Chronic conditions and self-perceived health among older employees in relation to indicators of labour participation and retirement over time.

BACKGROUND: A significant proportion of older employees leave the labour market early, amongst others via unemployment or disability benefits, implying that health might affect possibilities to extend working life. OBJECTIVE: This study 1) examined associations between chronic conditions (subtypes) and self-perceived health (SPH), independently, and indicators of labour participation and retirement over six-year follow-up among older employees, and 2) explored the impact of differences between prevalent and incident presence of chronic condition(s) in this relation. METHODS: Older workers (aged > 45 years) included in the Maastricht Cohort Study were studied (n = 1,763). The Health and Work Performance Questionnaire assessed chronic conditions and one item from the Short Form health survey-36 assessed SPH. Cox regression analyses assessed associations between chronic conditions and SPH, independently, and retirement intentions, employment status, decreasing working hours, and changes in work over time. RESULTS: Employees with coexistent physical-mental chronic conditions showed higher risks to lose employment and to receive a disability benefit (HR 1.85, 95% CI 1.23-2.78; HR 8.63, 95% CI 2.47-30.11) over time compared to healthy employees. No statistically significant associations were found between SPH and indicators of labour participation and retirement over time. Having chronic condition(s) was cross-sectionally associated with lower SPH scores and larger proportion of part-timers -compared to healthy employees. CONCLUSIONS: Chronic condition(s) among older employees were substantially associated with indicators of labour participation and retirement over time. The role of SPH was mainly instantaneous. Findings provide valuable input for preventive measures aiming to prevent an early labour market exit of older employees.

Efficacy of an indicated prevention strategy on sickness absence and termination of the employment contract: a 5-year follow-up study.

OBJECTIVE: It was shown that an indicated prevention strategy (IPS), based on screening and early intervention, can considerably decrease future risk of long-term sickness absence (LTSA>28 days) over one year. Given the nature of the interventions, the potential of an effect extending beyond the original one year of follow-up might be present. This study aims to determine the efficacy of this IPS on LTSA and termination of employment contract over five years by extended follow up of IPS trials. METHODS: Company records on sickness absence and termination of employment contract over five years were used from two randomized controlled trials (RCT) on the efficacy of the IPS (RCT I employees at high-risk for LTSA: intervention: N=263; RCT II high-risk employees with concurrent mild depressive complaints: intervention: N=139). Survival analysis was used to model time until the first LTSA episode and termination of employment contract. RESULTS: RCT I showed a decrease of 43.2 days of sickness absence (P=0.05) and a lower 5-year risk of LTSA in the intervention, as compared to the control group [hazard ratio (HR) 0.61, 95% confidence interval (CI) 0.41-0.90], however no considerable impact on employment contract (HR 0.85, 95% CI 0.54-1.35) (intention-to-treat, ITT). For RCT II, we found no large difference in days of SA and no difference in LTSA risk over five years (HR 1.31, 95% CI 0.70-2.47), whereas the risk of termination of the employment contract was lower (HR 0.62, 95% CI 0.39-0.99) (ITT). CONCLUSION: Effects of the IPS were observed over five years, albeit differential between the two approaches. A combination of elements of both interventions might lead to optimal results but needs further study.

Work-family conflict and depressive complaints among Dutch employees: examining reciprocal associations in a longitudinal study.

Objectives The aim of this study was to examine the reciprocal association between work-family conflict and depressive complaints over time. Methods Cross-lagged structural equation modeling (SEM) was used and three-wave follow-up data from the Maastricht Cohort Study with six years of follow-up [2416 men and 585 women at T1 (2008)]. Work-family conflict was operationalized by distinguishing both work-home interference and home-work interference, as assessed with two subscales of the Survey Work-Home Interference Nijmegen. Depressive complaints were assessed with a subscale of the Hospital Anxiety and Depression scale. Results The results showed a positive cross-lagged relation between home-work interference and depressive complaints. The results of the χ 2difference test indicated that the model with cross-lagged reciprocal relationships resulted in a significantly better fit to the data compared to the causal (Δχ 2(2)=9.89, P=0.001), reversed causation model (Δχ 2(2)=9.25, P=0.01), and the starting model (Δχ 2(4)=16.34, P=0.002). For work-home interference and depressive complaints, the starting model with no cross-lagged associations over time had the best fit to the empirical data. Conclusions The findings suggest a reciprocal association between home-work interference and depressive complaints since the concepts appear to affect each other mutually across time. This highlights the importance of targeting modifiable risk factors in the etiology of both home-work interference and depressive complaints when designing preventive measures since the two concepts may potentiate each other over time.

Impact of Development and Accommodation Practices on Older Workers' Job Characteristics, Prolonged Fatigue, Work Engagement, and Retirement Intentions Over Time.

OBJECTIVE: The impact of development and accommodation practices on older workers' retirement intentions was investigated in this prospective study, together with potential pathways and the role of career stage. METHODS: A subsample of full-time, older workers (n = 678) from the Maastricht Cohort Study was followed-up for 2 years. Regression analysis was conducted for three age groups. RESULTS: Development practices related positively with later retirement intentions in workers aged 55 to 59 years. The accommodation practice of demotion related negatively with later retirement intentions in worker aged at least 60 years. Decision latitude and work engagement were found to link development and accommodation practices with later retirement intentions in particular in workers aged 55 to 59 years. CONCLUSIONS: It was indicated in this prospective study that development and accommodation practices may be useful for prolonging working careers.

