Macro-organizational factors, the incidence of work disability, and work ability among the total workforce of home care workers in Sweden.
OBJECTIVE
To investigate the importance of macro-organizational factors, i.e. organizational sociodemographic and socioeconomic preconditions, of the municipal incidence of long-term sick leave, disability pension, and prevalence of workers with long-term work ability among home care workers.


METHODS
In an ecological study design, data from national databases were combined by record linkage. Descriptive and analytical statistics were used to estimate and interpret macro-organizational factors (economic resources, region, unemployment, employment, occupational rehabilitation, return to work, age structures of inhabitants and home care workers).


RESULTS
The incidence of long-term sick leave among female home care workers was twice as high as that of male home care workers, and incidence of disability pension was about four times as high for the women. A great variation in municipal incidence of long-term sick leave, disability pension, and long-term work ability (101-264, 0.6-19.6, and 913-1,279 per 1,000 full-time equivalent workers and year) was also found. The strongest single factor for long-term work ability was a high proportion of part-time or hourly paid employees, which explained 35% of the municipal variation. Macro-organizational factors explained long-term work ability (47-62% explained variance) better than long-term sick leave (33% explained variance). There was a low rehabilitation activity; only 2% received occupational rehabilitation and 5% of those on sick leave longer than 2 weeks returned to work within 30 days.


CONCLUSIONS
The differences in the municipal proportion of work ability incidence indicate a preventive potential, especially related to employment and return to work after sick leave.
Dellve
Lotta
L
Department of Occupational Medicine, Göteborg University, Sweden. lotta.dellve@amm.gu.se
Karlberg
Catarina
C
Allebeck
Peter
P
Herloff
Birgitta
B
Hagberg
Mats
M
D000328:Adult; D015331:Cohort Studies; D004185:Disability Evaluation; D005260:Female; D006699:Home Care Services / Q000458:organization & administration*; D018576:Home Health Aides; D006801:Humans; D015994:Incidence; D008297:Male; D009784:Occupational Diseases / Q000453:epidemiology / Q000209:etiology* / Q000534:rehabilitation; D015279:Organizational Culture; D012050:Rehabilitation, Vocational; D012179:Retirement / Q000706:statistics & numerical data; D018582:Sick Leave / Q000706:statistics & numerical data; D012931:Social Environment; D012943:Social Security / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D013548:Sweden / Q000453:epidemiology; D014938:Work Capacity Evaluation