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Prolungamento della vita lavorativa: salute e problemi correlati Giuseppe Costa e Angelo dErrico Servizio di Epidemiologia Università di Torino ASL 5 del.

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Presentazione sul tema: "Prolungamento della vita lavorativa: salute e problemi correlati Giuseppe Costa e Angelo dErrico Servizio di Epidemiologia Università di Torino ASL 5 del."— Transcript della presentazione:

1 Prolungamento della vita lavorativa: salute e problemi correlati Giuseppe Costa e Angelo dErrico Servizio di Epidemiologia Università di Torino ASL 5 del Piemonte Labor, 22 novembre 2006

2 workability Competences Knowledge Abilities Health Lifestyles Working conditions Material hazards Psychosocial hazards Believes Values Attitudes Satisfaction employability retirability

3

4 workability Competences Knowledge Abilities Health Lifestyles Working conditions Material hazards Psychosocial hazards Believes Values Attitudes Satisfaction employability retirability Social inequalities

5 Rate Ratio: ratio of mortality rate in lower occupational groups as compared to that in higher occupational groups. Asterisk (*) indicates that difference in mortality between socio-economic groups is statistically significant. Occupational inequalities in mortality in eleven European countries. Men, years Kunst A, et al. Mortality by occupational class among men 30–64 years in 11 European countries. Soc Sci Med 1998.

6 Mackenbach JP, et al. Widening socio-economic inequalities in mortality in six Western European countries. Int J Epidemiol Mortality Rate Ratios in lower occupational groups as compared to higher occupational groups: men

7 Mackenbach JP, et al. Widening socio-economic inequalities in mortality in six Western European countries. Int J Epidemiol Mortality Rate Ratios in lower occupational groups as compared to higher occupational groups: men large relative occupational inequalities widened during the last two decades

8 As was the case with mortality, rates of morbidity are usually higher among those with a lower educational level, occupational class or income level ( Cavelaars A, et al. Morbidity differences by occupational class among men in seven European countries: an application of the Erikson-Goldthorpe social class scheme. Int J Epidemiol 1998; 27: 222–230). Substantial inequalities are also found in the prevalence of most specific diseases (including mental illness) and most specific forms of disability (Dalstra JAA, et al. Socio-economic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol 2005; 34: 316–326; Avendano M, et al. Socioeconomic disparities in physical health in 10 European countries. In: Boersch-Supan A, et al. Health, ageing and retirement in Europe. Mannheim: Mannheim Research Institute for the Economics of Ageing, 2005: 89-94). Over the past decades, inequalities in morbidity by socio- economic position have been rather stable (Kunst AE, et al. Trends in socio-economic inequalities in self-assessed health in 10 European countries. Int J Epidemiol 2005; 34: 295–305). Together with inequalities in mortality, inequalities in morbidity contribute to large inequalities in healthy life expectancy (number of years lived in good health) (Sihvonen A, et al. Socio-economic inequalities in health expectancy in Finland and Norway in the late 1980s. Soc Sci Med 1998; 47(3): 303–315). As was the case with mortality, rates of morbidity are usually higher among those with a lower educational level, occupational class or income level ( Cavelaars A, et al. Morbidity differences by occupational class among men in seven European countries: an application of the Erikson-Goldthorpe social class scheme. Int J Epidemiol 1998; 27: 222–230). Substantial inequalities are also found in the prevalence of most specific diseases (including mental illness) and most specific forms of disability (Dalstra JAA, et al. Socio-economic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol 2005; 34: 316–326; Avendano M, et al. Socioeconomic disparities in physical health in 10 European countries. In: Boersch-Supan A, et al. Health, ageing and retirement in Europe. Mannheim: Mannheim Research Institute for the Economics of Ageing, 2005: 89-94). Over the past decades, inequalities in morbidity by socio- economic position have been rather stable (Kunst AE, et al. Trends in socio-economic inequalities in self-assessed health in 10 European countries. Int J Epidemiol 2005; 34: 295–305). Together with inequalities in mortality, inequalities in morbidity contribute to large inequalities in healthy life expectancy (number of years lived in good health) (Sihvonen A, et al. Socio-economic inequalities in health expectancy in Finland and Norway in the late 1980s. Soc Sci Med 1998; 47(3): 303–315).

9 workability Competences Knowledge Abilities Health Lifestyles Working conditions Material hazards Psychosocial hazards Believes Values Attitudes Satisfaction employability retirability Social inequalities

10 downward mobility Inter-generational through life-course in adult age (healthy w. effect) material morbidity health care outcomes behaviours support psychosocial dem/contr eff/rew selection income societal/neighbourhood context phys/chem/ erg hazards

11 downward mobility Inter-generational through life-course in adult age (healthy w. effect) material morbidity health care outcomes behaviours support psychosocial dem/contr eff/rew selection income societal/neighbourhood context phys/chem/ erg hazards health related downward mobility is a mechanism which is in place, its contribution to health inequalities is likely to be small Cardano M et al. Social Science Medicine, 2004, 58

12 Impact of poor health on social mobility within the labour market R 2 =.14 Statistical model: Analysis of variance Dependent variable: Social Mobility Metrical Index (SMMI) Cardano M et al.Social Science & Medicine 58 (2004): 1563–1574

