Sociodemographic Factors and Adjustment of Daily Activities During the COVID-19 Pandemic - Findings from the SHARE Corona Survey.

In the wake of the COVID-19 pandemic in 2020, older people across Europe have adjusted their daily activities as personal risk avoidance and as an amendment to policy recommendations and restrictions. In this study, we use multilevel logistic regressions to examine to what extent sociodemographic factors are associated with activity reduction among the older population (50+) in Europe and whether these associations are moderated by governmental policy responses to COVID-19. By combining data for~35,000 respondents from the SHARE Corona Survey on reported changes in daily activities and stringency of restrictions at the national level, we find that older age, poorer health and being female versus male were (consistently) associated with greater activity reduction across all activities both in countries with weak and in those with strong restrictions. Associations between education, employment and living situation, on the one hand, and activity reduction, on the other, were weaker and less consistent. We conclude that differences between sociodemographic groups are rather similar for countries with weak and those with strong restrictions and hence argue that group-specific policy recommendation are relevant independent of stringency recommendations.

The Persistence of High Levels of Living Alone Among Adults with Disabilities in Sweden, 1993-2011.

This study investigates how the probability to live alone has developed among working age individuals with and without disabilities in Sweden during the period 1993-2011 when extensive political reforms to improve the integration of disabled individuals in society were implemented. The results show that individuals with disabilities are approximately twice as likely to be living alone when compared to individuals without disabilities. People with disabilities were also more likely to report low life satisfaction, and this was especially true among individuals with disabilities living alone. Men and women with disabilities also tend to experience longer periods of living as a one-person household than non-disabled people. Over time we find no indications of reduced differences in family outcomes between disabled and non-disabled individuals but rather evidence to the contrary. These differences are interpreted as being the result of the disadvantage disabled individual's experience in the partner market and that people with disabilities are less successful in forming partnerships that can lead to cohabitation and family formation. The results thus show how disabled individuals still face societal barriers that limit their possibilities to find and sustain relationships that result in stable cohabitation despite increased efforts to improve their inclusion in Swedish society.

Industry mobility and disability benefits in heavy manual jobs: A cohort study of Swedish construction workers.

Objectives This study aimed to investigate whether change from the construction industry to work in other industries at age 45-55 years lowered risks of disability benefits (DB) later in life (60-64 years of age). We hypothesized that risks would be lowered the most among those changing from the heaviest occupations. Methods The study included men employed in the construction industry during 1971-1993. We selected workers from the largest occupational groups in heavy (concrete workers and painters) and less heavy (drivers, electricians and foremen) occupations. The occurrence of DB in 1990-2015 was retrieved from national registers. Regression analyses were used to calculate relative risks (RR) of DB at 60-64 years, comparing those working in other industries to those still in the construction industry at the age of 45, 50 and 55 years. Results Shifting out of from the construction industry was related to lowered DB risks at 60-64 years in all selected occupations. Effects were most pronounced among those who, at 55 years of age, worked in an industry other than construction, with significantly reduced RR for DB among concrete workers [RR 0.63, 95% confidence interval (CI) 0.51-0.77], electricians (RR 0.61, 95% CI 0.47-0.77) and foremen (RR 0.78, 95% 0.63-0.96). Conclusions Risks for DB at 60-64 years of age were reduced among those who changed from construction work to other industries. Notable reductions were observed among workers originating from both heavy and less heavy occupations, and future studies should explore other factors, in addition to heavy workload, as motivators for leaving the construction industry.

Impact of changes in welfare legislation on the incidence of disability pension. A cohort study of construction workers.

Aims: Study objectives were to investigate how changes in social insurance legislation influenced the incidence of disability pension. Methods: The study included 295,636 male construction workers who attended health examinations between 1971 and 1993, aged 20-60 years and without previous disability pension. Via the Swedish National Insurance Agency national register we identified 66,046 subjects who were granted disability pension up until 2010. The incidence rates were calculated and stratified according to age and diagnosis. Results: The incidence rate of disability pension was fairly stable until the 1990s when large variations occurred, followed by a strong decreasing trend from the early 2000s to 2010. Trends in incidence rates, stratified by age and diagnosis, showed a consistent decrease in cardiovascular disease for all age groups. In subjects aged 30-49 years there was a high peak around 2003 for musculoskeletal diseases and psychiatric diseases. For the age group 50-59 years, musculoskeletal diagnosis, the most common cause of disability pension, had a sharp peak around 1993 and then a decreasing trend. In the 60-64 age group, the incidence rate for psychiatric diagnosis was stable, while incidence rates for musculoskeletal diagnosis varied during the 1990s. Conclusions: There are considerable variations in the incidence rate of disability pension over time, with different patterns depending on age and diagnosis. Changes in social insurance legislation, as well as in administration processes, seem to influence the variation.

