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Open Access 01-12-2021 | Care | Research article

Sociodemographic characteristics and disability pensions of frequent attenders in occupational health primary care – a follow-up study in Finland

Authors: Tiia Reho, Salla Atkins, Mikko Korhonen, Anna Siukola, Markku Sumanen, Mervi Viljamaa, Jukka Uitti, Riitta Sauni

Published in: BMC Public Health | Issue 1/2021

Abstract

Background

Work disability is a complex issue that requires preventive efforts from healthcare systems and individuals, and that too often results in disability pensions (DP). While many studies have attempted to characterize risk factors of work disability, many showing for example a link between socioeconomic positions, working conditions and frequent attendance to OH primary care it is not known if frequent attendance is associated with DP despite the sociodemographic factors. This study aims to address this gap and examine the association between frequent attendance to OH primary care and DP, when adjusted by sociodemographic factors.

Methods

This study combines routine medical record data of an occupational health service provider with comprehensive national registers. Medical record data were used to define groups of frequent attenders to OH primary care (FA) (1-year-FA, 2-year-FA, persistent-FA and non-FA) from 2014 to 2016. The sociodemographic factors (including i.e. educational level, occupational class, unemployment periods) were derived from Statistic Finland and DP decisions were derived from Finnish Centre for Pensions. Association of frequent attendance to OH primary care with DP decisions were analyzed and adjusted by sociodemographic factors.

Results

In total, 66,381 patients were included. Basic and intermediate education along with manual and lower non-manual work predicted frequent attendance to OH primary care. Unemployment in 2013 did not predict frequent attendance to OH primary care. Frequent attendance to OH primary care was associated with DP within next two years, even when adjusted for sociodemographic factors. The association of frequent attendance to OH primary care with DP grew stronger as high service use persisted over time.

Conclusions

Frequent attendance to OH primary care is associated with DP risk in the near future despite the underlying sociodemographic differences. Patients using OH primary care services extensively should be identified and rehabilitative needs and measures necessary to continue in the work force should be explored. Sociodemographic issues that co-exist should be explored and considered when planning interventions.

Smits FT, Brouwer HJ, ter Riet G, van Weert HC. Epidemiology of frequent attenders: a 3-year historic cohort study comparing attendance, morbidity and prescriptions of one-year and persistent frequent attenders. BMC Public Health. 2009;9(1). https://doi.org/10.1186/1471-2458-9-36.

Rosella LC, Fitzpatrick T, Wodchis WP, Calzavara A, Manson H, Goel V. High-cost health care users in Ontario, Canada: demographic, socio-economic, and health status characteristics. BMC Health Serv Res. 2014;14(1):532. https://doi.org/10.1186/s12913-014-0532-2.CrossRefPubMedPubMedCentral

Smits FT, Brouwer HJ, Zwinderman AH, Mohrs J, Smeets HM, Bosmans JE, et al. Morbidity and doctor characteristics only partly explain the substantial healthcare expenditures of frequent attenders: a record linkage study between patient data and reimbursements data. BMC Fam Pract. 2013;14(1). https://doi.org/10.1186/1471-2296-14-138.

Reho T, Atkins S, Talola N, Sumanen M, Viljamaa M, Uitti J. Frequent attenders in occupational health primary care – a cross-sectional study. Scand J Public Health. 2018;47(1):28–36. https://doi.org/10.1177/1403494818777436.CrossRefPubMed

Vedsted P, Christensen MB. Frequent attenders in general practice care: a literature review with special reference to methodological considerations. Public Health. 2005;119(2):118–37. https://doi.org/10.1016/j.puhe.2004.03.007.CrossRefPubMed

Hansagi H, Olsson M, Sjöberg S, Tomson Y, Göransson S. Frequent use of the hospital emergency department is indicative of high use of other health care services. Ann Emerg Med. 2001;37(6):561–7. https://doi.org/10.1067/mem.2001.111762.CrossRefPubMed

Pymont C, Butterworth P. Longitudinal cohort study describing persistent frequent attenders in Australian primary healthcare. BMJ Open. 2015;5(10):e008975. https://doi.org/10.1136/bmjopen-2015-008975.CrossRefPubMedPubMedCentral

Carney TA, Guy S, Jeffrey G. Frequent attenders in general practice: a retrospective 20-year follow-up study. Br J Gen Pract. 2001;51(468):567–9.PubMedPubMedCentral

Gill D, Sharpe M. Frequent consulters in general practice: a systematic review of studies of prevalence, associations and outcome. J Psychosom Res. 1999;47(2):115–30. https://doi.org/10.1016/S0022-3999(98)00118-4.CrossRefPubMed

10.

Droomers M, Westert GP. Do lower socioeconomic groups use more health services, because they suffer from more illnesses? Eur J Pub Health. 2004;14(3):311–3. https://doi.org/10.1093/eurpub/14.3.311.CrossRef

11.

Kersnik J, Scvab I, Vegnuti M. Frequent attenders in general practice: quality of life, patient satisfaction, use of medical services and GP characteristics. Scand J Prim Health Care. 2001;19(3):174–7. https://doi.org/10.1080/028134301316982405.CrossRefPubMed

12.

