Are dental care records in childhood associated with financial hardship in adulthood?

INTRODUCTION: Previous studies show that dental health is associated with educational and labour market outcomes, but it is unclear whether dental care records in childhood can serve as early markers of financial hardship risk in adulthood. METHODS: Data on sociodemographic variables and dental records of all children born in Finland and who lived their childhood in the city of Espoo were obtained from national registers (n=1867). Debt defaults at the age of 23 years were used as a measure of adulthood financial hardship. Caries recorded in dental check-ups and unnotified absence from dental appointments in childhood were derived from electronic health systems. Logistic regression models were fitted to investigate the extent to which these variables were associated with financial hardship in adulthood before and after adjusting for parental social assistance use. RESULTS: The odds of adulthood debt defaults were higher for people with caries before the age of 13 years (odds ratio 1.37, compared with people without) and for people with significant caries multiple times (odds ratio 2.07). Unnotified absences from dental checks were strongly associated with debt defaults. These associations were substantially reduced after adjusting the models for parental social assistance use. CONCLUSIONS: The association between childhood dental care records and adulthood financial hardship mainly reflects the fact that parental socioeconomic status links to dental records. Nevertheless, data from dental care could be used in targeting appropriate measures to prevent financial hardship later in life.

The increasing association between child poverty and children in out-of-home care - an ecological longitudinal analysis of Finnish municipalities in the period 1992-2021.

BACKGROUND: International evidence indicates that child poverty increases the risk of child welfare intervention needs but Finland, paradoxically, has low child poverty rates and high child welfare intervention rates. We investigate the extent to which the rate of social assistance use in families with children, as a proxy for child poverty, can be associated with the rate of children in out-of-home care in Finnish municipalities. METHODS: Data on the annual rate of social assistance use and out-of-home care were drawn from national registers for 216 Finnish municipalities from 1992 to 2021. Linear regression models were utilised to investigate the extent to which the social assistance use rate explained child out-of-home care rates, both spatially and temporally, across municipalities and years while adjusting for the unemployment rate. RESULTS: The rate of out-of-home care increased from some 700 to 1600 per 100,000 children over the period 1992-2021. A percentage point higher rate of the social assistance use was associated with 44-72 more children placed in out-of-home care per 100,000 children, net of the unemployment rate. This association was stronger in more recent time periods. A smaller association was observed within municipalities over time: a percentage point increase in social assistant use was linked to some 4-25 more children placed in out-of-home care per 100,000 children. CONCLUSION: Out-of-home care is increasingly concentrated in Finnish municipalities with high rates of families receiving social assistance. Preventative child welfare interventions are therefore required in areas with higher rates of economic difficulties among families.

Contribution of parental health to the subsequent social assistance entry of the family with children: a nationwide register-linked birth cohort study in Finland.

AimOur aim in this paper was to estimate the contribution of different parental specialised health care diagnoses to the subsequent risk of entry into the social assistance system for families with children in the period 1998-2013. METHODS: We used longitudinal population-level register data consisting of all children born in 1997 in Finland and their registered parents (54 960 one and two-parent families with 801 336 observations in the period 1998-2013). Diagnoses assigned in public specialised healthcare and social assistance records were derived from nationwide administrative registers. Measures of parental socioeconomic status and previous diagnoses and the birth weight of the child were adjusted for in regression models which estimated the association between parental diagnoses and entry into the social assistance system in the following year. RESULTS: Families with a parent somatic diagnosis had a risk ratio of 1.4 for social assistance entry in the subsequent year of the diagnosis though substantial variation by diagnosis category was detected. Parent psychiatric diagnoses were linked to a higher, 3.01-fold risk of social assistance entry. Covariate adjustment reduced these risk ratios to 1.2 and 2.1, respectively. Some 2.9% of all social assistance entries may be attributed to parental psychiatric diagnoses while somatic health records account for another 7.2%, making their total contribution over 1/10th of all cases. CONCLUSION: Parental specialised healthcare records were associated with a higher risk of social assistance need. Thus more interventions to support financial management are required for parents with psychiatric diagnoses.

