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International Archives of Occupational and Environmental Health

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01.01.2009 | Original Article

Occupational class inequalities in health across employment sectors: the contribution of working conditions

verfasst von: Eero Lahelma, Mikko Laaksonen, Akseli Aittomäki

Erschienen in: International Archives of Occupational and Environmental Health | Ausgabe 2/2009

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Abstract

Objective

While health inequalities among employees are well documented, their variation and determinants among employee subpopulations are poorly understood. We examined variations in occupational class inequalities in health within four employment sectors and the contribution of working conditions to these inequalities.

Methods

Cross-sectional data from the Helsinki Health Study in 2000–2002 were used. Each year, employees of the City of Helsinki, aged 40–60 years, received a mailed questionnaire (n = 8,960, 80% women, overall response rate for 3 years 67%). The outcome was physical health functioning measured by the overall physical component summary of SF-36. The socioeconomic indicator was occupational social class. Employment sectors studied were health care, education, social welfare and administration (n = 6,557). Physical and mental workload, and job demands and job control were explanatory factors. Inequality indices from logistic regression analysis were calculated.

Results

Occupational class inequalities in physical health functioning were slightly larger in education (1.47) than in the other sectors (1.43–1.40). Physical workload explained 95% of inequalities in social welfare and 32–36% in the other sectors. Job control also partly explained health inequalities. However, adjusting for mental workload and job demands resulted in larger health inequalities.

Conclusion

Inequalities in physical health functioning were found within each employment sector, with minor variation in their magnitude. Physical workload was the main explanation for these inequalities, but its contribution varied between the sectors. In contrast, considering psychosocial working conditions led to wider inequalities. Improving physical working conditions among the lower occupational classes would help reduce health inequalities within different employment sectors.

Borg V, Kristensen TS (2000) Social class and self-rated health: can the gradient be explained by differences in lifestyle or work environment? Soc Sci Med 51:1019–1030PubMedCrossRef

Dahl E, Fritzell J, Lahelma E, Martikainen P, Kunst A, Mackenbach J (2006) Welfare state regimes and health inequalities. In: Siegrist J, Marmot M (eds) Social inequalities in health: new evidence and policy implications. Oxford University Press, Oxford, pp 193–222

Dalstra J, Kunst A, Borrell C, Breeze E, Cambois E, Costa G, Geurts J, Lahelma E, van Oyen H, Rasmussen N, Regidor E, Spadea T, Mackenbach M (2005) Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol 34:316–326PubMedCrossRef

Emslie C, Hunt K, Macintyre S (1999) Gender differences in minor morbidity among full-time employees of a British university. J Epidemiol Community Health 53:465–475PubMedCrossRef

Hemström Ö (2005) Health inequalities by wage income in Sweden: The role of work environment. Soc Sci Med 61:637–647PubMedCrossRef

Karasek RA (1985) Job content questionnaire and user’s guide. Revision 1.1. University of Massachusetts, Department of Work Environment, Lowell, MA

Kunst A, Bos V, Lahelma E, Bartley M, Lissau I, Regidor E, Mielck A, Cardano M, Dalstra J, Geurts J, Helmert U, Lennartsson C, Ramm J, Spadea T, Stronegger W, Mackenbach J (2005) Trends in socioeconomic inequalities in self-assessed health in 10 European countries. Int J Epidemiol 34:295–305PubMedCrossRef

Laaksonen E, Martikainen P, Lahelma E, Lallukka T, Chandola T, Head J, Marmot M (2007) Socioeconomic circumstances and common mental disorders among Finnish and British public sector employees: Evidence from the Helsinki Health Study and the Whitehall II Study. Int J Epidemiol 36:776–786PubMedCrossRef

Laaksonen M, Rahkonen O, Martikainen P, Lahelma E (2005) Socioeconomic position and self-rated health: The contribution of childhood socioeconomic environment, adult socioeconomic status, and material resources. Am J Public Health 95:1403–1409PubMedCrossRef

Laaksonen M, Rahkonen O, Martikainen P, Lahelma E (2006) Associations of working conditions with self-rated general health and mental health among municipal employees. Int Arch Occup Environ Health 79:205–212PubMedCrossRef

Lahelma E, Martikainen P, Rahkonen O, Roos E, Saastamoinen P (2005) Occupational class inequalities across key domains of health: Results from the Helsinki Health Study. Eur J Public Health 15:504–510PubMedCrossRef

Lundberg O (1991) Causal explanations for class inequality in health: an empirical analysis. Soc Sci Med 32:385–393PubMedCrossRef

Mackenbach J, Kunst A (1997) Measuring the magnitude of socio-economic inequalities in health: an overview of available measures illustrated with two examples from Europe. Soc Sci Med 44:757–771PubMedCrossRef