Reid S, Wessely S, Crayford T, Hotopf M. Frequent attenders with medically unexplained symptoms: service use and costs in secondary care. Br J Psychiatry. 2002;180(3):248–53. https://doi.org/10.1192/bjp.180.3.248.CrossRefPubMed

13.

Vedsted P, Olesen F. Social environment and frequent attendance in Danish general practice. Br J Gen Pract. 2005;55(516):510–5.PubMedPubMedCentral

14.

Scaife B, Gill P, Heywood P, Neal R. Socio-economic characteristics of adult frequent attenders in general practice: secondary analysis of data. Fam Pract. 2000;17(4):298–304. https://doi.org/10.1093/fampra/17.4.298.CrossRefPubMed

15.

Harkko J, Sumanen H, Pietiläinen O, Piha K, Mänty M, Lallukka T, et al. Socioeconomic differences in occupational health service utilization and sickness absence due to mental disorders: a register-based retrospective cohort study. Int J Environ Res Public Health. 2020;17(6):1–13. https://doi.org/10.3390/ijerph17062064.CrossRef

16.

Bergh H, Baigi A, Månsson J, Mattsson B, Marklund B. Predictive factors for long-term sick leave and disability pension among frequent and normal attenders in primary health care over 5 years. Public Health. 2007;121(1):25–33. https://doi.org/10.1016/j.puhe.2006.08.018.CrossRefPubMed

17.

Reho TTM, Atkins SA, Talola N, Sumanen MPT, Viljamaa M, Uitti J. Frequent attenders at risk of disability pension: a longitudinal study combining routine and register data. Scand J Public Health. 2020;48(2):181–9. https://doi.org/10.1177/1403494819838663.CrossRefPubMed

18.

Krokstad S, Johnsen R, Westin S. Social determinants of disability pension: a 10-year follow-up of 62 000 people in a Norwegian county population. Int J Epidemiol. 2002;31(6):1183–91. https://doi.org/10.1093/ije/31.6.1183.CrossRefPubMed

19.

Bruusgaard D, Smeby L, Claussen B. Education and disability pension: a stronger association than previously found. Scand J Public Health. 2010;38(7):686–90. https://doi.org/10.1177/1403494810378916.CrossRefPubMed

20.

Leinonen T, Martikainen P, Lahelma E. Interrelationships between education, occupational social class, and income as determinants of disability retirement. Scand J Public Health. 2012;40(2):157–66. https://doi.org/10.1177/1403494811435492.CrossRefPubMed

21.

Marmot M. Social determinants of health inequalities. Lancet. 2005;365(9464):1099–104. https://doi.org/10.1016/S0140-6736(05)71146-6.CrossRefPubMed

22.

Lappalainen K, Aminoff M, Hakulinen H, Hirvonen M, Räsänen K, Sauni R, et al. Työterveyshuolto Suomessa vuonna 2015 [occupational healthcare in Finland 2015 report] (in Finnish with english summary). Helsinki: Työterveyslaitos; 2016.

23.

Ikonen A, Räsänen K, Manninen P, Rautio M, Husman P, Ojajärvi A, et al. Use of health services by Finnish employees in regard to health-related factors: the population-based health 2000 study. Int Arch Occup Environ Health. 2013;86(4):451–62. https://doi.org/10.1007/s00420-012-0778-0.CrossRefPubMed

24.

Li CY, Sung FC. A review of the healthy worker effect in occupational epidemiology. Occup Med (Chic Ill). 1999;49(4):225–9. https://doi.org/10.1093/occmed/49.4.225.CrossRef

25.

Koskinen S, Lundqvist A, Ristiluoma N, eds. Terveys, toimintakyky ja hyvinvointi Suomessa 2011 [Health, functional capacity and welfare in Finland in 2011] (In Finnish with English summary). Helsinki; 2012.

26.

Kauppinen T, Mattila-Holappa P, Perkiö-Mäkelä M, Saalo A, Toikkanen J, Tuomivaara S, et al. Työ ja Terveys suomessa 2012 Seurantatietoa työoloista ja työhyvinvoinnista (In Finnish with English summary). Helsinki: Työterveyslaitos; 2013.

27.

Statistics Finland, FOLK-database, Basic data - data description. https://taika.stat.fi/en/aineistokuvaus.html#!?dataid=FOLK_19872019_jua_perus20_002.xml. .

28.

Forssas E, Manderbacka K, Arffman M, Keskimäki I. Socio-economic predictors of mortality among diabetic people. Eur J Pub Health. 2012;22(3):305–10. https://doi.org/10.1093/eurpub/ckr044.CrossRef

29.

Lahtinen H, Sirniö O, Martikainen P. Social class and the risk of unemployment: Trends, gender differences and the contribution of education. Acta Sociol (United Kingdom). 2020;63:303–21.

30.

WHO. Social determinants of health. https://www.who.int/teams/social-determinants-of-health. Accessed 16 Aug 2021.

31.

Marmot M, Bell R. Fair society, healthy lives. Public Health. 2012;126:S4–S10. https://doi.org/10.1016/j.puhe.2012.05.014.CrossRefPubMed

32.

