Beskæftigelsesudvalget 2019-20
BEU Alm.del Bilag 376
Offentligt
2241713_0001.png
European Journal of Public Health,
1–7
ß
The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.
org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly
cited. For commercial re-use, please contact [email protected]
doi:10.1093/eurpub/ckaa107
Downloaded from https://academic.oup.com/eurpub/article-abstract/doi/10.1093/eurpub/ckaa107/5870969 by Det Nationale Forskningscenter for Arbejdsmilj (NFA) user on 03 August 2020
.........................................................................................................
Cumulated and most recent job control and risk of
disability pension in the Danish Work Life Course
Cohort (DaWCo)
1
2
Elisabeth Framke
, Annemette Coop Svane-Petersen
1
, Anders Holm
, Hermann Burr
3
,
5,6,7
, Stephen Stansfeld
8
, Jeppe Karl Sørensen
1
,
Maria Melchior
4
, Børge Sivertsen
1,11,12
Marianna Virtanen
9,10
, Reiner Rugulies
, Ida E. H. Madsen
1
1
2
3
4
5
6
7
8
9
10
11
12
National Research Centre for the Working Environment, Copenhagen, Denmark
Department of Sociology, University of Western Ontario, London, ON, Canada
Unit Mental Health and Cognitive Capacity, Federal Institute for Occupational Safety and Health, Berlin, Germany
´
INSERM, Sorbonne Universite, Institut Pierre Louis d’Epidemiologie et de Sante Publique, IPLESP, Research Group in
´
´
´
Social Epidemiology, F75012 Paris, France
Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway
Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
Centre for Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London,
London, UK
School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu, Finland
Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
Section of Epidemiology, Department of Public Health, University of Copenhagen, Denmark
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Correspondence:
Elisabeth Framke, National Research Centre for the Working Environment, Lersø Parkalle 105, DK-2100
´
Copenhagen, Denmark. Tel:
þ45
(0) 39 16 5487, Fax: (þ45) 39 16 52 01, e-mail: [email protected]
Background:
Previous studies have found low job control to be associated with a higher risk of disability pension
(DP). Most studies have measured job control only at one time-point, and there is a lack of knowledge regarding
the role of exposure duration. This study examines the prospective association between job control and DP
measuring exposure both cumulated throughout work life and most recent.
Methods:
We included 712 519
individuals (about 4.5 million person-years) from The Danish Work Life Course Cohort which follows young
employees in Denmark from their entry into the labour market. Job control was assessed with a job exposure
matrix and DP with register data on public transfer payments. We adjusted for several potential life course
confounders, including physical demands at work and parental socioeconomic position and psychiatric and som-
atic diagnoses.
Results:
Employees in occupations with low job control had a higher risk of DP. There were effects
of both cumulated and most recent job control when mutually adjusted. Fully adjusted hazard ratios (HRs) were
1.14 [95% confidence intervals (CIs) 1.11–1.17] and 1.15 (95% CI 1.02–1.29) for cumulated and most recent job
control, respectively. Without mutual adjustment, estimates were 1.15 (95% CI 1.13–1.18) and 1.55 (95% CI 1.39–
1.72) for cumulated and most recent low job control, respectively.
Conclusions:
Low job control predicts a higher
risk of DP, even after adjustment for physical demands at work. The results indicate both gradual and short-term
effects of low job control on DP risk.
.........................................................................................................
Introduction
recent systematic review based on 39 studies concluded that low job
control was consistently associated with DP with a weighted average
relative risk of 1.40 (95% CI 1.21–1.61). When compared with other
psychological, social and organizational factors included in the re-
view job control showed the most robust association with risk of
DP.
2
Existing studies on the association between job control and DP
are limited by several methodological concerns. First, most previous
studies include little information on exposure duration which could
lead to underestimation of associations, since studies indicate that
longer, compared with shorter, duration is more harmful.
3,4
Second,
most studies were based on populations that were not followed from
labour market entry and consequently may be affected by healthy
J
cretion at work and is a predictor of disability pension (DP). A
1
2
ob control is the combination of decision authority and skill dis-
worker bias. Such bias likely leads to lower estimates due to not
including individuals in the population who were already granted
DP. Third, estimates from previous studies may be biased due to
selection of employees into and/or out of jobs with low job control.
Such a selection is probable, as research has demonstrated links
between childhood social factors, educational attainment, labour
market entry and psychosocial working conditions in adulthood.
5–9
Analyses failing to account for pre-existing DP risk factors among
individuals with lower job control may overestimate the association
between job control and DP. Fourth, most studies may be affected
by reporting bias likely leading to overestimation of associations,
since the psychological state of the individual may affect both the
reporting of job control at baseline and DP risk during follow-up.
10
Finally, physical demands at work may be associated with both job
control and DP and might therefore confound associations between
job control and DP; however, most previous studies have not
adjusted for physical work demands.