Psychiatric and neurodevelopmental diagnoses in adolescence and adulthood over-indebtedness among Finns born in 1987.

BACKGROUND: Adolescence psychiatric and neurodevelopmental diagnoses are common but their link to adulthood over-indebtedness is unknown. This study aims to determine this relationship and explores the possible mediating role of upper secondary education completion. METHODS: We analyzed the 1987 Finnish Birth Cohort, which consisted of a complete census of children born in Finland in 1987 and registered in the Medical Birth Register (n = 53 743). Records of debt payment defaults, at the age of 33, were used as a measure of over-indebtedness. Adolescent psychiatric and neurodevelopmental diagnoses at ages 13-17 were derived from the national hospital discharge register. Inverse probability treatment weighting was used to investigate the role of pre-exposure variables in this relationship, and the mediating role of upper secondary education completion. RESULTS: Compared to unexposed individuals, those affected by an adolescent psychiatric or neurodevelopmental diagnosis had a 15 percentage points higher prevalence of over-indebtedness in adulthood. This association was more common for males and was additionally notably strong for suicidality and conduct and oppositional disorders. Controlling for measured potential confounding factors, the diagnoses were linked to a 11-percentage point (95% confidence interval 9-12) higher risk of over-indebtedness. Completing at least upper secondary education reduced this effect by some 39%. CONCLUSION: People with psychiatric and neurodevelopmental disorders diagnosed in adolescence are at elevated risk of over-indebtedness in adulthood. Recognizing this high risk may help in efforts to prevent further debt problems. Better education may serve as a protective factor against over-indebtedness and perhaps similar other behavioural consequences.

Election promises on children's wellbeing and health 2015 to 2021 - a study of Finnish voting advice applications database.

BACKGROUND: According to the UN Convention on the Rights of the Child, children's views should be heard in policymaking. But it remains unclear to what extent children's wellbeing is considered in election promises. METHODS: We investigated the extent to which Finnish political candidates consider children and their wellbeing in their election promises. We used YLE, the national broadcaster's voting advice application database, and analysed some 35,000 politicians' election promises made in the 2015 and 2019 parliamentary and the 2017 and 2021 municipal elections. We calculated the proportion of candidates who mentioned children and examined the content of the election promises in which children were mentioned. Logistic regression models were used to examine the role of the background of the characteristics of candidates. RESULTS: In the 2015 and 2019 elections, some 12% and 19% of candidates, respectively, mentioned children in their election promises. The figures for the 2017 and 2021 municipal elections were higher at 19% and 24%, respectively. In the 2021 election, the candidates considering children in their election promises were younger and had higher education qualifications. Inspection of a random set of 350 promises indicated that common issues mentioned in respect of children were education and hobby activities. Concrete proposals to improve the wellbeing of children were rarely put forward. CONCLUSIONS: Political candidates are increasingly considering children in their election promises but concrete proposals to improve the wellbeing and health of children are rare. Effective policy solutions to improve the health of children should be discussed in election debates.

Pain in Multiple Sites and Clusters of Cause-Specific Work Disability Development among Midlife Municipal Employees.

This study investigates to what extent pain in multiple sites and common risk factors related to work environment, occupational class and health behaviours are associated with cause-specific work disability (WD) development clusters. The study population was derived from the Finnish Helsinki Health Study (n = 2878). Sequence analysis created clusters of similar subsequent cause-specific WD development in an eight-year follow-up period. Cross-tabulations and multinomial logistic regression were used to analyze the extent to which baseline factors, including pain in multiple sites, were associated with the subsequent WD clusters. A solution with five distinct WD clusters was chosen: absence of any WD (40%), low and temporary WD due to various causes (46%), WD due to mental disorders (3%), WD due to musculoskeletal (8%) and WD due to other causes (4%). Half of the employees in the musculoskeletal WD cluster had pain in multiple locations. In the adjusted model the number of pain sites, low occupational class and physical working conditions were linked to the musculoskeletal WD. The identified characteristics of the different WD clusters may help target tailored work disability prevention measures for those at risk.

