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Article ; Online: Work Resumption after a Fixed-Term Disability Pension: Changes over Time during a Period of Decreasing Incidence of Disability Retirement.

Laaksonen, Mikko

International journal of environmental research and public health

2021 Volume 18, Issue 9

Abstract: The incidence of disability retirement in Finland has sharply decreased over the last ten years. At the same time, the share of fixed-term pensions has increased to cover more than half of all new disability pensions. This study examined the efficiency ... ...

Abstract	The incidence of disability retirement in Finland has sharply decreased over the last ten years. At the same time, the share of fixed-term pensions has increased to cover more than half of all new disability pensions. This study examined the efficiency of fixed-term disability pensions under these changing circumstances with the aim of addressing the following research questions: are fixed-term disability pensions more often converted to permanent pensions, and how have the changes affected return to work? The study was based on register data of Finnish residents aged 25-62 whose fixed-term disability pension started in 2006 (
MeSH term(s)	Adult ; Aged ; Disabled Persons ; Finland/epidemiology ; Humans ; Incidence ; Male ; Middle Aged ; Pensions ; Retirement
Language	English
Publishing date	2021-04-27
Publishing country	Switzerland
Document type	Journal Article
ISSN	1660-4601
ISSN (online)	1660-4601
DOI	10.3390/ijerph18094618
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Article ; Online: Increasing labor force participation in older age requires investments in work ability.

Laaksonen, Mikko

Scandinavian journal of work, environment & health

2020 Volume 47, Issue 1, Page(s) 1–3

MeSH term(s)	Aged ; Employment ; Humans ; Socioeconomic Factors ; Work Capacity Evaluation
Language	English
Publishing date	2020-11-27
Publishing country	Finland
Document type	Editorial
ZDB-ID	191563-0
ISSN	1795-990X ; 0355-3140
ISSN (online)	1795-990X
ISSN	0355-3140
DOI	10.5271/sjweh.3941
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Article ; Online: Contribution of age, gender and occupational group to the higher risk of disability retirement among Finnish public sector employees.

Polvinen, Anu / Laaksonen, Mikko

Scandinavian journal of public health

2023 , Page(s) 14034948231153913

Abstract: Background: The aim of this study was to examine the differences in disability retirement between public and private sector employees and to examine the contribution of age, gender and occupational group to the differences between the sectors.: ... ...

Abstract	Background: The aim of this study was to examine the differences in disability retirement between public and private sector employees and to examine the contribution of age, gender and occupational group to the differences between the sectors. Methods: Our Finnish register data consisted of about two million non-retired men and women aged 30-62 years. Cox proportional hazard models were used to calculate hazard ratios for any, full and partial disability retirement in the public sector compared with the private sector. Results: The risk of any disability retirement was higher in the public sector than in the private sector in all occupational groups. The unadjusted hazard ratio ranged from 1.29 (95% CI 1.16-1.44) among teaching professionals to 2.25 (95% CI 1.95-2.58) among skilled agricultural, forestry and fishery workers. Adjustment for age and gender attenuated the differences between the sectors. After adjusting for age, gender and occupational group, the hazard ratio was 1.29 (95% CI 1.27-1.32) for any disability retirement and 2.02 (95% CI 1.96-2.08) for partial disability retirement, but there was no difference between the public sector and private sector employees for full disability retirement. Conclusions: Adjustment of age and gender attenuated the higher risk of disability retirement in the public sector, while adjustment for occupational group widened the sector differences in any and full disability retirement. The risk of partial disability retirement was higher in all occupational groups in the public sector than in the private sector. For full disability retirement, the differences between the sectors were small or non-existent.
Language	English
Publishing date	2023-02-22
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	1475054-5
ISSN	1651-1905 ; 1403-4948
ISSN (online)	1651-1905
ISSN	1403-4948
DOI	10.1177/14034948231153913
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Article ; Online: Unemployed and disabled for work: identifying 3-year labour market pathways from the beginning of a sickness absence using sequence and cluster analyses in a register-based longitudinal study in Finland.

Perhoniemi, Riku / Blomgren, Jenni / Laaksonen, Mikko

BMJ open

2023 Volume 13, Issue 12, Page(s) e076435

Abstract: Objectives: This study followed the labour market pathways of unemployed persons who started a sickness absence (SA) spell. We aimed to unravel subgroups based on altering labour market states and to identify covariates of these subgroups.: Design: ... ...