2
 BEU, Alm.del - 2019-20 - Bilag 376: Orientering om artikel fra NFA om lav kontrol i arbejdet og efterfølgende risiko for førtidspension blandt yngre arbejdstagere
2241713_0002.png
2 of 7
European Journal of Public Health
This study examines prospective associations between job control
and DP while accounting for the mentioned limitations. We ana-
lyzed data from 712 519 young employees in Denmark, followed
from their labour market entry. We included several measures on
childhood social factors, measured job control repeatedly, assessed
job control by a job exposure matrix (JEM) and adjusted for phys-
ical work demands. We hypothesized that low job control would be
associated with a higher risk of DP, and that the association would
remain after adjustment for physical demands. We included both
cumulated and most recent job control in all main and pre-planned
sensitivity analyses to analyze the effect of cumulated job control on
DP risk beyond the effect of most recent job control and vice versa,
allowing us to distinguish between gradual and short-term effects.
years of non-employment, we assigned a score equal to the lowest
score amongst employed individuals.
Downloaded from https://academic.oup.com/eurpub/article-abstract/doi/10.1093/eurpub/ckaa107/5870969 by Det Nationale Forskningscenter for Arbejdsmilj (NFA) user on 03 August 2020
Disability pension
We identified DP in the Danish Register for Evaluation of
Marginalization (DREAM) including weekly information on social
transfer payments.
18
We measured DP as the first record coded ‘783’
(DP) within the year 4 years after the exposure measurement year,
throughout follow-up from 1 January 1999 to 31 December 2010.
For example, exposures measured in 1995 were linked with out-
comes that occurred in 1999.
In Denmark, DP is granted and payed for by municipalities based
on an overall work ability assessment. Part-time DP and returning to
work from DP is rare in Denmark.
19
Methods
Design
We analyzed data from The Danish Work Life Course Cohort
(DaWCo) consisting of nationwide registers and a questionnaire
based JEM. DaWCo is described in details elsewhere.
11–13
Briefly,
DaWCo consists of all individuals living in Denmark, who entered
the labour market for the first time during 1995–2009 aged 15–
30 years. Labour market entry was defined by being included in
The Integrated Database for Labour Market Research
14
and simul-
taneously having gainful employment as main source of income for
the first time in the Employment Classification Module.
14
Since DP
is usually preceded by non-employment, we applied a 4-year time-
lag between exposure and outcome. This is the average time from
employment to first DP episode in DaWCo. Main analyses were
based on a published study protocol.
11
Covariates
Based on national registers,
14,20–25
we included information on the
following covariates concerning the population: age (continuous),
sex, migration background (individuals without migration back-
ground, immigrants/descendants of immigrants), cohabitation
(yes, no), income (deciles), education (highest completed catego-
rized into primary or lower secondary, upper secondary, short-cycle
tertiary, bachelor, master, doctoral, missing), psychiatric disorder
prior to 15 years (yes, no), employment status (employed, self-
employed, unemployed, studying, other non-employment), years
of non-employment since cohort entry (continuous), years of em-
ployment since cohort entry (continuous) and physical work
demands (most recent, JEM based
17
).
We included information concerning parents of the population
when the study individual was 15 years: parental labour market sta-
tus (employed, un-/non-employed and missing), parental educa-
tional level (primary or lower secondary, upper secondary, short-
cycle tertiary, bachelor or equivalent, master or doctoral, missing),
diagnosed parental mental disorder (yes, no) and somatic diseases
(yes, no) and, availability of parental information (non-missing,
missing).
Supplementary figure S1
shows the analytical framework in form
of a directed acyclic graph. All covariates were measured before or
concurrently with exposures.
Population
Of the 979 257 individuals with labour market entry during the
study period, we excluded individuals with missing information
on sex or migration background (n
¼
5176). We also excluded indi-
viduals who died (n
¼
71), emigrated (n
¼
13 087) or received DP
(n
¼
361) during entry year, or had received DP previously
(n
¼
158), yielding a cohort of 960 404 individuals. To ensure a 4-
year time-lag between exposure and outcome, we excluded 247 885
individuals with
<4
years of follow-up, yielding a final population of
712 519 individuals who entered the workforce in 1995–2006. Of the
individuals that were excluded to ensure the 4-year time-lag between
exposure and outcome, 80% entered the DaWCo in 2007–09. Less
than 0.5% of excluded individuals were granted DP. When com-
pared with the study population, excluded individuals were similar
regarding distribution of sex, but were more likely to emigrate.
Statistical analysis
We conducted all analyses using SAS 9.4. Using Cox regression with
calendar time as the underlying time axis accounting for period
effects of the DP granting system, we calculated hazard ratios
(HRs) and 95% CI for associations between job control and DP.
