Eero Lahelma

Longitudinal and domain-specific changes in sitting time (ST) across occupational classes are poorly understood. We examined changes in occupational class differences in total and domain-specific ST over a 5-year follow-up among young and early midlife employees. We used Helsinki Health Study survey data from 2017 to 2022 (n = 2762; 81% women; aged 19–39 years). Self-reported ST (min/day) was assessed across total ST and its five subdomains (work, leisure screen time, reading, transport, and other). Occupational class was categorized as manual and routine non-manual, semi-professional, and professional. Linear mixed models were used to estimate changes, with ST as the dependent variable and time, occupational class, and their interaction as the main independent variables. Analyses were stratified by gender and adjusted for sociodemographic and health-related factors. Total ST increased across occupational classes (+46 min/day, 95% CI: 37.6–54.4), driven by work-related ST (+24 min), and leisure screen ST (+21 min). Among women, manual and routine non-manual employees showed larger increases in total ST (+25 min vs. professionals) and leisure screen ST (+14 min), narrowing the total ST but widening screen time occupational class differences. Semi-professional women increased work ST (+21 min vs. professionals), narrowing occupational class differences in work ST. Among men, statistical significance of the associations could not be confirmed. ST increased across occupational classes, with domain-specific changes suggesting behavioural patterns. Increase in leisure screen time among manual and routine non-manual women employees may contribute to socioeconomic inequalities in health, highlighting the need for targeted, domain-specific interventions.

Background: Throughout human history, socioeconomic inequalities in health are shaped by interlinked structural changes, like emerging agriculture and industrialism, demographic and economic transitions, as well as epidemics of infectious diseases, catastrophes, and climate changes. Key questions include when health inequalities emerged, and how they evolved from early communities until modern societies. Method : Based on original sources, research literature, reviews, and their critical analysis, this historical review focuses on the evolution of health inequalities, their appearance and advancement. Availability of sources limits the scope to Europe and the western world. Findings : Early hunter-gatherer communities were socioeconomically relatively equal, likely lacking major health inequalities. As agriculture emerged in the neolithic time since 10000 BCE, societies became more prosperous and unequal. In medieval societies, with deep socioeconomic inequalities, health inequalities were presumably constrained by infectious diseases and catastrophes hitting populations “democratically”. John Graunt and William Petty showed in Britain novel socioeconomic and health inequalities emerging with early industrialist capitalism. By the “Revolutions of 1848” health inequalities encompassed industrial countries as shown by Rudolf Virchow and Edwin Chadwick. In the Black Report (1980) and present-day research health inequalities appear ubiquitous and often widening. Conclusions : The evolution of health inequalities follows both the constancy hypothesis, suggesting omnipresent health inequalities where social inequalities prevail, and the convergence-divergence hypothesis, suggesting variations in health inequalities from prehistory to modern time. A conundrum is, to what extent health inequalities were constrained by epidemics and catastrophes. Currently, health inequalities are a world-wide public issue to be tackled with egalitarian policies.

Aims: This study aims to examine associations between childhood and adulthood socioeconomic circumstances with drinking patterns. Methods: Data on socioeconomic circumstances and drinking patterns were derived from a survey among young and early midlife employees of the City of Helsinki in 2017 (n = 5875, 79% women). Logistic regression analysis was used to calculate odds ratios (ORs) and their 95% confidence intervals (CIs) for frequent, binge, and problem drinking (CAGE=Cutting down, Annoyance by criticism, Guilty feeling, Eye-openers). Childhood and adulthood socioeconomic circumstances were included. The models were adjusted for age and gender, and additionally for marital status and having underage children. Results: The mean alcohol units per week varied only little by socioeconomic circumstances although men with low material circumstances (6.3 units per week if low household wealth) drank somewhat more than their counterparts with better material circumstances (5.1 units per week if high household wealth). Binge drinking was more common among individuals with low socioeconomic circumstances, but frequent drinking among individuals with high socioeconomic circumstances. Differences in problem drinking varied by socioeconomic indicator. Adjusting for marital status and underage children attenuated the associations especially for binge and problem drinking. No socioeconomic measure was paramount although for binge and problem drinking household income and further material circumstances showed the strongest associations. Conclusions: There were only small differences by socioeconomic circumstances in the amount of alcohol used but individuals with low material circumstances most often showed adverse drinking patterns. Preventive measures focused on people with low material circumstances might diminish alcohol-related inequalities in health.