Abstract	Objectives: This study followed the labour market pathways of unemployed persons who started a sickness absence (SA) spell. We aimed to unravel subgroups based on altering labour market states and to identify covariates of these subgroups. Design: Register-based longitudinal study, with nine labour market states and 36-month units. Setting and participants: All Finnish persons aged 18-59 years with an SA in 2016 who were unemployed at the start of the SA spell (N=12 639). Outcome measures: Sequence analysis was used to study transitions between nine labour market states based on monthly register data on permanent and temporary (full and partial) disability pensions (DP), rehabilitation, all-cause SA, unemployment and employment. Individuals were grouped into clusters based on cluster analysis and intersequence distances. Multinomial regression analysis was used to examine covariates of cluster memberships. Results: Six clusters with the following pathway identities were found: (1) recurring unemployment (44%); (2) employment after a short SA (18%); (3) rehabilitation, recurring SA and unemployment (12%); (4) unknown sources of income (11%); (5) permanent DP after a prolonged SA (9%) and (6) temporary DP after a prolonged SA (7%).Compared with the reference cluster 2, all other clusters were associated with less employment days and having a chronic illness before the SA spell, SA based on a mental disorder and a rejected DP application during the follow-up. In addition, the clusters had some unique covariates. Conclusions: Unemployed persons starting an SA are a heterogeneous group, with different labour market pathways. For many, the combination of unemployment and work disability means low chances for employment or regained work ability during the following years. Unemployed persons with poorer health, long history outside employment, older age, low educational level, a rejected DP application and a mental disorder could benefit from targeted support.
MeSH term(s)	Humans ; Unemployment ; Longitudinal Studies ; Finland ; Disabled Persons ; Pensions ; Cluster Analysis ; Sick Leave ; Sweden
Language	English
Publishing date	2023-12-27
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-076435
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Article ; Online: Identifying labour market pathways after a 30-day-long sickness absence -a three-year sequence analysis study in Finland.

Perhoniemi, Riku / Blomgren, Jenni / Laaksonen, Mikko

BMC public health

2023 Volume 23, Issue 1, Page(s) 1102

Abstract: Background: Return-to-work (RTW) process often includes many phases. Still, multi-state analyses that follow relevant labour market states after a long-term sickness absence (LTSA), and include a comprehensive set of covariates, are scarce. The goal of ... ...

Abstract	Background: Return-to-work (RTW) process often includes many phases. Still, multi-state analyses that follow relevant labour market states after a long-term sickness absence (LTSA), and include a comprehensive set of covariates, are scarce. The goal of this study was to follow employment, unemployment, sickness absence, rehabilitation, and disability pension spells using sequence analysis among all-cause LTSA absentees. Methods: Register data covered full-time and partial sickness allowance, rehabilitation, employment, unemployment benefits, and permanent and temporary disability pension (DP), retrieved for a 30% representative random sample of Finnish 18-59 years old persons with a LTSA in 2016 (N = 25,194). LTSA was defined as a ≥ 30-day-long full-time sickness absence spell. Eight mutually exclusive states were constructed for each person and for 36 months after the LTSA. Sequence analysis and clustering were used to identify groups with different labour market pathways. In addition, demographic, socioeconomic, and disability-related covariates of these clusters were examined using multinomial regressions. Results: We identified five clusters with emphases on the different states: (1) rapid RTW cluster (62% of the sample); (2) rapid unemployment cluster (9%); (3) DP after a prolonged sickness absence cluster (11%); (4) immediate or late rehabilitation cluster (6%); (5) other states cluster (6%). Persons with a rapid RTW (cluster 1) had a more advantaged background than other clusters, such as a higher frequency of employment and less chronic diseases before LTSA. Cluster 2 associated especially with pre-LTSA unemployment and lower pre-LTSA earnings. Cluster 3 was associated especially with having a chronic illness before LTSA. Those in cluster 4 were on average younger and had a higher educational level than others. Especially clusters 3 and 4 were associated with a LTSA based on mental disorders. Conclusions: Among long-term sickness absentees, clear groups can be identified with both differing labour market pathways after LTSA and differing backgrounds. Lower socioeconomic background, pre-LTSA chronic diseases and LTSA caused by mental disorders increase the likelihood for pathways dominated by long-term unemployment, disability pensioning and rehabilitation rather than rapid RTW. LTSA based on a mental disorder can especially increase the likelihood for entering rehabilitation or disability pension.
MeSH term(s)	Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Finland ; Occupations ; Employment ; Disabled Persons ; Pensions ; Sequence Analysis ; Sick Leave
Language	English
Publishing date	2023-06-07
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-023-15895-2
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Article ; Online: Impact of a Finnish reform adding new sickness absence checkpoints on rehabilitation and labor market outcomes: an interrupted time series analysis.