We included each individual in the analyses with repeated observa-
tions relating job control during year ‘t’ to first DP record during
year
t
þ
4 years, i.e. 4 years after exposure assessment. The popula-
tion was followed from cohort entry until first DP episode
(n
¼
7305), emigration (n
¼
4937), death (n
¼
1743) or end of study
on 31 December 2010.
We included both cumulated and most recent job control in the
models. In model 1, we adjusted for age, sex, ethnicity, cohabitation,
income, education, employment status, psychiatric disorder prior to
15 years, years of non-employment and years of employment since
cohort entry, parental labour market status and education, parental
mental and somatic diagnosed diseases prior to individuals’ cohort
entry and finally, missing parental information. In model 2, we
further adjusted for physical work demands.
Age, cohabitation, income, education, employment status, years
of non-employment since cohort entry, years of employment since
cohort entry and physical work demands were included as time-
varying covariates. Remaining covariates were time-invariant.
Job control
We measured job control with a JEM based on the Danish Work
Environment Cohort Study (DWECS). DWECS was a survey on
working conditions and health, conducted in a random sample of
the Danish workforce from 1990 to 2010.15,16 Using multilevel
modelling, we constructed JEMs as the predicted level of job control
given occupation [according to DISCO-88, the Danish version of
the International Standard Classification of Occupations (ISCO)-88
system], sex, age and year of data collection (2000 and 2005).
Occupation explained a considerable proportion of the variation
in job control (Intra-class correlation
¼
0.30), indicating that job
control is suitable for JEMs.
17
DWECS items, response options
and JEM construction are described in detail elsewhere.
11
We assigned job control scores to each individual with yearly
updates from 1995 to 2006 with higher scores indicating lower job
control. Cumulated job control was measured as the sum of job
control scores from each cohort year, whereas most recent job con-
trol was measured as the job control score valid for the given year. In
 BEU, Alm.del - 2019-20 - Bilag 376: Orientering om artikel fra NFA om lav kontrol i arbejdet og efterfølgende risiko for førtidspension blandt yngre arbejdstagere
2241713_0003.png
Job control and risk of DP in DaWCo
3 of 7
Pre-planned sensitivity analyses
We repeated analyses by sex and industrial sector. Further, we ana-
lyzed job control as a dichotomous variable (median split) for each
exposure year. Finally, we analyzed associations between job control
and DP in the presence of mental and/or musculoskeletal disorders
using a competing risks model. We did this because we wanted to
explore whether job control was differently associated with DP due
to mental disorders vs. DP due to musculoskeletal disorders.
Diagnoses were retrieved from the National Patient Register
24
from birth and prior to DP granting, since DREAM does not include
this information. We included diagnoses according to ICD-10 clas-
sification system for the following two groups: mental disorders
(F00–F99) and musculoskeletal disorders (M00–M99), the two
most frequent reasons for granting DP.
26,27
We defined four events:
diagnosed mental disorder(s), diagnosed musculoskeletal disor-
der(s), a combination of diagnosed mental and musculoskeletal dis-
orders and no diagnosed disorder(s).
Table 1
Characteristics of the study population in their year of entry
into the workforce
n
Total sample
Sex
Men
Women
Age
15–17
18–19
20–24
25–30
Cohabitation
Yes
No
Unknown
Ethnicity
Danish
Non-Danish
Education
Primary or lower secondary
Upper secondary
Short-cycle tertiary
Bachelor or equivalent
Master or equivalent
Doctoral or equivalent
Not classified/unknown
Maternal psychiatric diagnosis
Yes
No
Paternal psychiatric diagnosis
Yes
No
Maternal somatic diagnosis
Yes
No
Paternal somatic diagnosis
Yes
No
Maternal education
Primary or lower secondary
Upper secondary
Short-cycle tertiary
Bachelor or equivalent
Master or doctoral
Not classified/unknown
Paternal education
Primary or lower secondary
Upper secondary
Short-cycle tertiary
Bachelor or equivalent
Master or doctoral
Not classified/unknown
Maternal occupational position
Employed
Non-employed
Unknown
Paternal occupational position
Employed
Non-employed
Unknown
Missing maternal data
Missing paternal data
712 519
361 642
350 877
80
286
287
58
257
096
329
837
50.8
49.2
20.0
11.3
40.2
40.3
8.3
66.7
30.8
2.5
88.7
11.3
73.9
19.3
0.5
1.4
0.6
0.0
4.4
6.2
87.3
5.7
86.6
4.3
89.2
5.8
86.5
22.3
23.1
1.6
11.2
2.2
39.6
12.2
25.5
2.2
5.7
4.6
49.9
71.1
20.7
8.2
76.7
13.0
10.3
6.5
7.7
%
Mean
Downloaded from https://academic.oup.com/eurpub/article-abstract/doi/10.1093/eurpub/ckaa107/5870969 by Det Nationale Forskningscenter for Arbejdsmilj (NFA) user on 03 August 2020
475 516
219 174
17 829
631 790
80 729
526 366
137 729
3374
9601
4161
8
31 280
44 028
622 147
40 818
616 696
30 288
635 887
41 172
616 342
158
164
11
79
15
282
86
181
15
40
32
355
885
884
068
999
327
356
682
964
535
236
492
610
Post-hoc sensitivity analyses
We repeated the fully adjusted main analysis while only including
one exposure measure in the model; that is cumulated job control
not controlled for most recent and vice versa.
