Rahman Shiri

OBJECTIVE: This study aimed to (i) investigate associations between different characteristics of exposure to shift work and breast cancer risk and (ii) identify effect modifiers. METHODS: Comprising 42 379 women from the Finnish Public Sector cohort, this longitudinal study included data from survey responses, payroll-based working hour records, and national breast cancer registry data. Cause-specific Cox proportional hazards models were used to estimate hazard ratios (HR), adjusting for age, marital status, socioeconomic status, living with a child, lifestyle, and occupational factors. Stratified analyses and interaction tests were performed to assess effect modification. RESULTS: Over an average follow-up of 9.8 years, 945 women were diagnosed with breast cancer. Among women aged ≥50 years, increased risk was associated with working >3 consecutive night shifts [hazard ratio (HR) 1.64, 95% confidence interval (CI) 1.22–2.21] and evening shifts (HR 1.28, 95% CI 1.03–1.59). Sleep problems and fatigue at work modified the association between night shift work and breast cancer risk, whereas psychological distress and diurnal preference did not. Permanent night shift workers reporting sleep problems (HR 1.76, 95% CI 1.01–3.09) or fatigue at work (HR 1.90, 95% CI 1.08–3.35) had a higher risk compared to day workers with similar symptoms. CONCLUSIONS: Women aged ≥50 years showed increased breast cancer risk for several shift work characteristics. Permanent night shift work was especially associated with increased risk among those reporting sleep problems or fatigue. These findings may help identify groups needing closer occupational health monitoring, though causal inference is limited by the observational design. Intervention studies are required to determine whether changes in work schedules or management of sleep problems and fatigue could reduce risk.

Aim: To identify effective interventions designed to improve work ability and reduce early exit from the labor market of midlife and older workers. Method: Searches were conducted in PubMed, Cochrane Library, Scopus, Web of Science, and PsycInfo up to February 17, 2025, focusing on studies aimed at improving work ability and associated conditions (work productivity, work engagement, job performance, and work capacity) and reducing early exit from the labor market among participants aged ⩾40 years. Two reviewers evaluated the quality of studies. The effectiveness of interventions was evaluated using meta-analysis and, when not feasible, qualitative synthesis. Results: Of 17,505 publications, 41 studies were included, comprising 14 randomized controlled trials (RCTs, n = 4123) and 27 non-randomized studies ( n = 4,616,452). Meta-analysis of RCTs showed that aerobic or strengthening exercises modestly improved work ability (pooled standardized mean difference 0.26, 95% CI 0.08–0.44). Qualitative synthesis indicated cognitive behavioral therapy (CBT) reduced productivity loss in workers with chronic health conditions. A meta-analysis of non-randomized studies showed policy reforms raising the eligible retirement age increased employment by 12 percentage points (pps) (95% CI 7–17) and decreased retirement by 29 pps (95% CI 8−50), but increased disability benefits by 6 pps (95% CI 1–11), unemployment by 7 pps (95% CI 2–12), and economic inactivity by 6 pps (95% CI 5–8). Policy reforms tightening unemployment benefit requirements increased employment and reduced unemployment, but increased disability benefits. Conclusions: Exercise improved work ability and CBT reduced productivity loss. Regulatory actions on retirement age and unemployment benefits were associated with higher work participation.