Background Population is rapidly ageing globally, and alcohol consumption among older adults has increased in recent years. Alcohol consumption is known to be socioeconomically patterned, but little is known about how these socioeconomic differences evolve as individuals age and over the transition into statutory retirement. Objective We aimed to examine changes in socioeconomic differences in drinking patterns during a 22-year follow-up among retiring employees. Methods We analyzed changes in drinking patterns among a cohort of ageing employees using data from the Helsinki Health Study surveying the aging City of Helsinki employees. Data were collected in five phases between 2000 and 2022. All participants were 40-60-year-old in Phase 1 and retired during the follow-up. The total number of participants was 4889. Non-drinking, binge drinking and average weekly units were used as measures for alcohol consumption. We used occupational class as our indicator of socioeconomic position and evaluated changes in alcohol consumption using generalized linear mixed effect models (GLMM). Age and gender were added as covariates. Results The higher class drunk more but the lower class were more likely to be binge drinkers or non-drinkers. During ageing, alcohol consumption by weekly doses and binge drinking decreased, and non-drinking became more common in all socioeconomic groups. The socioeconomic differences persisted over the follow-up, with little change over retirement transition. Conclusions Alcohol drinking declined, and non-drinking became more common, with socioeconomic differences in midlife persisting in older adulthood and over retirement transition.

We conducted the first validation of the Depression Anxiety Stress Scales (DASS-21) in Finnish. DASS-21 is a short public domain questionnaire, which presents a way to quickly and effectively screen for mental ill health. We recruited two large samples, one aged 24-45 (N = 3,101 [2,488 women]), and the other aged 60-82 (N = 5,462 [4,473 women]), all employees of the city of Helsinki at inclusion (2017 and 2000-2002). DASS-21 measured depression, anxiety, stress, and general distress reliably among Finnish-speaking adults. It appeared invariant with age and gender as evinced by invariance analyses, latent mean comparisons, and an examination of psychometric properties for the subscales and individual items. The subscales negatively correlated with the Emotional Well-being subscale of the RAND-36, as expected. A comparison of five structural models using confirmatory factor analyses and a robust estimation method (weighted-least-squares method) showed a good fit for a one-factor solution. We discuss the use and interpretation of the DASS-21 as both a measure of specific affective symptoms and unidimensional general distress. We provide future researchers and clinicians with norms and estimates of measurement error among Finnish-speaking adults.

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.

Work–family conflicts (WFC) have been associated with poor mental health, poor self-rated health and sickness absence. However, studies on short sickness absence are lacking and more information is needed also about long sickness absence regarding the direction of WFC, and potential explaining factors particularly among young and early middle-aged employees. The Helsinki Health Study baseline survey (2017) among 19- to 39-year-old municipal employees (N = 3683, 80% women, response rate 51.5%) was linked to employer’s sickness absence data. The associations of work-to-family conflicts (WTFC) and family-to-work conflicts (FTWC) with short (1–7 days) and long (over 7 days) sickness absence were analyzed using negative binomial regression analysis. Covariates were age, gender, family-related factors and work-related factors. Stratified analyses by occupational class were performed. The results are presented as rate ratios and their 95% confidence intervals. High WTFC were associated with short (1.25, 1.12–1.40) and long (1.37, 1.11-1.70) sickness absence. High FTWC were also associated with short (1.12, 1.03–1.22) and long (1.24, 1.06–1.45) sickness absence. Adjustment for family-related factors strengthened the associations, whereas adjustment for work-related factors abolished the associations between WTFC and sickness absence. Associations between WFC and sickness absence were observed among two lowest occupational classes only. WFC are associated with both short and long sickness absence. Work-related factors including the quality of supervisory work and shift work play a role in the association. Intervention studies could determine if improvements in combining work and family life lead to a reduction in sickness absence.

Retirement years are ideally spent in good health. We aimed to produce new information using person-oriented methods by identifying groups of statutory retirees who did or did not achieve this objective and the factors that distinguish these groups from each other. Our particular focus was on the years directly after the transition into retirement, and the pre-retirement factors that explained the development of health, using a more severe health-related outcome—hospitalization. We studied the retirement, hospitalizations, education, and work characteristics of former employees of the City of Helsinki, Finland (N = 6569), from complete registers. We used group-based trajectory models and identified groups of constant low, constant high, decreasing, and temporarily occurring hospitalizations, and one group of increasing hospitalizations among women and two groups of earlier and later increasing hospitalizations among men. Multinomial regression models showed that among women, belonging to groups with less favourable health was associated with secondary education, older age at retirement, and reduced working hours. Education and work characteristics before retirement both contribute to the development of health, as indicated by hospitalizations directly after retirement. Our findings show that socioeconomic inequalities in health are persistent and should also be addressed after transition into retirement.

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.