Results
Population
Table 1
shows characteristics of the population at cohort entry year.
About half of the population was women (49.2%). Mean age was
20.0 years. Most individuals were born in Denmark (88.7%) and had
primary or lower secondary education as highest completed educa-
tion (73.9%). Two thirds were cohabiting (66.7%). Most individu-
als’ parents had primary or lower secondary or upper secondary
education as highest completed education (in total, 45.4% and
37.7% for maternal and paternal education, respectively) and were
employed (71.1% and 76.7% for maternal and paternal employ-
ment, respectively).
Cumulated and most recent job control and DP
During 4 461 058 person-years of follow-up, we identified 7305 DP
cases (16.38 per 10 000 person-years).
Table 2
shows that both
cumulated and most recent job control were associated with risk
of DP. Comparing individuals in occupations with lower cumulated
job control to individuals in occupations with higher cumulated job
control yielded a HR for DP of 1.14 (95% CI 1.11–1.17) per 1 point
lower job control after accounting for most recent exposure. The HR
for the association between most recent job control and DP after
accounting for cumulated exposure was 1.51 (95% CI 1.36–1.67).
506 728
147 511
58 280
546
92
73
46
55
818
483
218
344
005
Job control and DP accounting for physical demands
Table 2
also shows results for the associations with further adjust-
ment for physical demands. The estimate for cumulated job control
was not affected by adjustment for physical demands (HR
¼
1.14,
95% CI 1.11–1.17). The estimate for most recent job control
(HR
¼
1.15, 95% CI 1.02–1.29) attenuated.
Note: Maternal and paternal diagnosis, education and occupational
position at the time when the study participant was 15 years old.
Pre-planned sensitivity analyses
Table 2
further shows associations between exposures and DP risk
by sex. Cumulated job control predicted a higher DP risk in model 2
in both sexes. The estimate was, however, higher in men (HR
¼
1.24,
95% CI 1.20–1.29) than women (HR
¼
1.04, 95%CI 1.00-1.08).
Associations between most recent exposure and DP were similar
in men (HR
¼
1.54, 95% CI 1.33–1.77) and women (HR
¼
1.48,
95%CI 1.28–1.72) in model 1, and were strongly attenuated in
both sexes in model 2.
When analyzing risk of DP in relation to job control as a
dichotomous variable, the HR for low job control was 1.13
(95% CI 1.05–1.22) in model 1. In model 2, there was no longer
an association.
Table 3
shows estimates for DP risk by industry. There was a
higher DP risk for either cumulated or most recent exposure in
six of eight industries (Manufacturing, Construction, Retail trade,
 BEU, Alm.del - 2019-20 - Bilag 376: Orientering om artikel fra NFA om lav kontrol i arbejdet og efterfølgende risiko for førtidspension blandt yngre arbejdstagere
2241713_0004.png
4 of 7
European Journal of Public Health
Table 2
Risk of DP in relation to cumulated and most recent levels of job control
Downloaded from https://academic.oup.com/eurpub/article-abstract/doi/10.1093/eurpub/ckaa107/5870969 by Det Nationale Forskningscenter for Arbejdsmilj (NFA) user on 03 August 2020
PY
Total population
Cumulated level of job control, per point decrease
Most recent level of job control, per point decrease
Men
Cumulated level of job control, per point decrease
Most recent level of job control, per point decrease
Women
Cumulated level of job control, per point decrease
Most recent of level of job control, per point decrease
Most recent job control, dichotomized
Low ( median job control)
High (ref.) (>median job control)
Cases
Cases per 10 000 PY
Model 1
HR
95% CI
Model 2
HR
95% CI
4 461 058
4 461 058
2 257 749
2 257 749
2 203 310
2 203 310
2 632 858
1 828 200
7305
7305
3733
3733
3572
3572
5699
1606
16.38
16.38
16.53
16.53
16.21
16.21
21.65
8.78
1.14
1.51
1.24
1.54
1.04
1.48
1.13
1.0
1.11–1.17
1.36–1.67
1.20–1.29
1.33–1.77
1.00–1.07
1.28–1.72
1.05–1.22
Ref.
