title: Change in economic difficulties and physical and mental functioning: Evidence from British and Finnish employee cohorts.
abstract: OBJECTIVE
  The main aims of this longitudinal study were to (i) examine associations between changes in economic difficulties and health functioning among middle-aged employees and (ii) assess whether the associations remained after considering conventional domains of socioeconomic position. The associations were tested in two European welfare state occupational cohorts to strengthen the evidence base and improve generalizability.
  
  
  METHODS
  Data came from two cohorts: the Finnish Helsinki Health Study (baseline 2000-2002, follow-up 2007, N = 6328) and the British Whitehall II Study (baseline 1997-1999, follow-up 2003-2004, N = 4350). Responses to the survey item "finding it hard to afford adequate food and clothes and pay bills" repeated at baseline and follow-up were used to examine persistent, increasing, and decreasing economic difficulties. Poor physical and mental health functioning were denoted as being in the lowest quartile of the Short Form 36 physical and mental component summary. Logistic regression analyses were adjusted for sex, age, childhood economic difficulties, household income at baseline and follow-up, employment status at follow-up, and baseline health functioning.
  
  
  RESULTS
  We observed strong sex- and age-adjusted associations between increasing [odds ratio (OR) range 1.69-2.96] and persistent (OR range 2.54-3.21) economic difficulties and poorer physical and mental health functioning in both British and Finnish occupational cohorts. These associations remained after full adjustments. Those reporting decreasing difficulties over follow-up also had poorer functioning (OR range 1.30-1.61) compared to those who did not have difficulties at baseline, possibly reflecting residual effects of economic difficulties at baseline.
  
  
  CONCLUSIONS
  Changes in economic difficulties are associated with poorer physical and mental health functioning independent of income, employment status, and baseline health functioning.
authors.affiliation: Hjelt Institute, Department of Public Health, University of Helsinki, Finland. tea.lallukka@ttl.fi.
authors.forename: Tea
authors.initials: T
authors.lastname: Lallukka
authors.forename: Jane E
authors.initials: JE
authors.lastname: Ferrie
authors.forename: Ossi
authors.initials: O
authors.lastname: Rahkonen
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Shipley
authors.forename: Olli
authors.initials: O
authors.lastname: Pietiläinen
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.forename: Michael G
authors.initials: MG
authors.lastname: Marmot
authors.forename: Eero
authors.initials: E
authors.lastname: Lahelma
mesh_terms: D003071:Cognition; D015331:Cohort Studies; D004651:Employment; D005387:Finland; D009043:Motor Activity; D006113:United Kingdom