Laaksonen, Mikko / Blomgren, Jenni / Rinne, Hanna / Perhoniemi, Riku

Scandinavian journal of work, environment & health

2023 Volume 49, Issue 8, Page(s) 588–597

Abstract: Objectives: In 2012, new checkpoints were introduced in the Finnish sickness absence system to improve early detection of long-term work disability and hasten return to work after illness. We examined whether the reform affected participation in ... ...

Abstract	Objectives: In 2012, new checkpoints were introduced in the Finnish sickness absence system to improve early detection of long-term work disability and hasten return to work after illness. We examined whether the reform affected participation in rehabilitation and labor market outcomes over a one-year period. Methods: We used interrupted time series analysis among persons who started receiving sickness allowance up to three years before and up to two years after the reform. Separate analyses were conducted among those who passed 30, 60, and 90 sickness allowance days. Poisson regression analysis was used, controlling for seasonal variation, gender, age, and educational level. Results: After the reform, participation in rehabilitation within one year of passing 30 sickness allowance days increased by 5.1% [incidence rate ratio (IRR) 1.051, 95% confidence interval (CI) 1.015-1.086]. The increase after 60 and 90 sickness allowance days was slightly larger. Looking at the type of rehabilitation, vocational rehabilitation from the earnings-related pension scheme increased most. Regarding the rehabilitation provided by the Social Insurance Institution of Finland (Kela), vocational rehabilitation, medical rehabilitation, and discretionary rehabilitation increased, but the increase was statistically significant only in the last case. Post-reform changes in employment, unemployment, sickness absence and disability retirement were negligible. Conclusions: The introduction of new sickness absence checkpoints was associated with an increase in participation in rehabilitation but did not affect labor market outcomes one year later. The reform thus was only partially successful in achieving its objectives. Future research should focus on identifying the most effective approaches for utilizing rehabilitation to enhance labor market participation after sickness absence.
MeSH term(s)	Humans ; Finland ; Interrupted Time Series Analysis ; Employment ; Unemployment ; Occupations ; Disabled Persons/rehabilitation ; Pensions ; Sick Leave
Language	English
Publishing date	2023-10-01
Publishing country	Finland
Document type	Journal Article
ZDB-ID	191563-0
ISSN	1795-990X ; 0355-3140
ISSN (online)	1795-990X
ISSN	0355-3140
DOI	10.5271/sjweh.4122
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Article ; Online: Determinants of transition from partial to full disability pension: A register study from Finland.

Polvinen, Anu / Laaksonen, Mikko

Scandinavian journal of public health

2021 Volume 50, Issue 5, Page(s) 622–628

Abstract: Aims: ...

Abstract	Aims:
MeSH term(s)	Aged ; Disabled Persons ; Employment ; Finland/epidemiology ; Humans ; Male ; Musculoskeletal Diseases/diagnosis ; Pensions ; Risk Factors
Language	English
Publishing date	2021-05-31
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	1475054-5
ISSN	1651-1905 ; 1403-4948
ISSN (online)	1651-1905
ISSN	1403-4948
DOI	10.1177/14034948211020172
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Article ; Online: The impact of vocational rehabilitation on employment outcomes: A regression discontinuity approach.

Laaksonen, Mikko / Ilmakunnas, Ilari / Tuominen, Samuli

Scandinavian journal of work, environment & health

2022 Volume 48, Issue 6, Page(s) 498–506

Abstract: Objectives: Since 2015, Finnish disability pension applicants who are rejected or receive a short-term temporary pension have, under certain conditions, also received a preliminary decision for vocational rehabilitation (VR). A key requirement for ... ...