1.14
1.15
1.24
1.17
1.04
1.06
1.01
1.0
1.11–1.17
1.02–1.29
1.20–1.29
1.00–1.38
1.00–1.08
0.90–1.26
0.94–1.09
Ref.
Notes: Cumulated and most recent levels of job control are included in the same models (mutually adjusted). Model 1: estimates are
adjusted for age, sex, ethnicity, cohabitation, income, education, employment status, psychiatric disorder prior to the age of 15, years of
non-employment, years of employment, parental labor market status and educational level, parental mental and somatic diagnosed
diseases and missing parental information. Model 2: estimates are further adjusted for physical demands at work. PY, Person-years.
Table 3
Risk of DP in relation to cumulated and most recent levels of job control by industry
PY
Cases
Cases per 10 000 PY
Model 1
HR
Agriculture, fishing and quarrying
Cumulated level of job control, per point decrease
Most recent level of job control, per point decrease
Manufacturing
Cumulated level of job control, per point decrease
Most recent level of job control, per point decrease
Construction
Cumulated level of job control, per point decrease
Most recent level of job control, per point decrease
Retail trade; hotels and restaurants
Cumulated job control, per point decrease
Most recent level of job control, per point decrease
Transport, storage and communication
Cumulated level of job control, per point decrease
Most recent level of job control, per point decrease
Financial intermediation, business etc.
Cumulated level of job control, per point decrease
Most recent level of job control, per point decrease
Public and personal services
Cumulated level of job control, per point decrease
Most recent level of job control, per point decrease
Activity not stated
Cumulated level of job control, per point decrease
Most recent level of job control, per point decrease
95% CI
Model 2
HR
95% CI
115 410
115 410
537 488
537 488
295 850
295 850
1 119 213
1 119 213
219 464
219 464
490 868
490 868
1 192 806
1 192 806
483 025
483 025
154
154
904
904
256
256
931
931
259
259
508
508
1346
1346
2944
2944
13.34
13.34
16.82
16.82
8.65
8.65
8.32
8.32
11.80
11.80
10.35
10.35
11.28
11.28
60.95
60.95
1.19
1.63
1.22
1.20
1.13
2.29
1.20
1.38
1.12
1.11
1.21
1.76
0.99
1.82
1.15
1.50
(0.95–1.47)
(0.73–3.62)
(1.15–1.29)
(0.96–1.50)
(0.99–1.31)
(1.19–4.40)
(1.10–1.30)
(1.02–1.87)
(0.98–1.29)
(0.68–1.82)
(1.10–1.32)
(1.25–2.50)
(0.94–1.04)
(1.49–2.23)
(1.10–1.20)
(0.49–4.59)
1.18
1.34
1.21
0.76
1.14
2.35
1.20
1.19
1.12
1.06
1.19
0.73
1.00
1.36
1.15
0.79
(0.95–1.47)
(0.52–3.43)
(1.14–1.28)
(0.55–1.04)
(0.99–1.31)
(1.22–4.55)
(1.10–1.30)
(0.85–1.66)
(0.97–1.28)
(0.60–1.86)
(1.09–1.31)
(0.48–1.09)
(0.94–1.05)
(1.08–1.72)
(1.10–1.20)
(0.20–3.08)
Financial intermediation, Public and personal services, and Activity
not stated).
Figure 1
illustrates model 2 estimates by industry and
shows HRs ranging from 1.19 (95% CI 1.09–1.31, cumulated expos-
ure, Financial intermediation industry) to 2.35 (95% CI 1.22–4.55,
most recent exposure, Construction industry).
For job control and risk of DP in the presence of mental disor-
der(s), musculoskeletal disorder(s), both or no disorder(s), we
found largely similar associations (results shown in Supplementary
e-Table
S1).
Discussion
This study was based on DaWCo following 712 519 employees from
labour market entry, measuring job control repeatedly using a JEM
and included several measures of childhood social factors. Including
both cumulated and most recent job control in the statistical mod-
els, we found that there was an association between cumulated job
control and risk of DP independent of most recent exposure, and
that there was an association between low most recent job control
and risk of DP independent of cumulated exposure. Associations
remained after adjustment for physical demands, the estimate for
most recent exposure; however, attenuated strongly.
Fully adjusted sex-stratified analyses showed that cumulated job
control predicted DP in both sexes, but estimates were higher in
men. A higher DP risk in relation to most recent exposure was seen
in both sexes before, but not after adjustment for physical demands.
Post hoc sensitivity analyses
When repeating the fully adjusted model while not mutually adjust-
ing cumulated and most recent low job control, we found estimates
of 1.15 (95% CI 1.13–1.18) and 1.55 (95% CI 1.39–1.72) for cumu-
lated and most recent low job control, respectively.
