Lifestyle-related risk factors and trajectories of work disability over 5 years in employees with diabetes: findings from two prospective cohort studies.
OBJECTIVE
To examine work disability trajectories among employees with and without diabetes and identify lifestyle-related factors associated with these trajectories.


METHODS
We assessed work disability using records of sickness absence and disability pension among participants with diabetes and age- sex-, socio-economic status- and marital status-matched controls in the Finnish Public Sector Study (1102 cases; 2204 controls) and the French GAZEL study (500 cases; 1000 controls), followed up for 5 years. Obesity, physical activity, smoking and alcohol consumption were assessed at baseline and the data analysed using group-based trajectory modelling.


RESULTS
Five trajectories described work disability: 'no/very low disability' (41.1% among cases and 48.0% among controls); 'low-steady' (35.4 and 34.7%, respectively); 'high-steady' (13.6 and 12.1%, respectively); and two 'high-increasing' trajectories (10.0 and 5.2%, respectively). Diabetes was associated with a 'high-increasing' trajectory only (odds ratio 1.90, 95% CI 1.47-2.46). Obesity and low physical activity were similarly associated with high work disability in people with and without diabetes. Smoking was associated with 'high-increasing' trajectory in employees with diabetes (odds ratio 1.88, 95% CI 1.21-2.93) but not in those without diabetes (odds ratio 1.32, 95% CI 0.87-2.00). Diabetes was associated with having multiple ( ≥ 2) risk factors (21.1 vs. 11.4%) but the association between multiple risk factors and the 'high-increasing' trajectory was similar in both groups.


CONCLUSIONS
The majority of employees with diabetes have low disability rates, although 10% are on a high and increasing disability trajectory. Lifestyle-related risk factors have similar associations with disability among employees with and without diabetes, except smoking which was only associated with poorer prognosis in diabetes.
Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland.
M
M
Virtanen
Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland.|Department of Epidemiology and Public Health, University College London, London, UK.
M
M
Kivimäki
Population-Based Cohorts Unit, Inserm UMS 011, Villejuif, France.|University Versailles, Saint Quentin en Yvelines, France.
M
M
Zins
INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Paris, France.|Sorbonne Universités, UPMC Univ Paris 06 UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, Paris, France.
R
R
Dray-Spira
Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland.
T
T
Oksanen
Department of Epidemiology and Public Health, University College London, London, UK.|School of Community and Social Medicine, University of Bristol, Bristol, UK.
J E
JE
Ferrie
Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland.
A
A
Okuloff
Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland.
J
J
Pentti
Department of Epidemiology and Public Health, University College London, London, UK.
J
J
Head
Population-Based Cohorts Unit, Inserm UMS 011, Villejuif, France.|University Versailles, Saint Quentin en Yvelines, France.
M
M
Goldberg
Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland.|Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
J
J
Vahtera
D000041:Absenteeism; D000328:Adult; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004651:Employment / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005602:France / Q000453:epidemiology; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D010415:Pensions / Q000706:statistics & numerical data; D017150:Public Sector / Q000706:statistics & numerical data; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data / Q000639:trends*; D014938:Work Capacity Evaluation