title: Work Disability among Employees with Diabetes: Latent Class Analysis of Risk Factors in Three Prospective Cohort Studies.
abstract: BACKGROUND
  Studies of work disability in diabetes have examined diabetes as a homogeneous disease. We sought to identify subgroups among persons with diabetes based on potential risk factors for work disability.
  
  
  METHODS
  Participants were 2,445 employees with diabetes from three prospective cohorts (the Finnish Public Sector study, the GAZEL study, and the Whitehall II study). Work disability was ascertained via linkage to registers of sickness absence and disability pensions during a follow-up of 4 years. Study-specific latent class analysis was used to identify subgroups according to prevalent comorbid disease and health-risk behaviours. Study-specific associations with work disability at follow-up were pooled using fixed-effects meta-analysis.
  
  
  RESULTS
  Separate latent class analyses for men and women in each cohort supported a two-class solution with one subgroup (total n = 1,086; 44.4%) having high prevalence of chronic somatic diseases, psychological symptoms, obesity, physical inactivity and abstinence from alcohol and the other subgroup (total n = 1,359; 55.6%) low prevalence of these factors. In the adjusted meta-analyses, participants in the 'high-risk' group had more work disability days (pooled rate ratio = 1.66, 95% CI 1.38-1.99) and more work disability episodes (pooled rate ratio = 1.33, 95% CI 1.21-1.46). These associations were similar in men and women, younger and older participants, and across occupational groups.
  
  
  CONCLUSIONS
  Diabetes is not a homogeneous disease in terms of work disability risk. Approximately half of people with diabetes are assigned to a subgroup characterised by clustering of comorbid health conditions, obesity, physical inactivity, abstinence of alcohol, and associated high risk of work disability; the other half to a subgroup characterised by a more favourable risk profile.
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland.
authors.forename: Marianna
authors.initials: M
authors.lastname: Virtanen
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland.|Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland.
authors.forename: Jussi
authors.initials: J
authors.lastname: Vahtera
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors.forename: Jenny
authors.initials: J
authors.lastname: Head
authors.affiliation: INSERM, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013, Paris, France.|Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Pierre Louis Institute of Epidemiology and Public Health, Department of Social Epidemiology, F-75013, Paris, France.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Dray-Spira
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland.
authors.forename: Annaleena
authors.initials: A
authors.lastname: Okuloff
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, United Kingdom.|1st Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Adam G
authors.initials: AG
authors.lastname: Tabak
authors.affiliation: Population-based Cohorts Unit, Inserm UMS 011, Villejuif, France.|University Versailles Saint Quentin en Yvelines, Versailles, France.
authors.forename: Marcel
authors.initials: M
authors.lastname: Goldberg
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland.
authors.forename: Jenni
authors.initials: J
authors.lastname: Ervasti
authors.affiliation: Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland.
authors.forename: Markus
authors.initials: M
authors.lastname: Jokela
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, United Kingdom.|Inserm U1018, Centre for Research in Epidemiology and Population Health, Villejuif, France.
authors.forename: Archana
authors.initials: A
authors.lastname: Singh-Manoux
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland.
authors.forename: Jaana
authors.initials: J
authors.lastname: Pentti
authors.affiliation: Population-based Cohorts Unit, Inserm UMS 011, Villejuif, France.|University Versailles Saint Quentin en Yvelines, Versailles, France.
authors.forename: Marie
authors.initials: M
authors.lastname: Zins
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Turku and Tampere, Finland.|Department of Epidemiology and Public Health, University College London, London, United Kingdom.|Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Mika
authors.initials: M
authors.lastname: Kivimäki
mesh_terms: D000041:Absenteeism; D000328:Adult; D015331:Cohort Studies; D003710:Demography; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology*; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000473:pathology; D009784:Occupational Diseases / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D018582:Sick Leave