Abstract	Objectives: Since 2015, Finnish disability pension applicants who are rejected or receive a short-term temporary pension have, under certain conditions, also received a preliminary decision for vocational rehabilitation (VR). A key requirement for eligibility is a certain amount of earnings during the previous five years (€34 910.29 in 2017). We exploit this discontinuity to examine the impact of assignment to VR on labor market outcomes. Methods: All new disability pension applicants from 2015 to 2017 were included. Fuzzy regression discontinuity design was used to evaluate the impact of assignment to VR on employment, unemployment and earned income two years later among those close to the threshold (+/- €20 000) providing eligibility for the preliminary decision. Arguably, those just below and just above the earnings limit are similar to each other, allowing causal interpretation of the estimates. Results: For each of the employment outcomes, we found a modest effect in the expected direction at the income threshold, but there is considerable uncertainty in these findings. On average, exceeding the income limit increased the probability of employment by 7.6 percentage points, but the estimate was far from statistical significance. Unemployment became slightly less common and earned income slightly increased, but the estimates were also clearly statistically non-significant. Conclusions: We found no consistent evidence of the impact of assignment to VR on employment outcomes among low-income disability pension applicants. However, given the narrow and specific study population, this should not be taken as evidence of ineffectiveness of VR more generally.
MeSH term(s)	Disabled Persons/rehabilitation ; Employment ; Humans ; Pensions ; Rehabilitation, Vocational ; Unemployment
Language	English
Publishing date	2022-06-13
Publishing country	Finland
Document type	Journal Article
ZDB-ID	191563-0
ISSN	1795-990X ; 0355-3140
ISSN (online)	1795-990X
ISSN	0355-3140
DOI	10.5271/sjweh.4038
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Article ; Online: Use of outpatient and inpatient health care services by occupation-a register study of employees in Oulu, Finland.

Rinne, Hanna / Laaksonen, Mikko / Blomgren, Jenni

BMC health services research

2022 Volume 22, Issue 1, Page(s) 597

Abstract: Background: The aim of this study was to examine how the use of outpatient and inpatient health services differs by occupational groups, and whether the differences are explained by sociodemographic factors and health status.: Methods: We used ... ...

Abstract	Background: The aim of this study was to examine how the use of outpatient and inpatient health services differs by occupational groups, and whether the differences are explained by sociodemographic factors and health status. Methods: We used register-based data on 25-64-year-old employees living in the city of Oulu, Finland, in 2018 (N = 61,848). Use of outpatient health care services (public, private and occupational health care) among men and women was analysed with negative binomial regression models, and use of inpatient health care with logistic regression models, using two occupational classifications: occupational group (1-digit level) and more detailed occupation (2-digit level). Adjusted covariates were age, education, income, marital status, special reimbursement entitlements for medicines, and sickness absence. Results: Examined at the level of larger occupational groups, the use of outpatient and inpatient health care was less common than average among managers, professionals and skilled agricultural, forestry and fishery workers; in women also among craft and related trades workers. Controlling for covariates explained only part of the differences, more among women than among men. Analysed at the level of more detailed occupations, the adjusted use of outpatient and inpatient care was more common among health associate professionals and stationary plant and machine operators, both among men and women. Furthermore, the use of outpatient care was common among male personal care workers, protective service workers and metal, machinery and related trades workers as well as among labourers in mining, construction, manufacturing and transport, and female customer services clerks and sales workers. Conclusion: The use of health care services differs by occupation, and the differences are not fully explained by sociodemographic factors and health status. High occupational risks, attitudes and knowledge may explain the more frequent use of health services. Furthermore, explanations may be sought from lack of access to occupational health care or healthier working conditions and behavior.
MeSH term(s)	Adult ; Ambulatory Care ; Delivery of Health Care ; Female ; Finland ; Humans ; Inpatients ; Male ; Middle Aged ; Occupations ; Outpatients
Language	English
Publishing date	2022-05-03
Publishing country	England
Document type	Journal Article
ZDB-ID	2050434-2
ISSN	1472-6963 ; 1472-6963
ISSN (online)	1472-6963
ISSN	1472-6963
DOI	10.1186/s12913-022-07970-y
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Article ; Online: Manual occupations with high all-cause mortality: The contribution of socioeconomic and occupational characteristics.

Rinne, Hanna / Laaksonen, Mikko

Scandinavian journal of public health

2020 Volume 49, Issue 2, Page(s) 237–244

MeSH term(s)	Adult ; Cause of Death/trends ; Female ; Finland/epidemiology ; Humans ; Longitudinal Studies ; Male ; Middle Aged ; Mortality/trends ; Occupations/statistics & numerical data ; Registries ; Risk Factors ; Socioeconomic Factors
Language	English
Publishing date	2020-11-06
Publishing country	Sweden
Document type	Journal Article
ZDB-ID	1475054-5
ISSN	1651-1905 ; 1403-4948
ISSN (online)	1651-1905
ISSN	1403-4948
DOI	10.1177/1403494820960653
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