Mackenbach J, Bakker M (eds) (2002) Reducing inequalities in health: a European perspective. Routledge, London

Mackenbach J, Bos V, Andersen O, Cardano M, Costa G, Harding S, Reid A, Hemström Ö, Valkonen T, Kunst A (2003) Widening inequalities in mortality in western Europe. Int J Epidemiol 32:830–837PubMedCrossRef

Marmot M, Davey Smith G, Stansfeld S, Patel C, North F, Head J, White I, Brunner E, Feeney A (1991) Health inequalities among British civil servants: the Whitehall II Study. Lancet 337:1387–1393PubMedCrossRef

Marmot MG, Bosma H, Hemingway H, Brunner E, Stansfeld S (1997) Contribution of job control and other risk factors to social variations in coronary heart disease incidence. Lancet 350:235–239PubMedCrossRef

Marmot M (2005) Social determinants of health. Lancet 365:1099–1104PubMed

Martikainen P, Stansfeld S, Hemingway H, Marmot M (1999) Determinants of socioeconomic differences in change in SF-36 physical and mental health functioning: the Whitehall II Study. Soc Sci Med 49:499–507PubMedCrossRef

Martikainen P, Valkonen T (1999) Bias related to the absence of information on occupation in studies on social class differences in mortality. Int J Epidemiol 28:899–904PubMedCrossRef

Martikainen P, Laaksonen M, Piha K, Lallukka T (2007) Does survey non-response bias the relationship between occupational social class and health? Scand J Public Health 35:212–215PubMedCrossRef

Monden C (2005) Current and lifetime exposure to working conditions. Do they explain educational differences in subjective health? Soc Sci Med 60:2465–2476PubMedCrossRef

Muntaner C, Sorlie P, O’Campo P, Johnson N, Backlund E (2001) Occupational hierarchy, economic sector, and mortality from cardiovascular disease among men and women. Findings from the National Longitudinal Mortality Study. Ann Epidemiol 11:194–201PubMedCrossRef

Rahkonen O, Laaksonen M, Martikainen P, Roos E, Lahelma E (2006) Job control, job demands or social class? The impact of working conditions on the relationship between social class and health. J Epidemiol Community Health 60:50–54PubMedCrossRef

Schrijvers C, van de Mheen D, Stronks K, Mackenbach JP (1998) Socioeconomic inequalities in health in the working population: The contribution of working conditions. Int J Epidemiol 27:1011–1018PubMedCrossRef

Siegrist J, Theorell T (2006) Socio-economic position and health: the role of work and employment. In: Siegrist J, Marmot M (eds) Social inequalities in health: new evidence and policy implications. Oxford University Press, Oxford, pp 73–100

Statistics Finland (1989) Sosioekonomisen aseman luokitus (socio-economic classification). Handbook 17. Statistics Finland, Helsinki

Valkonen T, Martikainen P, Jalovaara M, Koskinen S, Martelin T, Mäkelä P (2000) Changes in socioeconomic inequalities in mortality during an economic boom and recession among middle-aged men and women in Finland. Eur J Public Health 10:274–280CrossRef

van Lenthe F, Gevers E, Joung I, Bosma H, Mackenbach J (2002) Material and behavioral factors in the explanation of educational differences in the incidence of acute myocardial infarction: the Globe Study. Ann Epidemiol 12:535–542PubMedCrossRef

van Oort F, van Lenthe F, Mackenbach J (2005) Material, psychosocial, and behavioural factors in the explanation of educational differences in mortality in the Netherlands. J Epidemiol Community Health 59:214–220PubMedCrossRef

Ware JE, Kosinski M (2001) SF-36 physical and mental health summary scales: a manual for users of version 1, 2nd edn. QualityMetric, Lincoln

Warren JR, Hoonakker P, Carayon P, Brand J (2004) Job characteristics as mediators in SES–health relationships. Soc Sci Med 59:1367–1378PubMedCrossRef

Watson D (1988) Intraindividual and interindividual analyses of positive and negative affect: their relation to health complaints, perceived stress, and daily activities. J Pers Soc Psychol 54:1020–1030PubMedCrossRef

Titel: Occupational class inequalities in health across employment sectors: the contribution of working conditions
verfasst von: Eero Lahelma
Mikko Laaksonen
Akseli Aittomäki
Publikationsdatum: 01.01.2009
Verlag: Springer-Verlag
Erschienen in: International Archives of Occupational and Environmental Health / Ausgabe 2/2009
Print ISSN: 0340-0131
Elektronische ISSN: 1432-1246
DOI: https://doi.org/10.1007/s00420-008-0320-6

Springer Medizin

Abstract

Objective

Methods

Results

Conclusion

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