title: Comorbidity and work disability among employees with diabetes: Associations with risk factors in a pooled analysis of three cohort studies.
abstract: OBJECTIVE
  Among employees with diabetes, comorbidity may considerably deteriorate working capacity. We examined how socioeconomic status, lifestyle factors and job strain were related to work disability in individuals with diabetes with and without comorbidity.
  
  
  METHODS
  In this pooled analysis of individual-participant data from occupational cohorts from Finland (Finnish Public Sector Study FPS), UK (Whitehall II) and France (GAZEL), 1925 employees with diabetes were followed on average for 4 years. Participants were categorized into four groups, according to their baseline comorbidity status and subsequent work disability, as: non-comorbid diabetes with no/low work disability; comorbid diabetes with no/low work disability; non-comorbid diabetes with moderate/high work disability; and comorbid diabetes with moderate/high work disability. The risk of work disability was assessed with multinomial regression, using Group 1 (the first listed above) as the reference group.
  
  
  RESULTS
  Participants with low socioeconomic status had increased odds for higher work disability, irrespective of comorbidity (OR = 3.12; 95% CI 2.25-4.33, among participants with no comorbidity, and OR = 2.61; 95% CI 1.93-3.51 among those with comorbidity). Obesity was cross-sectionally associated with comorbidity (OR = 1.95; 95% CI 1.35-2.83 for comorbidity without disability), and this association was particularly pronounced among those whom became work disabled (OR = 2.61; 95% CI 1.89-3.60 for comorbidity with disability). Job strain was associated with high/moderate work disability, only among participants with comorbidity (OR = 1.63; 95% CI 1.14-2.34).
  
  
  CONCLUSIONS
  Pooled data from three cohort studies showed that low socioeconomic status, obesity, and job strain are linked to both comorbidity and increased work disability in employees with diabetes.
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland jenni.ervasti@ttl.fi.
authors.forename: Jenni
authors.initials: J
authors.lastname: Ervasti
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK Department of Public Health, University of Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
authors.affiliation: French National Institute of Health and Medical Research (Inserm), Research Unit 1136 - Pierre Louis Institute of Epidemiology and Public Health, France Sorbonne Universities, University Paris 06 - Pierre and Marie Curie, Paris, France.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Dray-Spira
authors.affiliation: Department of Epidemiology and Public Health, University College London, UK.
authors.forename: Jenny
authors.initials: J
authors.lastname: Head
authors.affiliation: French National Institute of Health and Medical Research (Inserm), Population-based Cohort Unit, Villejuif, France French National Institute of Health and Medical Research (Inserm), Research Unit 1168 Aging and chronic diseases - Epidemiological and public health approaches, Villejuif, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Goldberg
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.affiliation: Institute of Behavioural Sciences, University of Helsinki, Finland.
authors.forename: Markus
authors.initials: M
authors.lastname: Jokela
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland Turku University Hospital, University of Turku, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.affiliation: French National Institute of Health and Medical Research (Inserm), Population-based Cohort Unit, Villejuif, France French National Institute of Health and Medical Research (Inserm), Research Unit 1168 Aging and chronic diseases - Epidemiological and public health approaches, Villejuif, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Zins
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004651:Employment / Q000523:psychology; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology; D012307:Risk Factors; D018582:Sick Leave / Q000706:statistics & numerical data*; D012923:Social Class; D013315:Stress, Psychological / Q000453:epidemiology
keywords: Chronic illness; comorbidity; diabetes; disability pension; job stress; lifestyle; sick time; sickness absence; socioeconomic status; stress; work disability; work force