Mikko Laaksonen

This paper examines, using exogenous variation generated by a Finnish pension reform implemented in 2005, the interplay between health and financial incentives to postpone retirement. Based on detailed administrative data on individual health and retirement behavior, we focus on whether individual reactions to incentives vary according to health status and analyze whether individuals with ill health are also able to take advantage of the potential monetary benefits of delayed retirement created by the reform. We find that on average, individuals react to the financial incentives created by the reform as expected. This result holds for most of the health‐related subgroups we analyze. However, those with a long period of sickness absence are less likely to respond to changes in the financial incentives to postpone retirement.

Background: Mental distress among retirees and older people is a severe public health challenge, and information on new risk groups is needed. This study aims to identify subgroups of old-age retirees with varying associations between low social support and mental distress by applying model-based recursive partitioning (MOB). Methods: We used the Helsinki Health Study follow-up survey data of old-age retired former municipal sector employees of the City of Helsinki, Finland. Phase 1 data were collected in 2000–2002, when all participants were employed, Phase 2 in 2007, Phase 3 in 2012, Phase 4 in 2017, and Phase 5 in 2022 (n = 4,466, 81% women). Social support and covariates were measured at each Phase 1–5 and the outcome, mental distress (Depression Anxiety Stress Scales [DASS-21]) was measured at a single occasion, during Phase 5. The three subscales and the common factor of general distress were analysed separately. An approach rooted in computational statistics was used to investigate risk factor heterogeneity in the association of low social support and mental distress. MOB combines decision trees with regression analysis to identify subgroups with the most significant heterogeneity among risk factors. Results: Median (IQR) general distress score from DASS-21 was 5.7 (3.0, 9.0), while Social Support Questionnaire number-score (SSQN) was 1.5 (1.15, 2.05). The primary effect modifier for the association between social support and general distress was education (p < 0.001). Those with high education had a different association of low social support and general distress than those with low or medium education. Additionally, the subgroup with low and medium education had a significant effect modification for age (p = 0.01). For the association between low social support and depressive symptoms, the moderating effect of education was dependent on gender, as men with medium–high education had the weakest association, while for women with medium–high education the association was strongest. Conclusions: Our results suggest that stratification by sociodemographic variables is justifiable when investigating risk factors of mental distress in old-age retirees. The incongruent association of low social support and depressive symptoms in men with medium–high education compared to women with medium–high education is a promising target for confirmatory research.

Aims: Large differences exist in the risk of disability retirement between Finnish municipalities. This study examined whether individual-level and municipality-level characteristics explain these differences and which municipality-level characteristics are particularly important for the risk of disability retirement. Methods: Individual-level register data were supplemented with 10 municipality-level characteristics from various databases. A 20% sample of the Finnish population ( N =626,391) was followed for transition to disability retirement from 2016 to 2019 using multilevel Weibull models. Results: Of the total variation in the risk of disability retirement, 4.3% was attributed to the municipal-level and decreased to 1.8% when individual-level characteristics (gender, age, education level and entitlement to special reimbursement for medical expenses, reflecting morbidity) were controlled for. Further adjustment for municipality-level characteristics fully erased the differences between municipalities. The proportion of municipality-level variation was larger for disability retirement due to somatic illnesses than mental disorders. Of the municipality-level characteristics, socioeconomic structure, unemployment rate, poverty, net migration between municipalities, dependency ratio, the amount of tax revenue per capita and morbidity were associated with the risk of disability retirement. Conclusions: The municipality-level variation in the risk of disability retirement is largely explained by the individual characteristics of the inhabitants. However, various characteristics of the municipalities show associations with the risk of disability retirement. Recognizing such factors is essential for shaping policies that mitigate disability retirement risk.

Aims: To examine age-group and birth-cohort trends in perceived work ability in Finland in 2000–2020 and make projections of perceived work ability up to 2040 based on the observed birth-cohort development. Methods: Ten population-representative cross-sectional surveys conducted in Finland between 2000 and 2020 were used (overall N = 61,087, range 817–18,956). Self-reported estimates of current work ability in relation to the person’s lifetime best on a scale from zero to ten (0–10) were classified into three groups: limited (0–5), intermediate (6–7), and good (8–10). Multiple imputation was used in projecting work ability. Results: Examining past trends by 5-year birth-cohorts born between 1961 and 1995 showed that work ability has declined steadily over time among older birth-cohorts, while in the two younger cohorts a stable development before 2017 and a steep decline between 2017 and 2020 was seen. Trends by 5-year age groups showed a declining trend of good work ability among 20–44-year-olds, a stable trend among 45–54-year-olds, and an improving trend among 55-year-olds and older was observed for the period 2000–2020. Among the under 55-year-olds the prevalence of good work ability ended up around 75% and at 68% among the 55–59-year-olds, 58% among the 60–69-year-olds and 49% among the 70–74-year-olds in 2020. Birth-cohort projections suggested a declining work ability in the future among all age groups included (30–74 years). By 2040, the prevalence of good work ability is projected to decline by 10 to 15 percentage points among 45–74-year-olds. Conclusions: The projections suggest declining work ability in the future. Efforts to counteract the decline in work ability are needed.