Jyväsjärvi S, Keinänen-Kiukaanniemi S, Väisänen E, Larivaara P, Kivelä SL. Frequent attenders in a Finnish health Centre: morbidity and reasons for encounter. Scand J Prim Health Care. 1998;16(3):141–8. https://doi.org/10.1080/028134398750003089.CrossRefPubMed

33.

Karlsson H, Lehtinen V, Joukamaa M. Frequent attenders of Finnish public primary health-care - sociodemographic characteristics and physical morbidity. Fam Pract. 1994;11(4):424–30. https://doi.org/10.1093/fampra/11.4.424.CrossRefPubMed

34.

Palmgren H, Kaleva S, Savinainen M, Rajala K. Yrittäjien ja pienten yritysten työterveyshuolto Suomessa 2013–2014 (In Finnish with English summary). Helsinki: Työterveyslaitos; 2015.

35.

Sutela H, Pärnänen A. Yrittäjät Suomessa 2017 (Entrepreneurs in Finland) [In Finnish]. Helsinki: Tilastokeskus; 2018.

36.

Reho T, Atkins S, Talola N, Sumanen M, Viljamaa M, Uitti J. Comparing occasional and persistent frequent attenders in occupational health primary care - a longitudinal study. BMC Public Health. 2018;18(1):1–9. https://doi.org/10.1186/s12889-018-6217-8.CrossRef

37.

Polvinen A, Gould R, Lahelma E, Martikainen P. Socioeconomic differences in disability retirement in Finland: the contribution of ill-health, health behaviours and working conditions. Scand J Public Health. 2013;41(5):470–8. https://doi.org/10.1177/1403494813482400.CrossRefPubMed

38.

Gustafsson K, Aronsson G, Marklund S, Wikman A, Floderus B. Peripheral labour market position and risk of disability pension: a prospective population-based study. BMJ Open. 2014;4(8):e005230. https://doi.org/10.1136/bmjopen-2014-005230.CrossRefPubMedPubMedCentral

39.

Virtanen M, Kivimäki M, Vahtera J, Elovainio M, Sund R, Virtanen P, et al. Sickness absence as a risk factor for job termination, unemployment, and disability pension among temporary and permanent employees. Occup Env Med. 2006;63(3):212–7. https://doi.org/10.1136/oem.2005.020297.CrossRef

40.

Reho T, Atkins S, Talola N, Sumanen M, Viljamaa M, Uitti J. Occasional and persistent frequent attenders and sickness absences in occupational health primary care: a longitudinal study in Finland. BMJ Open. 2019;9(2):e024980. https://doi.org/10.1136/bmjopen-2018-024980.CrossRefPubMedPubMedCentral

41.

Laaksonen M, Rantala J, Järnefelt N, Kannisto J. Työkyvyttömyyden vuoksi menetetty työura (working careers lost due to disability) [in Finnish with English summary]. Helsinki: Finnish Centre for Pensions; 2016.

42.

Lappalainen L, Liira J, Lamminpää A, Rokkanen T. Work disability negotiations: supervisors’ view of work disability and collaboration with occupational health services. Disabil Rehabil. 2019;41(17):2015–25. https://doi.org/10.1080/09638288.2018.1455112.CrossRefPubMed

43.

Salonen L, Blomgren J, Laaksonen M, Niemelä M. Sickness absence as a predictor of disability retirement in different occupational classes: a register-based study of a working-age cohort in Finland in 2007-2014. BMJ Open. 2018;8(5):1–8. https://doi.org/10.1136/bmjopen-2017-020491.CrossRef

44.

Kivimäki M, Forma P, Wikström J, Halmeenmäki T, Pentti J, Elovainio M, et al. Sickness absence as a risk marker of future disability pension: the 10-town study. J Epidemiol Community Heal. 2004;58(8):710–1. https://doi.org/10.1136/jech.2003.015842.CrossRef

45.

Atkins S, Reho T, Talola N, Sumanen M, Viljamaa M, Uitti J. Improved recording of work relatedness during patient consultations in occupational primary health care: a cluster randomized controlled trial using routine data. Trials. 2020;21(1):1–8. https://doi.org/10.1186/s13063-020-4168-8.CrossRef

46.

Pihlajamäki M, Uitti J, Arola H, Korhonen M, Nummi T, Taimela S. Self-reported health problems in a health risk appraisal predict permanent work disability: a prospective cohort study of 22,023 employees from different sectors in Finland with up to 6-year follow-up. Int Arch Occup Environ Health. 2020;93(4):445–56. https://doi.org/10.1007/s00420-019-01497-2.CrossRefPubMed

Title: Sociodemographic characteristics and disability pensions of frequent attenders in occupational health primary care – a follow-up study in Finland
Authors: Tiia Reho
Salla Atkins
Mikko Korhonen
Anna Siukola
Markku Sumanen
Mervi Viljamaa
Jukka Uitti
Riitta Sauni
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Care
Published in: BMC Public Health / Issue 1/2021
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-021-11873-8

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Springer Medicine

Sociodemographic characteristics and disability pensions of frequent attenders in occupational health primary care – a follow-up study in Finland

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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