Indicators and determinants of the years of working life lost: a narrative review.

OBJECTIVE: This narrative review summarizes the available indicators for working life expectancy and years of working life lost (YWLL) and their determinants. METHODS: We searched PubMed and Embase databases from their inception until August 2020 and screened all studies proposing an indicator for working life expectancy or YWLL. We also reviewed studies focusing on sociodemographic, lifestyle and work-related determinants of working life expectancy and YWLL. The results were synthesized narratively. RESULTS: We identified 13 different indicators for the length of working life or YWLL. The most frequently used indicators were 'working life expectancy', 'healthy working life expectancy', and YWLL. Working life expectancy and healthy working life expectancy are longer for men than women. Working life expectancy at the age of 50 has been increasing since the mid-90s, and the increase has been larger for women, reducing the sex difference. Working life is shorter for people with a low level of education, in lower occupational classes, for people exposed to high physical work demands, those living in the most socioeconomically deprived areas, people with overweight or obesity, smokers, people who are inactive during leisure time and in people with a chronic health problem. CONCLUSIONS: Despite increasing interest in understanding the determinants of YWLL, only a few studies have simultaneously considered multiple exit routes from the labour market. We propose a new measure for total YWLL considering all relevant exit routes from employment. This comprehensive measure can be used to assess the effect of given policy changes on prolonging working life.

Predictors of working days lost due to sickness absence and disability pension.

OBJECTIVE: To identify social and health-related predictors of the number of days lost due to sickness absence (SA) and disability pension (DP) among initially 55-year-old public-sector workers. METHODS: The data from the Finnish Helsinki Health Study included participants aged 55 years at the baseline (in 2000-2002, N = 1630, 81% women), and were enriched with register-based information on SA and DP. The cumulative number of calendar days lost due to SA ≥ 1 day or DP between ages 55 and 65 was calculated. Negative binomial regression model was used to identify the predictors of days lost. RESULTS: The average calendar days lost was 316 days (about 220 working days) during a 10-year follow-up, and 44% were due to SA and 56% due to DP. Smoking [incidence rate ratio (IRR) = 1.19, 95% CI 1.01-1.40 for past and IRR = 1.30, CI 1.07-1.58 for current], binge drinking (IRR = 1.22, CI 1.02-1.46), lifting or pulling/pushing heavy loads (IRR = 1.35, CI 1.10-1.65), awkward working positions (IRR = 1.24, CI 1.01-1.53), long-standing illness limiting work or daily activities (IRR = 2.32, CI 1.93-2.79), common mental disorder (IRR = 1.52, CI 1.30-1.79), and multisite pain (IRR = 1.50, CI 1.23-1.84) increased the number of days lost, while high level of education (IRR = 0.66, CI 0.52-0.82) and moderate level of leisure-time physical activity (IRR = 0.80, CI 0.67-0.94) reduced the number of days lost. CONCLUSIONS: Modifiable lifestyle risk factors, workload factors, common mental disorder, and multisite pain substantially increase the number of days lost. However, the findings of this study could be generalized to female workers in the public sector. Future research should also consider shorter SA spells in estimating working years lost and working life expectancy.

Debt matters? Mental wellbeing of older adults with household debt in England.

