{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T15:52:13Z","timestamp":1780501933244,"version":"3.54.1"},"reference-count":59,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T00:00:00Z","timestamp":1614902400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Work disability may originate early during work history and involve sickness absences (SA) and eventually permanent disability. We studied this process over 15 years. Questionnaire data collected in 1981 on health, working conditions, and lifestyle of Finnish municipal employees aged 44\u201358 years (n = 6257) were linked with registers on SA (\u226510 workdays), disability pension, and death from the period 1986\u20131995. Trajectory analysis was used to assess development in SA (days\/year) over 5 years (1981\u20131985). We analyzed determinants of the trajectories with multinomial regression, while trajectory membership was used as a predictor of disability pension (DP) during the subsequent 10 years in survival analysis. Three SA trajectories emerged: increasing (women: 6.8%; men: 10.2%), moderate (21.2%; 22.7%), and low. In a mutually adjusted model, the increasing trajectory in women was associated with baseline musculoskeletal (MSD), mental and respiratory disorders, injuries, obesity, sleep problems, and low exercise (effect sizes OR &gt; 2), and in men with MSD, sleep problems, smoking, low exercise, and non-satisfaction with management. The moderate trajectory associated with MSD, \u2018other somatic disorders\u2019, sleep problems, and awkward work postures in both genders; in women, also overweight, cardiovascular and respiratory morbidity, and (inversely) knowledge-intensive work, and in men, smoking and mental disorders were thus associated. Ten-year risks of DP contrasting increasing vs. low SA were more than 10-fold in both genders and contrasting moderate vs. low SA 3-fold in women and 2-fold in men. These findings emphasize the need for early identification of workers with short-term problems of work ability and interventions regarding lifestyle, health, and working conditions, to help prevent permanent disability.<\/jats:p>","DOI":"10.3390\/ijerph18052614","type":"journal-article","created":{"date-parts":[[2021,3,5]],"date-time":"2021-03-05T11:46:09Z","timestamp":1614944769000},"page":"2614","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Process of Work Disability: From Determinants of Sickness Absence Trajectories to Disability Retirement in a Long-Term Follow-Up of Municipal Employees"],"prefix":"10.3390","volume":"18","author":[{"given":"P\u00e4ivi","family":"Leino-Arjas","sequence":"first","affiliation":[{"name":"Finnish Institute of Occupational Health, FI-00250 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorma","family":"Seitsamo","sequence":"additional","affiliation":[{"name":"Finnish Institute of Occupational Health, FI-00250 Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6962-7042","authenticated-orcid":false,"given":"Clas-H\u00e5kan","family":"Nyg\u00e5rd","sequence":"additional","affiliation":[{"name":"Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland"},{"name":"Gerontology Research Center, Tampere University, FI-33014 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1510-3216","authenticated-orcid":false,"given":"Prakash","family":"K.C.","sequence":"additional","affiliation":[{"name":"Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland"},{"name":"Gerontology Research Center, Tampere University, FI-33014 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5868-0980","authenticated-orcid":false,"given":"Subas","family":"Neupane","sequence":"additional","affiliation":[{"name":"Unit of Health Sciences, Faculty of Social Sciences, Tampere University, FI-33014 Tampere, Finland"},{"name":"Gerontology Research Center, Tampere University, FI-33014 Tampere, Finland"},{"name":"Tampere University Hospital, 33521 Tampere, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Hultin, H., Lindholm, C., Malfert, M., and Moller, J. (2012). Short-term sick leave and future risk of sickness absence and unemployment\u2014the impact of health status. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-861"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1136\/oem.2006.031393","article-title":"Using administrative sickness absence data as a marker of future disability pension: The prospective DREAM study of Danish private sector employees","volume":"65","author":"Lund","year":"2008","journal-title":"Occup. Environ. Med."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Wallman, T., Wedel, H., Palmer, E., Rosengren, A., Johansson, S., Eriksson, H., and Sv\u00e4rdsudd, K. (2009). Sick-leave track record and other potential predictors of a disability pension. A population based study of 8218 men and women followed for 16 years. BMC Public Health, 9.","DOI":"10.1186\/1471-2458-9-104"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"516","DOI":"10.5271\/sjweh.3293","article-title":"Transitions between sickness absence, work, unemployment, and disability in Denmark 2004\u20132008","volume":"38","author":"Pedersen","year":"2012","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_5","unstructured":"OECD (2010). Sickness, Disability and Work: Breaking the Barriers, OECD Publishing."