Aim: This systematic review and meta-analysis assessed the associations of health symptoms and conditions and their consequences with disability retirement among middle-aged workers. Methods: Searches were conducted in PubMed, Web of Science, PsychInfo, and Scopus from their inception until February 2025. Observational longitudinal studies involving workers aged 40–64 years were included. Two reviewers independently assessed the methodological quality of the studies. A random-effects meta-analysis was performed, with heterogeneity and publication bias evaluated. Results: From 13,899 reports, 68 reports from 34 longitudinal studies ( N = 3,743,192 participants) were included. The meta-analysis found that health symptoms, including long sleep (≥ 8.5 h, hazard ratio [HR] 1.79, 95% CI 1.35–2.37), insomnia (HR 1.45, CI 1.29–1.64), and pain (HR 2.09, CI 1.40–3.11), health conditions, including mental health conditions (HR 2.19, CI 1.78–2.70), musculoskeletal disorders (HR 2.13, CI 1.25–3.64), diabetes (HR 1.55, CI 1.02–2.34), hypertension (HR 1.25, CI 1.05–1.50), cardiovascular disease (HR 1.98, CI 1.59–2.47), respiratory disease (HR 1.60, CI 1.12–2.29), and limiting long-standing illnesses (HR 4.81, CI 2.05–11.30), and health consequences, including impaired perceived work ability (HR 6.21, CI 2.93–13.15), suboptimal self-rated general health (HR 3.28, CI 2.36–4.56), and daily activity limitations (HR 6.29, CI 3.74–10.57) contribute to the increased risk of all-cause disability retirement. Interactions between different comorbidities were additive. Conclusions: This meta-analysis highlights the significant impact of sleep problems, mental health conditions, various chronic diseases, and impaired work ability on the risk of disability retirement among middle-aged workers. Targeted interventions to promote sleep management and health conditions, particularly mental health, are crucial to mitigating the risk of disability retirement.

Objective: This quasi-experimental study aimed to examine whether favorable changes in health- and work-related factors improve work ability of midlife and older workers. Methods: The study included 2,312 Finnish social and health care employees (89.4% women, mean age 51.5 ± 5.8 years) who participated in repeated surveys between 2017 and 2022. Propensity score weighting and generalized linear models were applied to estimate the associations of a one standard deviation favorable change in health and lifestyle factors, psychosocial work environment and working hour characteristics with perceived work ability. Results: Favorable changes in health-related factors including improvement in sleep quality (RR 2.03, 95% CI 1.47–2.82), reduction in psychological distress (RR 1.68, 95% CI 1.24–2.30), increase in leisure-time physical activity (1.53, 95% CI 1.13–2.08), quitting smoking (RR 1.58, 95% CI 1.01–2.48), decrease in alcohol intake (RR 2.21, 95% CI 1.54–3.17) were associated with improved work ability. Of work-related factors, reduction in job demands (RR 1.51, 95% CI 1.12–2.03) and job demand-control ratio (RR 1.55, 95% CI 1.11–2.16), and increase in job control (RR 1.49, 95% CI 1.05–2.13) and job rewards (RR 1.60, 95% CI 1.20–2.13) were associated with improved work ability. Conclusions: Positive changes in modifiable health- and work-related risk factors can improve work ability of midlife and older social and health care employees. These identified risk factors are essential in design and implementation of multidimensional interventions aimed at supporting extended workforce participation among older workers.

Aims: This systematic review and meta-analysis aimed to identify sociodemographic, lifestyle, and occupational risk factors for disability retirement among middle-aged workers. Methods: Searches were conducted in PubMed, Web of Science, PsychInfo, Scopus, and Google Scholar from their inception until February 2025. Observational longitudinal studies involving workers aged 40–64 years were included. Two reviewers independently assessed the methodological quality of the studies. A random-effects meta-analysis was performed, with heterogeneity and publication bias evaluated. Results: From 13,899 reports, 71 reports from 39 longitudinal studies ( N =7,309,799 participants) were included. The meta-analysis found that older workers, women, those with 12 years or less education, and workers in intermediate or low occupational class are at increased risk of all-cause disability retirement. Other high-risk groups include past (hazard ratio (HR) 1.08, 95% confidence interval (CI) 1.01–1.15) and current (HR 1.29, 95% CI 1.17–1.41) smokers, individuals who are underweight (HR 1.49, 95% CI 1.00–2.23) or obese (HR 1.54, 95% CI 1.31–1.81), individuals lacking physical activity (HR 1.46, 95% CI 1.04–2.06), and those who consume excessive amounts of alcoholic drinks (HR 1.43, 95% CI 1.18–1.73). Additionally, high workload (HR 1.38, 95% CI 1.23–1.56) and low job control (HR 1.47, 95% CI 1.32–1.63) also contribute to the increased risk. Conclusions: This meta-analysis highlights the significant impact of being vulnerable groups, lifestyle risk factors, and physical and psychosocial work factors on the risk of disability retirement among middle-aged workers. Targeted interventions to create a supportive work environment and encourage healthy lifestyles are crucial to mitigating the risk of disability retirement.