Mortality in persons with disability pension due to common mental disorders: A cohort study of Swedish construction workers.

Aims: This study investigated mortality in disability pensions due to common mental disorder, and variation over time after first receiving disability pension. Methods: Objectives were explored in 301,863 construction workers (97.2% men) recruited through healthcare examinations from 1971-1993. By linking with the Swedish National Insurance Agency registers, disability pensions until 2014 were identified. Common mental disorder was defined as disability pension diagnosis due to anxiety, stress-related disorders or moderate depression. Mortality was calculated in all-psychiatric diagnosis and diagnostic sub-groups, and compared to persons without disability pensions, using Poisson regression. Additional analyses were stratified by age at follow-up. Results: In total 6030 subjects received disability pensions based on psychiatric diagnoses, and 2624 constituted common mental disorder. Analyses in an all-psychiatric diagnosis displayed increased mortality risks in men (relative risk 3.6; 95% confidence interval 3.3-3.9) and women (relative risk 2.1; 95% confidence interval 1.6-2.6). Common mental disorder was associated with mortality, especially in men (relative risk 2.5; 95% confidence interval 2.2-2.8). Increased relative risks in alcohol and substance abuse were also observed. Results in analyses stratified by age at follow-up displayed persistent high relative risks for mortality in older ages (75-89 years) in men in all-psychiatric disability pensions diagnosis (relative risk 2.8; 95% confidence interval 2.1-3.7) and common mental disorder diagnosis (relative risk 2.6; 95% confidence interval 1.8-3.6), compared to men without disability pensions. Similar results were found in women, but few cases lowered the precision of estimates. Conclusions: This study shows that disability pension based on common mental disorders, often regarded as a 'lighter' psychiatric diagnosis, is a risk for early mortality in construction workers, even several years after first receiving disability pension.

Heavy work and disability pension - a long term follow-up of Swedish construction workers.

OBJECTIVES: The objective of this study was to investigate the occurrence of disability pensions over time among workers with physically demanding jobs. METHODS: The occurrence of disability pension was prospectively studied between 1980-2008 among 325 549 Swedish construction workers. The risks for disability pension and years lost of working life were compared among 22 occupational groups, adjusting for age, body mass index, height, and smoking habits. RESULTS: The risk varied considerably among blue-collar workers. For example, rock workers had double the risk of disability pension [relative risk (RR) 2.16, 95% confidence interval (95% CI) 1.96-2.39] compared to electricians. Most working years lost due to disability pensions (about 75%) were found among men >50 years, mainly due to musculoskeletal and cardiovascular diseases. The years of working life lost due to disability pension varied from 0.7 (salaried employees) to 3.2 years (rock workers) among occupational groups. CONCLUSION: Work environment is an important predictor for disability pension among construction workers with those in physically heavy jobs having the highest burden of disability. If the purpose is to increase labor force participation for workers with heavy jobs, strategies to reduce physical demands at work among elderly workers are important.

Poor health, unhealthy behaviors, and unfavorable work characteristics influence pathways of exit from paid employment among older workers in Europe: a four year follow-up study.

