title: Socioeconomic gradient in work disability in diabetes: evidence from three occupational cohorts.
abstract: BACKGROUND
  The role of socioeconomic status in work disability among employees with diabetes is not well known. We examined the association between socioeconomic status and work disability among employees with and without diabetes taking into account comorbid conditions.
  
  
  METHODS
  We used individual participant data from three occupational cohorts from Finland, France and the UK (employees with diabetes, n=2170, age-matched and sex-matched controls without diabetes, n=4340). In all cohorts, survey data were linked with register data and the employees were followed up on average for 4.4 years. Socioeconomic status was based on occupational titles. Work disability (sickness absence and disability pension) was indexed as the numbers of disability days and episodes. The study-specific estimates were pooled using meta-analysis and effect modifications were studied with meta-regression.
  
  
  RESULTS
  The average numbers of disability days and episodes per year were 1.5-3.5 times higher for persons with diabetes compared to those without. Among persons with diabetes, the risk of work disability was almost four times higher in the lowest compared to the highest occupational position (relative index of inequality (RII) for days 3.82; 95% CI 2.77 to 5.56; RII for episodes 3.80; 95% CI 3.13 to 4.61). This association was consistent in both sexes and regardless of comorbid conditions. In relative terms, the association of socioeconomic status and work disability was similar among those free of diabetes.
  
  
  CONCLUSIONS
  A strong socioeconomic gradient in work disability was observed among people with and without diabetes.
authors: Finnish Institute of Occupational Health, Helsinki, Finland.
authors: Jenni
authors: http://orcid.org/0000-0001-9113-2428
authors: J
authors: Ervasti
authors: Department of Epidemiology and Public Health, University College London, London, UK Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
authors: Mika
authors: M
authors: Kivimäki
authors: INSERM, UMR S 1136, Paris, France Sorbonne Universités, UPMC Univ Paris 06, UMR S 1136, Paris, France.
authors: Rosemary
authors: R
authors: Dray-Spira
authors: Department of Epidemiology and Public Health, University College London, London, UK.
authors: Jenny
authors: J
authors: Head
authors: Population-based Cohorts Unit, UMS 011, INSERM, Villejuif, France University Versailles Saint Quentin en Yvelines, Paris, France.
authors: Marcel
authors: M
authors: Goldberg
authors: Finnish Institute of Occupational Health, Helsinki, Finland.
authors: Jaana
authors: J
authors: Pentti
authors: Institute of Behavioural Sciences, University of Helsinki, Helsinki, Finland.
authors: Markus
authors: M
authors: Jokela
authors: Finnish Institute of Occupational Health, Helsinki, Finland University of Turku and Turku University Hospital, Turku, Finland.
authors: Jussi
authors: J
authors: Vahtera
authors: Population-based Cohorts Unit, UMS 011, INSERM, Villejuif, France University Versailles Saint Quentin en Yvelines, Paris, France.
authors: Marie
authors: M
authors: Zins
authors: Finnish Institute of Occupational Health, Helsinki, Finland.
authors: Marianna
authors: M
authors: Virtanen
mesh_terms: D000328:Adult; D015331:Cohort Studies; D048909:Diabetes Complications / Q000191:economics*; D006233:Persons with Disabilities; D004651:Employment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012923:Social Class
keywords: DIABETES; META ANALYSIS; OCCUPATIONAL HEALTH; SICKNESS ABSENCE; SOCIAL INEQUALITIES