OBJECTIVE: This meta-analysis aimed to identify sociodemographic, lifestyle, work-related and health risk factors for voluntary early old-age retirement among middle-aged workers. METHODS: Searches were conducted in PubMed, Web of Science, PsycInfo, and Scopus from their inception until February 2025. Observational longitudinal studies involving workers aged 40–64 years were included. Two reviewers evaluated the methodological quality of the studies. A random-effects meta-analysis was performed, and heterogeneity and publication bias were assessed. RESULTS: From 13 899 publications, 23 longitudinal studies (N=2 270 430 participants) were included. The following factors were associated with an increased risk of early old-age retirement: age [hazard ratio (HR) 1.35, 95% CI (confidence interval) 1.12–1.63 per year increase], overweight or obesity (HR 1.10, 95% CI 1.03–1.17), physically demanding work (HR 1.29, 95% CI 1.05–1.59), low job control (HR 1.14, 95% CI 1.11–1.17), low influence at work (HR 1.10, 95% CI 1.02–1.19), low organizational justice (HR 1.27, 95% CI 1.10–1.46), lack of skills and knowledge development (HR 2.16, 95% CI 1.63–2.85), suboptimal self-rated general health (HR 1.22, 95% CI 1.12–1.34), chronic physical conditions (HR 1.11, 95% CI 1.05–1.17), and depressive symptoms (HR 1.34, 95% CI 1.12–1.61). Conversely, a lower risk was found among individuals who were unmarried, separated, or widowed (HR 0.74, 95% CI 0.60–0.91). CONCLUSIONS: This meta-analysis underscores the impact of overweight, physical and psychosocial work factors, lacking skills and knowledge development and health conditions on early old-age retirement risk among middle-aged workers. Targeted interventions to encourage healthy lifestyles, foster a supportive work environment, and promote mental health may help to reduce early old-age retirement risk.

OBJECTIVE: This systematic review and meta-analysis aimed to identify risk factors for unemployment among middle-aged workers. METHODS: Searches were carried out in PubMed, Web of Science and Google Scholar until November 2024, focusing on observational longitudinal studies that involved workers aged 40–64 years. Three reviewers evaluated the quality of the studies. A random-effects meta-analysis was employed, and heterogeneity and publication bias were assessed. RESULTS: Out of 10 432 reports, 19 longitudinal studies (N=374 585 participants) were included in the review. The meta-analysis identified multiple risk factors associated with unemployment, including suboptimal self-rated general health [hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.21–1.70], mental health conditions [HR 1.48, 95% CI 1.30–1.68, particularly depressive symptoms (HR 1.42, 95% CI 1.14–1.76)], low job control (HR 1.30, 95% CI 1.17–1.43), and lack of physical activity (HR 1.56, 95% CI 1.13–2.15). Additionally, a higher risk of unemployment was observed among individuals with ≤12 years of education (HR 1.17, 95% CI 1.00–1.36), those who are unmarried, separated, or widowed (HR 1.43, 95% CI 1.14–1.79), and immigrants (HR 1.26, 95% CI 1.11–1.44). Age, gender, smoking, alcohol consumption, musculoskeletal disorders, cardiovascular and respiratory diseases, digestive diseases, diabetes, neoplasm, and limitations in daily activities did not increase unemployment risk. CONCLUSIONS: This meta-analysis highlights the impact of mental health conditions, low job control, and lack of leisure-time physical activity on unemployment risk among middle-aged workers. Interventions aimed at improving mental health and increasing job control and physical activity could reduce unemployment risk.