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.

Background: In 2012, new sickness allowance checkpoints after 30, 60 and 90 sickness absence days were introduced in Finland to improve earlier detection of long-term work disability and to fasten return to work after illness. We examined whether the reform affected participation in rehabilitation and employment outcomes one year after the start of sickness allowance. Methods: We conducted an interrupted time series analysis among working-age persons accumulating at least 30, 60 and 90 sickness allowance days and starting their SA during a time span covering three years before the reform and two years after the reform. Poisson regression analysis controlling for seasonal variation, gender, age, and education level was used. Results: After the reform, the probability of receiving rehabilitation within one year after the start of a sickness allowance period lasting at least 30 days was increased by 5.1% (IRR 1.051, 95% CI 1.015-1.086). The increase after the reform was slightly larger regarding the 60 and 90 day checkpoints. Looking at the type of rehabilitation, vocational rehabilitation from the earnings-related pension scheme increased the most. Regarding the rehabilitation provided by the Social Insurance Institution of Finland, vocational rehabilitation, medical rehabilitation, and discretionary rehabilitation increased, but only the latter increase was statistically significant. In contrast to rehabilitation, changes in employment outcomes (employment, unemployment, sickness allowance and disability pension) after the reform were negligible. Conclusions: The introduction of new sickness allowance checkpoints increased participation in rehabilitation but did not affect employment outcomes one year later. The results indicate that the reform only partly succeeded in fulfilling its goals. Future policy changes should seek to find measures to help people enter the labor market after rehabilitation. Key messages: • The introduction of new sickness allowance checkpoints after 30, 60 and 90 sickness absence days increased rehabilitation but did not affect employment outcomes one year later. • Future policy changes should seek to find measures to help people enter the labor market after rehabilitation.

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.

Background: Simple and efficient survey measures to predict staying in or leaving work are needed. We examined the association of single-item self-rated work ability (SRWA) with disability retirement in two large population-based samples and compared the association of SRWA to two other scales, work ability score (WAS) and self-rated health (SRH), used earlier in studies.Methods: The study population comprised 6034 participants aged 35–58 from the population-based Health 2000 and FinHealth 2017 cohort studies, pooled together. SRWA, WAS and SRH were all classified in three categories: poor, limited and good. A 36-month follow-up for disability retirement via linkage to electronic records was included in the analysis.Results: Of the participants, 195 retired during the follow-up. All three measures strongly predicted disability retirement. Hazard ratio (HR) for poor SRWA (vs. good) was 8.48 [95% confidence interval (CI) 5.41–13.28], WAS 7.99 (95% CI 5.62–11.37) and SRH 5.96 (95% CI 4.17–8.51). HR for limited SRWA (vs. good) was 4.35 (95% CI 3.21–5.91), WAS 3.54 (95% CI 2.49–5.04) and SRH 2.27 (95% CI 1.59–3.23). Taking into account gender, age, education and mental health narrowed the gap between poor and limited vs. good work ability as predictors of disability retirement, but the differences remained clear.Conclusions: Limited or poor self-rated work ability or health are strong predictors of disability retirement. The SRWA measure is a useful survey-measure of work ability in community-based surveys.

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.

Background Occupational class inequalities in physical functioning and their changes after retirement are poorly understood. We examined occupational class trajectories in physical functioning 10 years before and after transition to old-age and disability retirement. We included working conditions and behavioural risk factors as covariates, given their established link to health and retirement. Methods We used the Helsinki Health Study cohort data from surveys 2000–2002 to 2017, and included 3901 women, who were employed by the City of Helsinki, Finland, and retired during the follow-up. Mixed-effect growth curve models were used to examine changes in RAND-36 Physical Functioning subscale (range 0–100) 10 years before and after the retirement date by occupational class. Results Old-age (n=3073) and disability retirees (n=828) lacked class differences in physical functioning 10 years before retirement. By retirement transition, physical functioning declined and class inequalities emerged, the predicted scores being 86.1 (95% CI 85.2 to 86.9) for higher class and 82.2 (95% CI 81.5 to 83.0) for lower class old-age retirees, and 70.3 (95% CI 67.8 to 72.9) for higher class and 62.2 (95% CI 60.4 to 63.9) for lower class disability retirees. Physical functioning declined and class inequalities slightly widened among old-age retirees after the retirement, whereas among disability retirees the decline plateaued and class inequalities narrowed over time after retirement. Physical work and body mass index somewhat attenuated the class inequalities after adjustment. Conclusions Class inequalities in physical functioning widened after old-age retirement and narrowed after disability retirement. The examined work and health-related factors contributed weakly to the inequalities.