Jacob Pedersen

Background: Musculoskeletal pain (MSP) is a major occupational health challenge and a leading cause of disability and economic burden worldwide. However, prospective evidence on how pain intensity across multiple body regions affects long-term labour market participation and production losses remains limited. This study quantifies working-life expectancy (WLE) and working years lost (WYL) associated with multisite MSP among senior workers and introduces a novel method to estimate its related economic burden. Methods: The study includes 23 071 Danish employees aged 50–66 years from the SeniorWorkingLife study (2018 and 2022), linked to national labour-market registers through 2024. Self-reported pain intensity (low, moderate, high) in four body regions was examined. WLE and WYL were estimated using the expected labour market affiliation method, and economic costs were calculated from individual wage data. Results: Moderate-to-high pain in two body regions was associated with reduced WLE and higher production losses. Employees with high back and leg pain had mean annual losses of €8167 per person (€58.8 million total), with 38% attributable to sickness absence. Total losses linked to back and leg pain were estimated at €2.0 billion (0.5% of Denmark’s GDP). Conclusion: MSP in senior workers, particularly when affecting multiple body regions, imposes a substantial economic burden through reduced WLE and increased sickness absence. Targeted interventions are needed to manage MSP and sustain employment among older workers.

Background: Sickness absence (SA) poses an important and costly societal and public health challenge. However, no previous studies have investigated SA trajectories among individuals in their first full-time employment, delving into the contribution of early SA to future long-term absence among young employees. We aimed to identify SA trajectories in young full-time employees and explore them as risk markers for subsequent long-term SA (LTSA). Method: In a nationwide register-based cohort of 91 633 young employees (aged 15–30) entering the Danish labour market between 2010 and 2018, we applied group-based multi-trajectory modelling to identify SA trajectories based on daily information on SA during the first year of full-time employment. Proportional hazard models were used to examine associations between trajectory groups and subsequent 2-year risk of LTSA after the first year (>30 days). Results: A model with three distinct SA trajectory groups was selected: (1) no or few shorter SA spells (59% for women, 62% for men), (2) frequent shorter spells (36% for women, 34% for men) and (3) frequent longer spells (6% for women, 4% for men). A clear social and health gradient in SA trajectories was identified with individuals with frequent shorter or frequent longer SA spells having lower education and a history of mental health problems. Compared to having no or few shorter spells, belonging to trajectories with frequent shorter or longer spells was associated with higher risk of subsequent LTSA (fully adjusted HRs ranging from 1.82 to 2.21). Conclusion: Around 40% of young employees’ SA was characterised by frequent shorter or longer spells during the first year of full-time employment, constituting an early risk marker for future LTSA. More attention should be paid to young individuals who, at the beginning of their work life, show increased SA patterns.

OBJECTIVE: Work-related stress is an important public health concern in all industrialized countries and is linked to reduced labor market affiliation and an increased disease burden. We aimed to quantify the labor market costs of work-related stress for a large sample of Danish employees. METHODS: We linked four consecutive survey waves on occupational health and five national longitudinal registers with date-based information on wage and social benefits payments. From 2012 to 2020, we followed survey participants for two year-periods, yielding 110 559 person-years. We identified work stress by combining three dichotomous stress indicators: (i) self-perceived work stress, (ii) Cohen 4-level perceived stress scale, and (iii) job strain. Using the multi-state expected labor market affiliation (ELMA) method, we estimated the labor market expenses associated with work-related stress. RESULTS: Of the employees, 26–37% had at least one work-stress indicator. Men aged 35–64 years and women aged 18–64 years with work-related stress had up to 81.6 fewer workdays and up to 50.7 more days of sickness absence during follow-up than similarly aged men without work stress. The average annual work absenteeism loss per employee linked to work-related stress was €1903 for men and €3909 for women, corresponding to 3.3% of men’s average annual wages and 9.0% of women’s average annual wages, respectively. The total annual expenses were €305.2 million for men and €868.5 million for women. CONCLUSION: Work-related stress was associated with significant labor market costs due to increased sickness absence and unemployment. The prevention of work-related stress is an important occupational health concern, and the development of effective interventions should be given high priority.

We identified occupations with a high incidence of prolonged sickness absence (SA) in Nordic employees and explored similarities and differences between the countries. Utilizing data from national registers on 25–59-year-old wage-earners from Denmark, Finland, Norway and Sweden, we estimated the gender- and occupation-specific age-adjusted cumulative incidence of SA due to any cause, musculoskeletal diseases and mental disorders. To increase the comparability of occupations between the countries, we developed a Nordic crosswalk for occupational codes. We ranked occupational groups with the incidence of SA being statistically significantly higher than the population average of the country in question and calculated excess fractions with the employee population being the reference group. We observed considerable occupational differences in SA within and between the countries. Few occupational groups had a high incidence in all countries, particularly for mental disorders among men. In each country, manual occupations typically had a high incidence of SA due to any cause and musculoskeletal diseases, while service occupations had a high incidence due to mental disorders. Preventive measures targeted at specific occupational groups have a high potential to reduce work disability, especially due to musculoskeletal diseases. Particularly groups with excess SA in all Nordic countries could be at focus.