BACKGROUND: A record number of older individuals have household debt, but little is known about possible links between debts and their mental wellbeing. This study examines the extent to which different aspects of household indebtedness predict mental wellbeing among this population. METHODS: A sample of 17,091 individuals (72,700 observations) aged 50 and over in England was derived from waves 1-8 of the English Longitudinal Study of Ageing. Mental wellbeing was assessed by two outcome measures: number of depressive symptoms (CES-D 8) and quality of life (CASP-19 score). The predictors of mental wellbeing were examined using quartiles of non-zero overall debt amount, debt-to-income and debt-to-non-housing wealth ratios as alternative measures of debt burden. Linear regression models estimated the associations of mortgage and non-mortgage debt measures with mental wellbeing while adjusting for observable socioeconomic confounding factors. Individual fixed effect models were used to control for all time-constant factors among a longitudinal subsample. RESULTS: Individuals in the highest debt-to-wealth quartile were particularly at risk of lower mental wellbeing, that is, a higher number of depressive symptoms and lower quality of life. After covariate adjustment, non-mortgage debt predicted lower mental wellbeing on both measures but mortgage debt was only linked to lower quality of life. Among the subsample who experienced changes in high non-mortgage debt levels, a small association of these changes with mental wellbeing outcomes were observed. Asymmetric within-individual estimation showed that both getting rid of and acquiring new debts during the study period predicted symmetrically (small) increases and decreases, respectively, in mental wellbeing. CONCLUSION: These findings indicate that among older individuals in England, non-mortgage debt status is linked to poor mental wellbeing. High, non-mortgage, debt-to-wealth ratios may help identify risk of mental wellbeing issues in older people with debts.

Who maintains good health functioning? The contribution of social, work-related and behavioural factors to mental and physical health functioning trajectories in ageing employees.

OBJECTIVES: The determinants of poor functioning and subsequent early exit from work are well established but very little is known about the positive determinants of maintaining good functioning among the ageing workforce. We investigated modifiable determinants of maintaining good mental and physical health functioning. METHODS: We used prospective survey data collected across four waves among the midlife employees of the City of Helsinki, Finland, 2000-2017 (n=3342). Health functioning was repeatedly measured using the Short Form 36 (SF-36) inventory. Trajectories of mental and physical health functioning were separately examined using group-based trajectory analysis. Multinomial logistic regression models were fitted to examine determinants of each trajectory. RESULTS: Four trajectory solutions for the developmental patterns in health functioning during the follow-up period were selected, with a slightly different shape of the first trajectory for mental and physical functioning: (1) continuously low (mental), low and decreasing (physical), (2) increasing, (3) decreasing and (4) continuously high functioning. After adjustments, the employees in the continuously high mental health functioning group were more likely to have optimal job demands, high job control, no sleep problems and no binge drinking behaviour. Employees in the continuously high physical functioning group had more likely low levels of physically strenuous work and hazardous working environment and no sleep problems and normal weight. CONCLUSION: High job control, good sleep and avoiding binge drinking may help maintain good mental health functioning. Low levels of physical or environmental work exposures, good sleep and recommended healthy weight may support maintenance of good physical health functioning among ageing employees.

Psychological distress and sickness absence: Within- versus between-individual analysis.

BACKGROUND: Uncertainty remains whether associations for psychological distress and sickness absence (SA) observed between and within individuals differ, and whether age, gender and work-related factors moderate these associations. METHODS: We analyzed SA records of 41,184 participants of the Finnish Public Sector study with repeated survey data between 2000 and 2016 (119,024 observations). Psychological distress was measured by the General Health Questionnaire (GHQ-12), while data on SA days were from the employers' registers. We used a hybrid regression estimation approach adjusting for time-variant confounders-age, marital status, occupational class, body mass index, job contract type, months worked in the follow-up year, job demand, job control, and workplace social capital-and time-invariant gender (for between-individual analysis). RESULTS: Higher levels of psychological distress were consistently associated with SA, both within- and between-individuals. The within-individual association (incidence rate ratio (IRR) 1.68, 95% CI 1.61-1.75 for SA at high distress), however, was substantially smaller than the between-individual association (IRR 2.53, 95% CI 2.39-2.69). High levels of psychological distress had slightly stronger within-individual associations with SA among older (>45 years) than younger employees, lower than higher occupational class, and among men than women. None of the assessed work unit related factors (e.g. job demand, job control) were consistent moderators. LIMITATIONS: These findings may not be generalizable to other working sectors or cultures with different SA policies or study populations that are male dominated. CONCLUSIONS: Focus on within-individual variation over time provides more accurate estimates of the contribution of mental health to subsequent sickness absence.