 BEU, Alm.del - 2019-20 - Bilag 376: Orientering om artikel fra NFA om lav kontrol i arbejdet og efterfølgende risiko for førtidspension blandt yngre arbejdstagere
2241713_0005.png
Job control and risk of DP in DaWCo
5 of 7
Downloaded from https://academic.oup.com/eurpub/article-abstract/doi/10.1093/eurpub/ckaa107/5870969 by Det Nationale Forskningscenter for Arbejdsmilj (NFA) user on 03 August 2020
Figure 1
DP in relation to cumulated and most recent level of job control by industry. Cumulated and most recent levels of job control are
included in the same models (mutually adjusted). HRs are adjusted for age, sex, ethnicity, cohabitation, income, education, employment
status, psychiatric disorder prior to the age of 15, years of non-employment, years of employment, parental labour market status and
educational level, parental mental and somatic diagnosed diseases, missing parental information and physical demands at work. PY,
Person-years; HR, hazard ratio
Associations were seen in most but not all industries, and no sub-
stantial differences were seen when distinguishing between DP pre-
ceded by diagnosed mental or musculoskeletal disorder or both.
Finally,
post-hoc
sensitivity analyses including only one exposure
measurement in each model showed similar results for cumulated
job control but a stronger association for most recent exposure.
Comparison with previous studies
Our results are in agreement with a systematic review concluding
that low job control predicts DP.
2
We added new knowledge by
accounting for limitations in previous studies related to healthy
worker bias, selection of employees into and/or out of jobs with
low job control, lack of exposure duration information and report-
ing bias. Further, our results are also in agreement with register-
based twin studies concluding that associations between psycho-
social working conditions and DP seem independent of familial
confounding.
28,29
To the best of our knowledge, this study is the first to analyze
effect of cumulated job control on DP using repeated exposure
measurements. Previously, one study
4
reported an association be-
tween job control throughout working life and DP. That study,
however, measured job control only once, in midlife, when partic-
ipants were asked to retrospectively assess job control. Our study
contributes with new insights on effects of cumulated and most
recent job control, as we found independent effects of both. This
suggests that effects of job control on DP are both gradual and short
term, simultaneously, and that including exposure history is import-
ant to gain a more complete picture. It should be noted that cumu-
lated and most recent job control are highly correlated, but due to
the large number of observations, identification of the effect of both
cumulated and most recent job control is possible simultaneously.
The estimate for most recent job control when not mutually adjust-
ing for cumulated job control (HR
¼
1.55, 95% CI 1.39–1.72) may
be the most comparable estimate in relation to estimates found in
previous studies (weighted average RR
¼
1.40, 95% CI 1.21–1.61).
2
Studies on job control and DP differ regarding included covari-
ates.
2
Some studies included adjustment for physical demands,
others did not, and among studies adjusting for physical demands
results were mixed.
2
Our results suggest that effects of cumulated job
control on DP are independent from those of physical demands in
both sexes. For most recent job control that was not the case. The
reason may be that the measurement of physical demands better
captures recent than historical physical job demands.
We found low job control to predict a higher DP risk in most, but
not all industries. A study by Clausen
et al.
30
found influence at
work to predict DP in a large sample of the Danish workforce and
in most, but not all, subtypes of work. It appears that associations
are robust at the population level, although more research is needed
to establish if these associations hold in all subgroups of industries
and different types of work.
Strengths and limitations
Strengths include the large, nationwide cohort of employees fol-
lowed from labour market entry onwards and the use of annually
repeated exposure and covariate measurements allowing us to exam-
ine cumulated and most recent exposure. Moreover, we accounted
for several childhood social factors, physical demands and changes
over time in the DP granting system by using calendar time as time
axis.
Some limitations should be mentioned. First, we assessed job
control using a JEM. Therefore, associations should be interpreted
in relation to occupations, i.e. as risk of DP in employees in occu-
pations with lower job control compared with employees in occu-
pations with higher job control. The use of the JEM methodology
results in some exposure misclassification, as some employees could
have a low level of individual exposure while working in occupations
with an average high level of exposure and vice versa, likely leading
to underestimation of the observed associations.
31
Second, the regis-
ter used for outcome measurement did not include information on
medical causes of DP. Therefore, we do not know whether DP was
due to mental disorders, somatic diseases or both. We tried to ad-
dress this limitation by adding information on diagnosed somatic
diseases and psychiatric disorders from The National Patient
Register and found largely similar associations. Third, while the
present study included information on childhood social factors,
DaWCo does not include information on childhood adversities,
such as alcohol-related problems, which have been shown to be
associated with DP.
7
Fourth, we did not include adjustments for
other psychosocial factors at work in our analyses. A recent review
reported that while the evidence for the role of job control in
 BEU, Alm.del - 2019-20 - Bilag 376: Orientering om artikel fra NFA om lav kontrol i arbejdet og efterfølgende risiko for førtidspension blandt yngre arbejdstagere
2241713_0006.png
6 of 7
European Journal of Public Health
4
Sundstrup E, Hansen AM, Mortensen EL, et al. Retrospectively assessed psycho-
social working conditions as predictors of prospectively assessed sickness absence
and disability pension among older workers.
