (>14.62 mg/m3-years) was 1.27 (95% CI 0.82 to 1.98). However, for miners born after 1928 and hired in the earliest recruitment era (1946-1954), a significantly elevated risk was seen in the highest RQ tertile (OR=6.47 [95% CI 1.33 to 31.5]; 50 matched sets). CONCLUSIONS: An impact of quartz dust on first AMI was observed only in a small subgroup that had virtually no pre-exposure to RQ. Further studies on the basis of complete occupational history are required to substantiate this finding.

[Sickle Cell Disease in Newborns in Germany: Analysis of the AOK Health Insurance Data]. / Sichelzellkrankheit unter Neugeborenen in Deutschland: Eine Studie an Routinedaten der AOK.

BACKGROUND: Sickle cell disease (SCD, ICD-10:D57) is a hemoglobinopathy of global public health relevance. As an autosomal recessive genetic disorder, it affects 70-150 newborns in Germany per year (1-2 per 10,000). Early detection during the asymptomatic first 3 months of life would meet national treatment recommendations and prevent disease sequelae. OBJECTIVES: Objectives are 1) to measure the prevalence of SCD in newborns in the AOK's claims data, 2) to determine the age at first diagnosis D57, and 3) to count typical hospitalizations. METHODS: Inpatient and outpatient data on 204 children born in 2009 and 2010, insured with the AOK for at least one day in their year of birth and coded as D57 during 6 calendar years were analyzed. The number of newborns in the AOK in 2009 and 2010 (denominator) is known. VALIDATION: Valid SCD cases (numerator) fulfilled the requirement for D57 (except D57.3) to be coded at least 2 times in different quarters of years. The prevalence proportion (PP) was calculated with a bootstrapped confidence interval (CI). The first mention of D57 per case was dated in quarters of years (Q). The Standardized Incidence Ratio (SIR) was calculated to compare hospitalizations from the month 13 to month 61 with the age- and sex-matched population (1-4-year olds). The calculations were performed with SPSS 22 and Excel. RESULTS: The validation resulted in 78 SCD cases. The prevalence was 1.96 (95% CI 1.53-2.41) per 10,000 newborns. Regions of higher prevalence were Berlin, Bremen and Hamburg (summarized) and North Rhine-Westphalia. In only 15.4% of the cases, D57 was mentioned early (in Q1-2). The median date was in Q7. There were 266 hospitalizations in relation to 78 children, with an SIR=6.8. The rate of hospitalizations was thus 6.8 times higher than in the population. Feared outcomes such as pneumonia, septicemia and splenic disorders were among the hospital discharge diagnoses. CONCLUSIONS: SCD in Germany is evident in claims data of Germany's largest statutory health insurance. At present, the opportunity for early detection is being widely missed. The time to diagnosis could be shortened by the inclusion of SCD in the universal newborn screening. Until this policy is implemented, parents with a relevant family background and health professionals should pay more attention to SCD.

Mortality in rheumatoid arthritis: the impact of disease activity, treatment with glucocorticoids, TNFα inhibitors and rituximab.

OBJECTIVES: To investigate the impact of disease activity, the course of the disease, its treatment over time, comorbidities and traditional risk factors on survival. METHODS: Data of the German biologics register RABBIT were used. Cox regression was applied to investigate the impact of time-varying covariates (disease activity as measured by the DAS28, functional capacity, treatment with glucocorticoids, biologic or synthetic disease modifying antirheumatic drugs (DMARDs)) on mortality after adjustment for age, sex, comorbid conditions and smoking. RESULTS: During 31 378 patient-years of follow-up, 463 of 8908 patients died (standardised mortality ratio: 1.49 (95% CI 1.36 to 1.63)). Patients with persistent, highly active disease (mean DAS28 > 5.1) had a significantly higher mortality risk (adjusted HR (HRadj)=2.43; (95% CI 1.64 to 3.61)) than patients with persistently low disease activity (mean DAS28 < 3.2). Poor function and treatment with glucocorticoids > 5 mg/d was significantly associated with an increased mortality, independent of disease activity. Significantly lower mortality was observed in patients treated with tumour necrosis factor α (TNFα) inhibitors (HRadj=0.64 (95% CI 0.50 to 0.81), rituximab (HRadj=0.57 (95% CI 0.39 to 0.84), or other biologics (HRadj=0.64 (95% CI 0.42 to 0.99), compared to those receiving methotrexate. To account for treatment termination in patients at risk, an HRadj for patients ever exposed to TNFα inhibitors or rituximab was calculated. This resulted in an HRadj of 0.77 (95% CI 0.60 to 0.97). CONCLUSIONS: Patients with long-standing high disease activity are at substantially increased risk of mortality. Effective control of disease activity decreases mortality. TNFα inhibitors and rituximab seem to be superior to conventional DMARDs in reducing this risk.

[Length of stay in institutionalised long-term care 1999-2011: a population-based study]. / Verweildauer in vollstationärer Dauerpflege 1999-2011: Eine bevölkerungsbezogene Analyse.

BACKGROUND AND OBJECTIVE: From the perspective of welfare economics, institutionalised long-term care (ILTC) is expensive and thus requires key figures. This article provides the population-based mean length of stay in ILTC, which is a meaningful measure for monitoring purposes. METHOD: The Sullivan method was applied to official statistics on population and long-term care between 1999 and 2011. This method splits up the life expectancy at birth into one part in and one part out of ILTC. The part in ILTC can be interpreted as length of stay. RESULTS: In 2011, males in Germany experienced 5.5 months in ILTC, females 14.4 months. In 1999, the length of stay was 3.8 and 11.8 months, respectively. Thus, the length of stay in ILTC has increased over time. However, the increase regarding women stopped in 2007. Furthermore, the onset of ILTC has been protracted. In 2011, the mean age at the start of ILTC was 77.6 years (males) and 81.7 years (females). In 1999 the mean age was 74.5 years (males) and 79.9 years (females). In 2011, males spent 0.6% of their life expectancy in ILTC, females 1.4%. In 1999, this share was 0.4% (males) and 1.2% (females). CONCLUSIONS: The utilisation of ILTC needs to be monitored by meaningful key figures over time. The length of stay, as proposed here, provides information on life expectancy and ILTC prevalence collapsed into one measure. This article reports the length of stay and substantiates its increase over time (in women, the increase ended in 2007). It is recommended to regularly update the time series by using official statistics.