Objective: Depressive and anxiety disorders are prevalent among employees in general. Still, knowledge regarding the contribution of these disorders to the dynamics of the labor market in terms of working time, sickness absence, and unemployment is scarce. We aim to quantify the linkage of depressive and anxiety disorders with labor market participation using the expected labor market affiliation method (ELMA), in a large sample of Danish employees. Methods: We combined three survey waves on occupational health with six high-quality national registers in N = 43,148 Danish employees, of which the 2012 survey contributed 29,665 person years, the 2014 survey 33,043 person years, and the 2016 survey 35,375 person years. We used the new ELMA method to estimate the multi-state transition probabilities and 2-year expected time in work, sickness absence, and unemployment. Depressive and anxiety disorders were assessed by the Major Depression Inventory and the SCL-ANX4 scales, respectively. We adjusted for multiple variables by applying inverse probability weighting in groups of gender and age. Results: Depressive and anxiety disorders among employees link to reduced labor market affiliation by significantly changed transitions probabilities between the labor markets states, viewed as reduced working time by 4–51 days (in two years), increased time in sickness absence by 6–44 days (in two years), and unemployment by 6–12 days (in two years) when compared to employees without depression or anxiety disorders. The results were most pronounced for women employees and for employees with both depression and anxiety disorders. Conclusions: The study reveals detailed insight into what extent depression and anxiety disorders influence the labor market affiliation, in terms of the complex interrelation between working time, sickness absence, and unemployment. The study emphasizes the importance of preventing and handling depressive and anxiety disorders among employees for strengthening work participation.

Objective This study aimed to estimate the impact of high physical work demands on expected labor market affiliation (ELMA) among men and women of different ages in the general working population. Methods After participating in the Danish Work Environment and Health study (2012, 2014, and/or 2016), 46 169 employees were followed for two years in national registers. Using multi-state modeling, taking all day-to-day transition probabilities of labor market affiliation into account (work, unemployment, sickness absence, temporary out, and permanently out), and performing multilevel adjustment, we estimated the prospective association between physical work demands (ergonomic index including 7 factors) and ELMA. Results During 104 896 person-years of follow-up, we identified of 439 045 transitions. Using low physical work demands as reference, higher physical work demands were associated with fewer days of active work (2–35 days) during 730 days of follow-up, and more days of sickness absence (4–26 days) and unemployment (ranging 1-9 days) among men and women of aged 40–49 and 50–64 years. Among men and women aged 18–39 years, high physical work demands only had minor and inconsistent impact on ELMA. Conclusions Analyzing multiple and highly detailed patterns of transition probabilities concerning labor market affiliation we showed that reducing physical work demands is likely to increase the active working time and prevent high societal cost of sickness absence and unemployment, especially among middle-aged and older workers.

This longitudinal study examined the labor market affiliations of marginal part-time workers (<15 working hours/week) compared with full-time workers (32–40 working hours/week) within gender and age groups. Analyses were based on 1,492,187 Danish employees with marginal part-time or full-time work at baseline using register data of working hours and labor market affiliation from the Labor Market Account. We used the Expected Labor Market Affiliation method within gender and age groups to estimate the time spent in different labor market states over a 5-year follow-up from 2012–2017. The multistate model included five recurrent labor market states: work, unemployment, long-term sickness absence, studying, and temporarily out, and the results were adjusted for education level, morbidity, and ethnicity. A marginal part-time worker generally had fewer days of work without social benefits and spent more days studying during follow-up compared with a full-time worker. In addition, marginal part-time workers ≥ 25 years old had more days of unemployment and more days of long-term sickness absence. These findings suggest that marginal part-time workers have fewer paid workdays without social benefits compared with full-time workers, depending on age. Further studies should explore whether marginal part-time work is a stepping stone into or out of the labor market.

Objective This study investigates the role of age for the prospective association between physical work demands and long-term sickness absence (LTSA). Methods We followed 69 117 employees of the general working population (Work Environment and Health in Denmark study 2012–2018), without LTSA during the past 52 weeks preceding initial interview, for up to 2 years in the Danish Register for Evaluation of Marginalisation. Self-reported physical work demands were based on a combined ergonomic index including seven different types of exposure during the working day. Using weighted Cox regression analyses controlling for years of age, gender, survey year, education, lifestyle, depressive symptoms and psychosocial work factors, we determined the interaction of age with physical work demands for the risk of LTSA. Results During follow-up, 8.4% of the participants developed LTSA. Age and physical work demands interacted (pConclusion The health consequences of high physical work demands increase with age. Workplaces should consider adapting physical work demands to the capacity of workers in different age groups.

As detailed data on labor market affiliation become more accessible, new approaches are needed to address the complex patterns of labor market affiliation. We introduce the expected labor market affiliation (ELMA) method by estimating the time-restricted impact of perceived stress on labor market affiliation in a large sample of Danish employees. Data from two national surveys were linked with a national register. A multi-state proportional hazards model was used to calculate ELMA estimates, i.e., the number of days in work, sickness absence, and unemployment during a 4-year follow-up period, stratified by gender and age. Among employees reporting frequent work-related stress, the expected number of working days decreased with age, ranging from 103 days lost among older women to 37 days lost among younger and middle-aged men. Young and middle-aged women reporting frequent work- and personal life-related stress lost 62 and 81 working days, respectively, and had more days of sickness absence (34 days and 42 days). In conclusion, we showed that perceived stress affects the labor market affiliation. The ELMA estimates provide a detailed understanding of the impact of perceived stress on labor market affiliation over time, and may inform policy and practice towards a more healthy and sustainable working life.