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1058","DOI":"10.1136\/jech-2015-205719","article-title":"The influence of chronic health problems and work-related factors on loss of paid employment among older workers","volume":"69","author":"Leijten","year":"2015","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1136\/oemed-2013-101591","article-title":"Influence of poor health on exit from paid employment: A systematic review","volume":"71","author":"Robroek","year":"2014","journal-title":"Occup. Environ. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1080\/00140130903067771","article-title":"The impact of ergonomic work environment exposures on the risk of disability pension: Prospective results from DWECS\/DREAM","volume":"52","author":"Labriola","year":"2009","journal-title":"Ergonomics"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Lahelma, E., Laaksonen, M., Lallukka, T., Martikainen, P., Pietilainen, O., Saastamoinen, P., Gould, R., and Rahkonen, O. (2012). Working conditions as risk factors for disability retirement: A longitudinal register linkage study. BMC Public Health, 12.","DOI":"10.1186\/1471-2458-12-309"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"233","DOI":"10.5271\/sjweh.3354","article-title":"The contribution of overweight, obesity, and lack of physical activity to exit from paid employment: A meta-analysis","volume":"39","author":"Robroek","year":"2013","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.drugalcdep.2015.06.047","article-title":"Cigarette smoking and alcohol use as predictors of disability retirement: A population-based cohort study","volume":"155","author":"Korhonen","year":"2015","journal-title":"Drug Alcohol Depend."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"209832","DOI":"10.1155\/2013\/209832","article-title":"Clinically diagnosed insomnia and risk of all-cause and diagnosis-specific disability pension: A nationwide cohort study","volume":"2013","author":"Jansson","year":"2013","journal-title":"Sleep Disord."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1093\/aje\/kwq462","article-title":"Sleep problems and disability retirement: A register-based follow-up study","volume":"173","author":"Lallukka","year":"2011","journal-title":"Am. J. Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.berh.2015.08.002","article-title":"Economic impact of musculoskeletal disorders (MSDs) on work in Europe","volume":"29","author":"Bevan","year":"2015","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1258\/jrsm.2011.100231","article-title":"Work and common psychiatric disorders","volume":"104","author":"Henderson","year":"2011","journal-title":"J. R. Soc. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e005533","DOI":"10.1136\/bmjopen-2014-005533","article-title":"Work outcomes of sickness absence related to mental disorders: A systematic literature review","volume":"4","author":"Dewa","year":"2014","journal-title":"BMJ Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"332","DOI":"10.1016\/j.annepidem.2010.02.004","article-title":"Work arrangements, physical working conditions, and psychosocial working conditions as risk factors for sickness absence: Bayesian analysis of prospective data","volume":"20","author":"Laaksonen","year":"2010","journal-title":"Ann. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1080\/14034950410021853","article-title":"Swedish Council on Technology Assessment in Health Care (SBU). Chapter 5. Risk factors for sick leave\u2014General studies","volume":"63","author":"Allebeck","year":"2004","journal-title":"Scand. J. Public Health Suppl."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s12995-016-0106-9","article-title":"Standardized assessment of psychosocial factors and their influence on medically confirmed health outcomes in workers: A systematic review","volume":"11","author":"Rosario","year":"2016","journal-title":"J. Occup. Med. Toxicol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1093\/alcalc\/agx079","article-title":"Sociodemographic Differences Between Alcohol Use and Sickness Absence: Pooled Analysis of Four Cohort Studies","volume":"53","author":"Ervasti","year":"2018","journal-title":"Alcohol Alcohol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1111\/j.1600-0838.2009.00886.x","article-title":"The impact of physical activity on sickness absence","volume":"20","author":"Lahti","year":"2010","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Quist, H.G., Thomsen, B.L., Christensen, U., Clausen, T., Holtermann, A., Bjorner, J.B., and Andersen, L.L. (2014). Influence of lifestyle factors on long-term sickness absence among female healthcare workers: A prospective cohort study. BMC Public Health, 14.","DOI":"10.1186\/1471-2458-14-1084"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"47","DOI":"10.5271\/sjweh.3186","article-title":"Sleep problems and sickness absence among middle-aged employees","volume":"38","author":"Rahkonen","year":"2012","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1093\/eurpub\/ckp162","article-title":"Interrelationships between education, occupational class, income and sickness absence","volume":"20","author":"Piha","year":"2010","journal-title":"Eur. J. Public Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1136\/jech.2006.056135","article-title":"Explaining the social gradient in long-term sickness absence: A prospective study of Danish employees","volume":"62","author":"Christensen","year":"2008","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1177\/1403494810378916","article-title":"Education and disability pension: A stronger association than previously found","volume":"38","author":"Bruusgaard","year":"2010","journal-title":"Scand. J. Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1177\/1403494811435492","article-title":"Interrelationships between education, occupational social class, and income as determinants of disability retirement","volume":"40","author":"Leinonen","year":"2012","journal-title":"Scand. J. Public Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1080\/14034950410021844","article-title":"Swedish Council on Technology Assessment in Health Care (SBU). Chapter 4. Methodological aspects in sickness-absence research","volume":"63","author":"Hensing","year":"2004","journal-title":"Scand. J. Public Health Suppl."},{"key":"ref_29","first-page":"7","article-title":"Background and objectives of the Finnish research project on aging workers in municipal occupations","volume":"17","author":"Ilmarinen","year":"1991","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_30","first-page":"12","article-title":"Perceived work changes between 1981 and 1992 among aging workers in Finland","volume":"23","author":"Huuhtanen","year":"1997","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_31","first-page":"12","article-title":"Classification of municipal occupations","volume":"17","author":"Ilmarinen","year":"1991","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1146\/annurev.clinpsy.121208.131413","article-title":"Group-based trajectory modeling in clinical research","volume":"6","author":"Nagin","year":"2010","journal-title":"Annu. Rev. Clin. Psychol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1136\/oem.2007.034983","article-title":"Factors associated with long-term sick leave in sick-listed employees: A systematic review","volume":"65","author":"Hoving","year":"2008","journal-title":"Occup. Environ. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1159\/000360229","article-title":"Group-based trajectory modeling: An overview","volume":"65","author":"Nagin","year":"2014","journal-title":"Ann. Nutr. Metab."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1111\/dme.12787","article-title":"Lifestyle-related risk factors and trajectories of work disability over 5 years in employees with diabetes: Findings from two prospective cohort studies","volume":"32","author":"Virtanen","year":"2015","journal-title":"Diabet. Med."},{"key":"ref_36","first-page":"306","article-title":"Pain in multiple sites and sickness absence trajectories: A prospective study among Finns","volume":"154","author":"Haukka","year":"2013","journal-title":"PA"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1080\/13548500903012830","article-title":"Sickness absence: A gender-focused review","volume":"14","author":"Bekker","year":"2009","journal-title":"Psychol. Health Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1136\/oem.2007.033910","article-title":"Explanations for gender differences in sickness absence: Evidence from middle-aged municipal employees from Finland","volume":"65","author":"Laaksonen","year":"2008","journal-title":"Occup. Environ. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"475","DOI":"10.3233\/WOR-131628","article-title":"Modifiable workplace risk factors contributing to workplace absence across health conditions: A stakeholder-centered best-evidence synthesis of systematic reviews","volume":"45","author":"White","year":"2013","journal-title":"Work"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"261","DOI":"10.5271\/sjweh.1337","article-title":"Common prognostic factors of work disability among employees with a chronic somatic disease: A systematic review of cohort studies","volume":"35","author":"Detaille","year":"2009","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1097\/JOM.0000000000000921","article-title":"Predictors of Depression and Musculoskeletal Disorder Related Work Disability Among Young, Middle-Aged, and Aging Employees","volume":"59","author":"Ervasti","year":"2017","journal-title":"J. Occup. Environ. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"146","DOI":"10.5271\/sjweh.3620","article-title":"Joint association of multimorbidity and work ability with risk of long-term sickness absence: A prospective cohort study with register follow-up","volume":"43","author":"Sundstrup","year":"2017","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Salonen, L., Blomgren, J., and Laaksonen, M. (2020). From long-term sickness absence to disability retirement: Diagnostic and occupational class differences within the working-age Finnish population. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-09158-7"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"541","DOI":"10.3233\/WOR-131709","article-title":"Modifiable worker risk factors contributing to workplace absence: A stakeholder-centred best-evidence synthesis of systematic reviews","volume":"49","author":"Wagner","year":"2014","journal-title":"Work"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1105","DOI":"10.1016\/j.jclinepi.2007.04.008","article-title":"A meta-analysis of observational studies identifies predictors of sickness absence","volume":"60","author":"Duijts","year":"2007","journal-title":"J. Clin. Epidemiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1136\/tc.2006.017798","article-title":"Does smoking increase sick leave? Evidence using register data on Swedish workers","volume":"16","author":"Lundborg","year":"2007","journal-title":"Tob. Control."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1136\/oem.2008.039248","article-title":"Health-related behaviours and sickness absence from work","volume":"66","author":"Laaksonen","year":"2009","journal-title":"Occup. Environ. Med."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1136\/oem.2006.028563","article-title":"The fraction of long-term sickness absence attributable to work environmental factors: Prospective results from the Danish Work Environment Cohort Study","volume":"64","author":"Lund","year":"2007","journal-title":"Occup. Environ. Med."},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"Lallukka, T., Kaila-Kangas, L., Koskinen, S., Haukka, E., Kausto, J., Leino-Arjas, P., Kaikkonen, R., Halonen, J., and Shiri, R. (2019). Occupational exposures and sickness absence trajectories: A nationally representative seven-year follow-up study among Finnish working-aged people. Int J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16122099"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1002\/ajim.20252","article-title":"Psychosocial work environment and registered absence from work: Estimating the etiologic fraction","volume":"49","author":"Nielsen","year":"2006","journal-title":"Am. J. Ind. Med."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"807","DOI":"10.1016\/S0277-9536(02)00450-1","article-title":"Job characteristics, physical and psychological symptoms, and social support as antecedents of sickness absence among men and women in the private industrial sector","volume":"57","author":"Vaananen","year":"2003","journal-title":"Soc. Sci. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1037\/a0012639","article-title":"Work strain, health, and absenteeism: A meta-analysis","volume":"13","author":"Darr","year":"2008","journal-title":"J. Occup. Health Psychol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1093\/occmed\/kqw104","article-title":"Trajectory analyses of sickness absence among industrial and municipal employees","volume":"67","author":"Virtanen","year":"2017","journal-title":"Occup. Med."},{"key":"ref_54","first-page":"58","article-title":"Mortality, disability and changes in occupation among aging municipal employees","volume":"17","author":"Tuomi","year":"1991","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1050","DOI":"10.1093\/eurpub\/ckw081","article-title":"Sickness allowance trajectories preceding disability retirement: A register-based retrospective study","volume":"26","author":"Laaksonen","year":"2016","journal-title":"Eur. J. Public Health"},{"key":"ref_56","unstructured":"Ilmarinen, J., and Louhevaara, V. (1999). Job Demands of Ageing Employees Over 12-Year Period. FinnAge\u2014Respect for the Aging: Action Programme to Promote Health, Work Ability and Well-Being Aging Workers 1990\u20131996, Finnish Institute of Occupational Health."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1136\/oemed-2018-105235","article-title":"Multisite musculoskeletal pain trajectories from midlife to old age: A 28-year follow-up of municipal employees","volume":"75","author":"Neupane","year":"2018","journal-title":"Occup. Environ. Med."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"261","DOI":"10.5271\/sjweh.3576","article-title":"Effectiveness of very early workplace interventions to reduce sickness absence: A systematic review of the literature and meta-analysis","volume":"42","author":"Demou","year":"2016","journal-title":"Scand. J. Work Environ. Health"},{"key":"ref_59","first-page":"134","article-title":"Workplace interventions to improve work ability: A systematic review and meta-analysis of their effectiveness","volume":"44","author":"Oakman","year":"2018","journal-title":"Scand. J. Work Environ. Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/5\/2614\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:33:36Z","timestamp":1760160816000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/5\/2614"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,5]]},"references-count":59,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["ijerph18052614"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18052614","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,5]]}}}