Recurrent pain and work disability: a record linkage study.

PURPOSE: We examined the associations between recurrent single- and multisite pain and incident sickness absence (SA) of different lengths and the risk of disability pension (DP). METHODS: The data were derived from the Finnish Helsinki Health Study. Pain measures were recorded for panel 1 in 2000/2 and 2007, and for panel 2 in 2007 and 2012 (altogether 3191 employees). SA data were obtained from the employer's personnel register and DP events from the Finnish Centre for Pensions. Negative binomial regression models with generalized estimation equations were used to model the incidence of self-certified short- (1-3 days), and medically certified medium- (4-14 days) and long-term (more than 14 days) SA episodes. Cox regression models were fitted for the associations between pain and all-cause DP and competing risk models for DP by diagnostic groups. Social and health-related covariates were adjusted for. RESULTS: Recurrent pain was associated with short-, medium- and long-term SA. Additionally, recurrent single- and multisite pain increased the risk of long-term SA. Recurrent single or multisite pain was further associated with an increased risk of DP, while a single instance of pain did not increase the risk. CONCLUSIONS: These results suggest that recurrent pain is a robust determinant of subsequent SA and DP risk. Improved understanding of determinants of recurrent pain is needed to inform the development of targeted measures to reduce SA and premature exit from employment.

Favourable changes in physical working conditions and the risk of all-cause sickness absence: a pseudo-experiment.

BACKGROUND: We determined whether favourable changes in physical workload and environmental factors reduce sickness absence (SA) days using observational cohort data as a pseudo-experiment. METHODS: The data from the Finnish Helsinki Health Study included three cohorts of employees of the City of Helsinki [2000/2002-07 (N = 2927), 2007-12 (N = 1686) and 2012-17 (N = 1118), altogether 5731 observations]. First, we estimated the propensity score of favourable changes (reduction in exposures) in physical workload and environmental factors during each 5-year follow-up period on the baseline survey characteristics using logistic regression. Second, we created and stabilized inverse probability of treatment weights for each participant using the propensity scores. Lastly, we used generalized linear model and fitted negative binomial regression models for over-dispersed count data to estimate whether the favourable changes decrease the risk of short-term (1-3 days), intermediate-term (4-14 days) and long-term (>14 days) SA using employer's register data. RESULTS: During a 5-year follow-up, 11% of the participants had favourable changes in physical workload factors, 13% in environmental factors and 8% in both factors. The incidence of short-term, intermediate-term and long-term SA were lower in employees with favourable workplace changes compared with those without such changes. The reductions were largest for long-term SA. Reporting favourable changes in both workload and environmental factors reduced the number of SA days by 41% within 1 year after the changes and by 32% within 2 years after the changes. CONCLUSION: This pseudo-experimental study suggests that improving physical working conditions reduces SA.

Within-individual analysis of pain and sickness absence among employees from low and high occupational classes: a record linkage study.

OBJECTIVES: Pain is linked to an increased risk of sickness absence (SA); however, the extent to which unmeasured time-invariant differences explain this association is yet unknown. Therefore, we determined the within-individual associations between pain and short-term (in the survey year) and long-term (2 years following the survey years) SA risk in high and low occupational classes while controlling for the potential bias due to unobservable time-invariant characteristics. METHODS: The Helsinki Health Study data consisting of midlife public sector employees with mailed surveys from up to four time points, and SA record linkage were used (3983 persons). The within-individual estimates were calculated using hybrid negative binomial regression models. RESULTS: Acute/subacute pain was associated with a 13% increase in the rate of short-term SA days (incidence rate ratio 1.13 [95% CI 1.01 to 1.27]), while the association was somewhat stronger for chronic pain (1.32 [1.19-1.47]). For the employees in the low occupational class, these associations were robust (1.29 [1.10-1.50] for acute/subacute and 1.43 [1.23-1.66] for chronic pain), whereas only chronic pain was associated with SA among those in the high occupational class (1.25 [1.08-1.46]). Chronic pain was also associated with SA days in the long term without occupational class differences. Similar results were obtained for multisite pain (pain in several locations). CONCLUSIONS: These results indicate that particularly chronic and multisite pain have a within-individual link to SA but ignoring unobservable differences between those reporting pain and those not might yield overstated effect sizes. Pain might have a different relation to SA in low and high occupational classes.