Cancer mortality in workers exposed to dieldrin and aldrin: over 50 years of follow up.

OBJECTIVE: Dieldrin and aldrin, pesticides widely used until the 1970s, have been under suspicion of being carcinogenic. In this study, overall and cause-specific mortality was assessed in a cohort of 570 employees occupationally exposed to the pesticides dieldrin and aldrin to investigate the long-term health effects, in particular carcinogenic effects. METHODS: All of the employees worked in the production plants between January 1954 and January 1970 and were followed for cause-specific mortality until 30 April 2006. Based on dieldrin levels in blood samples taken from 343 workers during the exposure period, the total intake of dieldrin was estimated for each individual subjects in the cohort. The estimated total intake ranged from 11 to 7,755 mg of dieldrin, with an average of 737 mg. RESULTS: Two hundred and twenty-six workers had died before 30 April 2006 compared with an expected number of 327.3, giving a standardized mortality ratio (SMR) of 69.0 (95% confidence interval (CI): 60.3-78.7). Overall cancer mortality was also significantly lower than expected (SMR: 76.4, 95% CI: 60.8-94.9). Also, none of the specific cancer sites showed a significant excess mortality and no association between exposure level and cancer mortality was found. CONCLUSION: The results from this study support findings from other epidemiological and recent animal studies concluding that dieldrin and aldrin are not likely human carcinogens.

Leukemia risk in caprolactam workers exposed to benzene.

PURPOSE: To investigate the leukemia risk in a group of benzene exposed workers. METHODS: We conducted a retrospective cohort mortality study on 311 men who worked between January 1, 1951 and December 31, 1968 in a Caprolactam plant in the Netherlands. In the production of Caprolactam (the Nylon 6 monomer) pure benzene is used as an extracting agent and the workers at this plant have been exposed to substantial concentrations of benzene. The cohort was followed for mortality until January 1, 2001. The total mortality was below the expected number, which was mainly caused by a deficit of cardiovascular disease mortality. RESULTS: In the total group, there was one death from leukemia, compared with an expected number of 1.17. Despite the substantial exposures to benzene (on average 159 ppm-years per person) there was no indication for increased leukemia mortality within the cohort. We have applied earlier quantitative risk assessments to our cohort and conclude that some of these assessments overestimate the risk observed in our cohort of Caprolactam workers.

Mortality update of workers exposed to acrylonitrile in The Netherlands.

To study the possible carcinogenic effects of acrylonitrile, we updated the follow up of a cohort of 2842 acrylonitrile workers. The comparison group consisted of 3961 workers from a nitrogen fixation plant. Industrial hygiene assessments quantified past exposure to acrylonitrile, 8-hour averages as well as peak exposure, the use of personal protective equipment, and exposure to other potential carcinogenic agents. Standardized mortality ratios were calculated to adjust for the effect of age distribution, length of follow up, and temporal changes in background mortality rates. Cumulative dose-effect relations were determined for 3 exposure categories and 3 latency periods. The results show that no cancer excess seems related to exposure to acrylonitrile. This additional follow up of a cohort of 2842 workers exposed to acrylonitrile further supports the notion that occupational exposures to acrylonitrile that have occurred in the past have not noticeably increased workers' cancer mortality rates.

Cancer mortality in a cohort of licensed herbicide applicators.

OBJECTIVES: In order to expand our knowledge on the possible long-term health effects of exposure to herbicides, we updated the follow-up of a cohort of 1341 licensed herbicide applicators in the Netherlands. The earlier report indicated that there might be an increased risk for multiple myeloma in this group. Although that finding was statistically significant, the result was based on a small number of cases. METHODS: We expanded the follow-up from 1 January 1988 to 1 January 2001, which added 13 years to the follow-up. We now report on the causes of death of 196 exposed workers. RESULTS: Our findings indicate that licensed herbicide applicators were at an increased risk for skin cancer mortality [standardized mortality ratio (SMR)=357.4, 95% confidence interval (CI) 115.1-827.0]. It is not clear if this excess of skin cancer should be attributed to herbicide exposure or to excess exposure to sunlight.

Cancer mortality in workers exposed to dieldrin and aldrin: an update.

This study was conducted to investigate the possible long-term health effects, in particular carcinogenic effects, of occupational exposure to the organochlorine insecticides dieldrin and aldrin. We updated an earlier cohort mortality study of 570 employees involved in the production of these insecticides. All of the employees had worked in the production plants between 1 January 1954 and 1 January 1970 and were followed for cause-specific mortality until 1 January 2001. Based on dieldrin levels in blood samples taken during the exposure period, available for 343 workers, individual estimates of the total intake of dieldrin were estimated for all individual subjects in the cohort. The estimated total intake ranged from 11 to 7755 mg of dieldrin, with an average of 737 mg. One hundred and seventy-one workers had died before 1 January 2001, compared with an expected number of 226.6, giving a standardized mortality ratio (SMR) of 75.6 [95% confidence interval (CI): 64.6-87.7]. This deficit in total mortality was mainly attributable to a deficit in cardiovascular disease mortality, but cancer mortality was also lower than expected. The observed number of deaths from rectal cancer was significantly higher than expected (SMR = 300.0; 95% CI: 109.5-649.3), but was most pronounced in the low-intake subgroup and appears to be unrelated to exposure to dieldrin and aldrin. This study reinforces the earlier findings that occupational exposure of workers to significant amounts of dieldrin and aldrin has not led to a higher cancer mortality than would be found in an unexposed population.