OBJECTIVES: The aim of this study was to get insight into the role of poor health, unhealthy behaviors, and unfavorable work characteristics on exit from paid employment due to disability pension, unemployment, and early retirement among older workers. METHODS: Respondents of the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE) in 11 European countries were selected when (i) aged between 50 years and the country-specific retirement age, (ii) in paid employment at baseline, and (iii) having information on employment status during the 4-year follow-up period (N=4923). Self-perceived health, health behaviors, and physical and psychosocial work characteristics were measured by interview at baseline. Employment status was derived from follow-up interviews after two and four years. Cox proportional hazards regression analyses were used to identify determinants of unemployment, disability pension, and early retirement. RESULTS: Poor health was a risk factor for disability pension [hazard ratio (HR) 3.90, 95% confidence interval (95% CI) 2.51-6.05], and a lack of physical activity was a risk factor for disability pension (HR 3.05, 95% CI 1.68-5.55) and unemployment (HR 1.84, 95% CI 1.13-3.01). A lack of job control was a risk factor for disability pension, unemployment, and early retirement (HR 1.30-1.77). CONCLUSIONS: Poor health, a lack of physical activity, and a lack of job control played a role in exit from paid employment, but their relative importance differed by pathway of labor force exit. Primary preventive interventions focusing on promoting physical activity as well as increasing job control may contribute to reducing premature exit from paid employment.

Leaving the labour market: the impact of exit routes from employment to retirement on health and wellbeing in old age.

The study analyses whether and to what degree specific routes into retirement affect older people, i.e. the relationship between heterogeneous exit patterns and post-retirement health and wellbeing. We used longitudinal data from two points in time; data related to t0 were collected in 1993, 1994, 1995 and 1996 and data related to t1 were collected in 2002 and 2003 (N = 589). We focused on older people (55+ at t1) who were employed at t0 and retired at t1. We used confirmative factor analysis to identify identical measures of health and wellbeing at both t0 and t1. Hence, we were able to control for pre-retirement health and wellbeing when evaluating the effects of different exit routes. These routes were defined as dependence on incomes from sickness benefit, disability pension, part-time pension, unemployment insurance and active labour market programmes. Our initial structural equation model showed a clear relation between exit routes and post-retirement wellbeing. People who prior to retirement were pushed into social benefit programmes related to health and unemployment were significantly worse off as retirees, especially those with health-related benefits. However, these relationships disappeared once pre-retirement wellbeing was added to the model. Our main conclusion is that post-retirement wellbeing first and foremost is a consequence of accumulation of advantages and disadvantages during the life course. Both labour market exit routes and post-retirement wellbeing can be seen as outcomes of this process. There are no independent effects of the retirement process. Judging from our findings, there is no reason to believe that involvement in social security programmes allowing early retirement on health grounds has any additional negative consequences for health and wellbeing.

Timing of retirement and mortality--a cohort study of Swedish construction workers.

Recent studies indicate that early retirement per se may have a negative effect on health to such an extent that it increases mortality risk. One type of early retirement often referred to in these studies is retirement with disability pension/benefit. Given the overall objective of disability benefit programmes--to help the disabled live socially and economically satisfactory lives, freed from exposure to employment health hazards and thus avoid further declines in health--the finding is challenging. This paper examined the relationship between timing of retirement and mortality using a cohort of Swedish construction workers. The mortality risk of disability pensioners--excluding those with diagnoses normally connected to increased mortality--was compared with the risk of those continuing to work. Although initial indications were in line with earlier results, it became obvious that the increased mortality risk of disability pensioners did not depend on early retirement per se but on poor health before early retirement not explicitly recognized in the diagnosis on which the disability pension rested. The results indicate that there are no general differences in mortality depending on timing of retirement. Future studies of mortality differences arising from working or not working must sufficiently control for health selection effects into the studied retirement paths.

Occupation, work environment, and disability pension: a prospective study of construction workers.

AIMS: This study investigated the importance of occupation and work environment for the risk of disability pension among construction workers in Sweden. METHODS: The data include around 389,000 construction workers who participated in health examinations from 1971 to 1992. During that period 68,000 participants received disability pension in some form. Between 1985 and 1992 questionnaires were used to collect data regarding hazards in the work environment. Some 87,000 participants answered that questionnaire, and almost 6,000 of these were in receipt of a disability pension. To analyse the risk of disability pension in different occupations, incidence rates (SIR) were calculated according to the person-year method. Logistic regression was used to calculate age-controlled odds ratios according to physical and psychosocial work environment factors. RESULTS: The results show considerable variation in risk for disability pension between different occupations within the construction industry. Furthermore, analysis of work environment factors indicated associations with physical, ergonomic, and psychosocial work environment factors. DISCUSSION: A considerable variation between occupations indicates that characteristics in the work situation are important when explaining the risk of disability pension. The results from this study indicate that improvements in working conditions are an important area of intervention in order to facilitate and prolong labour market participation among elderly people.