BMC Public Health
2018;18:149.
Narusyte J, Ropponen A, Alexanderson K, Svedberg P. Internalizing and external-
izing problems in childhood and adolescence as predictors of work incapacity in
young adulthood.
Soc Psychiatry Psychiatr Epidemiol
2017;52:1159–68.
Fahy AE, Stansfeld SA, Smuk M, et al. Longitudinal associations of experiences of
adversity and socioeconomic disadvantage during childhood with labour force
participation and exit in later adulthood.
Soc Sci Med
2017;183:80–7.
Harkonmaki K, Korkeila K, Vahtera J, et al. Childhood adversities as a predictor of
¨
disability retirement.
J Epidemiol Community Health
2007;61:479–84.
Kjellberg K, Lundin A, Falkstedt D, et al. Long-term physical workload in middle
age and disability pension in men and women: a follow-up study of Swedish
cohorts.
Int Arch Occup Environ Health
2016;89:1239–50.
Gravseth HM, Bjerkedal T, Irgens LM, et al. Life course determinants for early
disability pension: a follow-up of Norwegian men and women born 1967-1976.
Eur
J Epidemiol
2007;22:533–43.
relation to DP is more robust than the evidence for other psycho-
logical and organizational factors at work, those other factors may
also play a role in relation to risk of DP.
2
However, other psycho-
social work factors, e.g. repetitive tasks or bullying or violence at
work, are not necessarily confounders, they could also partly be
consequences of low job control and therefore could be mediators
in the association between low job control and risk of DP. We sug-
gest that future studies examine how job control relates to other
psychosocial factors in relation to DP. Finally, generalizability is a
limitation. We consider our results generalizable to the Danish
workforce, but since national DP granting systems differ, our results
may not be generalizable to other countries’ workforces.
Downloaded from https://academic.oup.com/eurpub/article-abstract/doi/10.1093/eurpub/ckaa107/5870969 by Det Nationale Forskningscenter for Arbejdsmilj (NFA) user on 03 August 2020
5
6
7
8
Conclusions
Cumulated and most recent lower job control predict a higher DP risk
after mutual adjustment and after adjustment for physical demands at
work in this cohort following young employees in Denmark from
labour market entry onwards. Our analyses accounted for reporting
bias and selection of employees with a higher DP risk into occupations
with lower job control. Our findings suggest that mechanisms linking
job control with DP are both gradual and short term and that includ-
ing exposure history is important to gain a more complete picture of
the effects of job control on DP.
9
10 Framke E, Sørensen JK, Nordentoft M, et al. Perceived and content-related emo-
tional demands at work and risk of long-term sickness absence in the Danish
workforce: a cohort study of 26 410 Danish employees.
Occup Environ Med
2019;76:
895–900.
11 Svane-Petersen AC, Holm A, Burr H, et al. Psychosocial working conditions and
depressive disorder: disentangling effects of job control from socioeconomic status
using a life-course approach.
Soc Psychiatry Psychiatr Epidemiol
2020;55:217–28.
12 Svane-Petersen AC, Madsen IEH, Framke E, et al. Study protocol for analyses on
the prospective association of job control with risk of disability pension in The
Danish Work Life Course Cohort (DaWCo). Available at: https://figshare.com/
articles/SvanePetersen_et_al_protocol_job_control_and_disability_pension_pdf/
7902050/1, last accessed June 10, 2020.
13 Madsen IEH, Svane-Petersen AC, Holm A, et al. Study protocol for analyses on the
prospective association of work-related violence, and decision latitude with risk of
depression in The Danish Work Life Course Cohort (DaWCo). Available at: https://
figshare.com/articles/Study_protocol_for_analyses_on_the_prospective_associ
ation_of_workrelated_violence_and_decision_latitude_with_risk_of_depression_
in_The_Danish_Work_Life_Course_Cohort_DAWCO_/6722852, last accessed
June 10, 2020.
14 Petersson F, Baadsgaard M, Thygesen LC. Danish registers on personal labour
market affiliation.
Scand J Public Health
2011;39:95–8.
15 Burr H, Bjorner JB, Kristensen TS, et al. Trends in the Danish work environment in
1990-2000 and their associations with labor-force changes.
Scand J Work Environ
Health
2003;29:270–9.
16 Feveile H, Olsen O, Burr H, Bach E. Danish Work Environment Cohort Study 2005:
from idea to sampling design.
Stat Trans
2007;8:441–58.
17 Madsen IEH, Gupta N, Budtz-Jørgensen E, et al. Physical work demands and
psychosocial working conditions as predictors of musculoskeletal pain: a cohort
study comparing self-reported and job exposure matrix measurements.
