Investigating municipal and company influences on employment of people with chronic health conditions.

AIMS: In many countries, people with chronic health conditions have a weaker attachment to the labour market and fewer chances of re-employment. Much of the existing literature estimates the importance of institutional factors at the level of the municipality of residence or employer accommodation at the company level individually. This study examined the two levels simultaneously to disentangle the separate effects of municipal-level and of company-level factors. METHODS: Using full population data from Denmark, we estimated cross-classified multilevel models for people newly diagnosed with chronic conditions in 2010-2013 (more than 60,000 individuals in 20,000 companies). We tracked their employment outcomes for up to 5 years after diagnosis. RESULTS: The findings suggest that, in the short term, factors at the company level explain differences in the employment levels of individuals with chronic conditions more than institutional factors at the municipal level. A combination of average wage, company-level seniority, company size, and industry seem to explain much of company-level influence. In the longer term, the importance of company-level factors seemed to decline. Company-level factors explained blue collar workers' employment rates better than those of white collar workers, which is in line with the notion that blue collar workers expend more physical effort in their work so that they may be more reliant on company accommodation than white collar workers in the case of chronic conditions. CONCLUSIONS: Company-level factors affected the employment of persons newly diagnosed with chronic health conditions in the short term (in particular among workers in blue collar jobs), while municipal-level factors did not.

Oral health promotion and labour market prospects of socially disadvantaged and unemployed people - a randomised controlled trial.

BACKGROUND: Previous studies indicate that poor oral health may constitute a barrier for labour market success. This study examines whether an oral health promotion intervention has an effect on economic self-support, and proximity to the labour market, among socially disadvantaged unemployed people. METHODS: From April-June 2018, we enrolled 273 vulnerable people on welfare benefits into a randomised controlled trial. Participants were allocated to either control (n=159), or intervention (n=114). Intervention consisted of individual support to improve individuals' oral health by reducing significant barriers to dental care. Ten participants were excluded, leaving 263 participants (intervention n=110, control n=153) for analyses. A national register was used to assess economic self-support and proximity to the labour market within 1.5 years post-intervention. Items of information on health and socio-demographics were obtained from a questionnaire and from national registers. Logistic and multiple linear regression modelling was performed. RESULTS: Overall, higher frequencies of economic self-support and proximity to the labour market were found in the intervention group, although no significant results were seen for economic self-support alone. Adjusted models revealed significantly higher odds (odds ratio=1.85, 95% confidence interval 1.08-3.17) among the intervention group of achieving proximity to the labour market after 12 months. After 18 months, the intervention group had on average obtained 5 more weeks (95% confidence interval 0.02-9.99) with proximity to the labour market. CONCLUSIONS: Overall, the oral health promotion intervention had a positive effect on proximity to the labour market in the intervention group, especially within the first year of the study. Our findings suggest that interventions promoting oral health among socially disadvantaged and unemployed groups may contribute to social rehabilitation.