Common mental disorders and trajectories of work disability among midlife public sector employees - A 10-year follow-up study.

OBJECTIVE: We examined trajectories of work disability, indicated by sickness absence and disability retirement, among midlife public sector employees with and without common mental disorders (CMD) at baseline. We also examined adverse childhood events, occupational class, long-standing illness and health behaviour as determinants of the trajectories. METHODS: A sample from the Helsinki Health Study was extracted comprising 2350 employees. Baseline characteristics were obtained from mail surveys conducted in 2000-2 and 2007. CMD were measured by the General Health Questionnaire. Participants were followed between the ages of 50-59. Work disability trajectories were modelled by the annual number of work disability months in group-based trajectory analysis. Multinomial regression was used to predict trajectory group memberships. RESULTS: Three trajectories were identified: no work disability (consisting 59% of the all employees), stable/low (31%) and high/increasing disability (10%). Employees with CMD were more likely to belong to the stable/low (odds ratio 1.73 [95% confidence interval 1.37-2.18]), and the high/increasing (2.55 [1.81-3.59]) trajectories. Stratified models showed that the determinants of the trajectories were largely similar for those with CMD compared to those without CMD except that obesity was a somewhat stronger predictor of the high/increasing trajectory among employees with CMD. LIMITATIONS: The focus on midlife public sector employees limits the generalisability to other employment sectors and younger employees. CONCLUSIONS: CMD were strongly associated with a trajectory leading to early exit from employment and a stable/low work disability trajectory. These findings have implications for interventions promoting work ability of employees with mental ill-health.

Obesity and socioeconomic disadvantage in midlife female public sector employees: a cohort study.

BACKGROUND: The two-way relationship between obesity and socioeconomic disadvantage is well established but previous studies on social and economic consequences of obesity have primarily focused on relatively young study populations. We examined whether obesity is associated with socioeconomic disadvantage through the 10-12-year follow-up, and how obesity-related socioeconomic inequalities develop during midlife among women. METHODS: Baseline data were derived from the female population of the Helsinki Health Study cohort, comprising 40-60 -year-old employees of the City of Helsinki, Finland in 2000-2002 (n = 6913, response rate 69%). The follow-up surveys were carried out in 2007 (n = 5810) and 2012 (n = 5400). Socioeconomic disadvantage was measured by five dichotomous measures. Repeated logistic regression analyses utilising generalized estimating equations (GEE) were used to test the association between baseline self-reported obesity and the likelihood of socioeconomic disadvantage through all phases. The effect of time on the development of inequalities was examined by time interaction terms in random effect logistic regression models. RESULTS: After adjustment for educational level, baseline obesity was associated with repeated poverty (OR = 1.23; 95% CI; 1.05-1.44), frequent economic difficulties (OR = 1.74; 95% CI; 1.52-1.99), low household net income (OR = 1.23; 95% CI; 1.07-1.41), low household wealth (OR = 1.90; 95% CI; 1.59-2.26) and low personal income (OR = 1.22; 95% CI; 1.03-1.44). The differences in poverty rate and low personal income between the participants with obesity and participants with normal weight widened during the follow-up. Living without a partner and early exit from paid employment explained the widening of inequalities. CONCLUSIONS: Weight status inequalities in socioeconomic disadvantage persisted or widened during the late adulthood.