Occup
Environ Med
2018;75:752–8.
18 Burr H, Pedersen J, Hansen JV. Work environment as predictor of long-term
sickness absence: linkage of self-reported DWECS data with the DREAM register.
Scand J Public Health
2011;39:147–52.
19 Rasmussen PH, Nielsen CV. Utilization of occupational ability by persons on early
retirement. A registry study.
Ugeskr Laeger
2003;165:1335–8.
20 Hjollund NH, Larsen FB, Andersen JH. Register-based follow-up of social benefits
and other transfer payments: accuracy and degree of completeness in a Danish
interdepartmental administrative database compared with a population-based
survey.
Scand J Public Health
2007;35:497–502.
21 Pedersen CB. The Danish Civil Registration System.
Scand J Public Health
2011;39:
22–5.
22 Baadsgaard M, Quitzau J. Danish registers on personal income and transfer pay-
ments.
Scand J Public Health
2011;39:103–5.
23 Jensen VM, Rasmussen AW. Danish Education Registers.
Scand J Public Health
2011;39:91–4.
24 Lynge E, Sandegaard JL, Rebolj M. The Danish National Patient Register.
Scand J
Public Health
2011;39:30–3.
25 Mors O, Perto GP, Mortensen PB. The Danish Psychiatric Central Research
Register.
Scand J Public Health
2011;39:54–7.
Supplementary data
Supplementary data
are available at
EURPUB
online.
Funding
The Danish Worklife Course Cohort was funded by a grant from the
Danish Working Environment Research Fund
(grant number 17-2014-
03). The analyses for this article were further supported by grants
from the
Danish Working Environment Research Fund
(grant numbers
43-2014-03 and 27-2017-03) and
NordForsk
(grant number 75021).
Conflicts of interest:
None declared.
Key points
•
Both cumulated and most recent job control independently
•
•
•
•
predicted risk of disability pension (DP), indicating that
mechanisms linking job control with DP are both gradual
and shorter term.
Including exposure history is important to gain a more com-
plete picture of the effects of job control on DP.
Job control remained associated with a higher risk of DP after
adjustment for physical demands at work.
Associations between job control and DP were not explained
by risk factors pre-existing labour market entry.
Increasing job control may help prevent DP in younger
employees in Denmark.
References
1
2
Karasek R, Theorell T.
Healthy Work: Stress, Productivity, and the Reconstruction of
Working Life.
New York: Basic Books, 1990.
Knardahl S, Johannessen HA, Sterud T, et al. The contribution from psychological,
social, and organizational work factors to risk of disability retirement: a systematic
review with meta-analyses.
BMC Public Health
2017;17:176.
Sundstrup E, Hansen AM, Mortensen EL, et al. Cumulative occupational mech-
anical exposures during working life and risk of sickness absence and disability
pension: prospective cohort study.
Scand J Work Environ Health
2017;43:415–25.
3
 BEU, Alm.del - 2019-20 - Bilag 376: Orientering om artikel fra NFA om lav kontrol i arbejdet og efterfølgende risiko for førtidspension blandt yngre arbejdstagere
Job control and risk of DP in DaWCo
˚
26 Ankestyrelsen.
Førtidspensioner: Arsstatistik 2010.
Copenhagen: Ankestyrelsen, 2011.
27 Falkstedt D, Backhans M, Lundin A, et al. Do working conditions explain the
increased risks of disability pension among men and women with low education? A
follow-up of Swedish cohorts.
Scand J Work Environ Health
2014;40:483–92.
28 Ropponen A, Samuelsson A, Alexanderson K, Svedberg P. Register-based data of
psychosocial working conditions and occupational groups as predictors of disability
pension due to musculoskeletal diagnoses: a prospective cohort study of 24,543
Swedish twins.
BMC Musculoskelet Disord
2013;14:268.
7 of 7
29 Samuelsson A, Ropponen A, Alexanderson K, Svedberg P. Psychosocial working con-
ditions, occupational groups, and risk of disability pension due to mental diagnoses: a
cohort study of 43,000 Swedish twins.
Scand J Work Environ Health
2013;39:351–60.
30 Clausen T, Burr H, Borg V. Do psychosocial work conditions predict risk of dis-
ability pensioning? An analysis of register-based outcomes using pooled data on
40,554 observations.
Scand J Public Health
2014;42:377–84.
31 Rothman K, Greenland S, Lash TL, editors.
Modern epidemiology,
3rd edn.
Philadelphia, PA: Lippincott Williams & Wilkins, 2008.
Downloaded from https://academic.oup.com/eurpub/article-abstract/doi/10.1093/eurpub/ckaa107/5870969 by Det Nationale Forskningscenter for Arbejdsmilj (NFA) user on 03 August 2020