13 downward mobility Inter-generational through life-course in adult age (healthy w. effect) material morbidity health care outcomes behaviours support psychosocial dem/contr eff/rew selection income societal/neighbourhood context phys/chem/ erg hazards more controversial the question of the size of the contribution of intergenerational and life-course selection to the adult pattern of health inequalities Singh-Manoux A et al. Social Science and Medicine, 2005, 60

14 downward mobility Inter-generational through life-course in adult age (healthy w. effect) material morbidity health care outcomes behaviours support psychosocial dem/contr eff/rew selection income societal/neighbourhood context phys/chem/ erg hazards within a stable workforce, physical, chemical, ergonomic, psychosocial risk factors in the workplaces are determinants that may explain a larger part of social inequalities in some specific health risks such as occupational diseases, cardiovascular disease, muscoloskeletal disorders, mental health

15 Sample of 1479 employees in Torino (797 workers and 682 clerks) % exposed to Job Strain

16 downward mobility Inter-generational through life-course in adult age (healthy w. effect) material morbidity health care outcomes behaviours support psychosocial dem/contr eff/rew selection income societal/neighbourhood context phys/chem/ erg hazards while behavioural and other material circumstances like income should be involved to explain the rest, but the relative amount and the independency of each contribution remain controversial McLeod J et al. J Epidemiol Community Health 2003, 57. Siegrist J et al. Social Science and Medicine, 2004, 58. Lynch J et al. J Epidemiol Community Health 2006, 60

17 % Smoking by social class– Italian males 2000

18 downward mobility Inter-generational through life-course in adult age (healthy w. effect) material morbidity health care outcomes behaviours support psychosocial dem/contr ff/rew selection income societal/neighbourhood context phys/chem/ erg hazards The amount of inequalities in health outcomes attributable to limitation in access to appropriate and effective health care is related to the model of health care organization which is in place

19 Mortality in colon cancer Coronarografy in AMI Revascularization in AMI Inappropriate hospital admissions HIGH 1111 MEDIUM1.21 ( )0.93 (0.86 – 1.02)0.93 (0.85 – 1.02)1.12 ( ) LOW1.33 ( )0.83 (0.76 – 0.90)0.83 (0.76 – 0.91)1.19 ( ) Inequalities in different health care indicators by educational level in Turin less educated individuals may be more vulnerable to inappropriate hospitalization Piedmont Region. Health Report 2006

20 Mortality in colon cancer Coronarografy in AMI Re-vascularization in AMI Inappropriate hospital admissions HIGH 1111 MEDIUM1.21 ( )0.93 (0.86 – 1.02)0.93 (0.85 – 1.02)1.12 ( ) LOW1.33 ( )0.83 (0.76 – 0.90)0.83 (0.76 – 0.91)1.19 ( ) Inequalities in different health care indicators by educational level in Turin less educated patients with myocardial infarction may confront more limitations in accessing effective and appropriate care such as coronarography and re-vascularization Piedmont Region. Health Report 2006

21 Mortality in colon cancer Coronarografy in AMI Re-vascularization in AMI Inappropriate hospital admissions HIGH 1111 MEDIUM1.21 ( )0.93 (0.86 – 1.02)0.93 (0.85 – 1.02)1.12 ( ) LOW1.33 ( )0.83 (0.76 – 0.90)0.83 (0.76 – 0.91)1.19 ( ) Inequalities in different health care indicators by educational level in Turin less educated patients with colon cancer may experience more unfavourable outcomes Piedmont Region. Health Report 2006

22 downward mobility Inter-generational through life-course in adult age (healthy w. effect) material morbidity health care outcomes behaviours support psychosocial dem/contr ff/rew selection income societal/neighbourhood context phys/chem/ erg hazards contextual determinants may make the difference in buffering the effect of each of the determinants of health inequalities by providing supporting environments

23 USA Netherlands London Helsinki Turin Madrid II vs. I quartile III vs. I quartile Most unempl. vs. I quartile 1,50 Effect of neighbourhood unemployment on mortality Males aged ,00 1,00

24 Aging (and cohort?) ? ? ?? workability Competences Knowledge Abilities Health Lifestyles Working conditions Material hazards Psychosocial hazards Believes Values Attitudes Satisfaction employability retirability ?

25 Aging (and cohort?) ? ? ?? workability Competences Knowledge Abilities Health Lifestyles Working conditions Material hazards Psychosocial hazards Believes Values Attitudes Satisfaction employability retirability ? Context/regulation: Preferences Constraints Opportunities

26 Aging (and cohort?) ? ? ?? workability Competences Knowledge Abilities Health Lifestyles Working conditions Material hazards Psychosocial hazards Believes Values Attitudes Satisfaction employability retirability ?

27 % variation in mortality among adults (30-59 yrs) that have improved their education btw 1981 and 1991 Education at 1981 noneprimary seconda ry High sc. males females SLT, unpublished data, 2006

28 Aging (and cohort?) ? ? ?? workability Competences Knowledge Abilities Health Lifestyles Working conditions Material hazards Psychosocial hazards Believes Values Attitudes Satisfaction employability retirability ?

29 Aging and health Diseases and aging Vulnerability to severity Functional vulnerability of the target organ/tissue Vulnerability in mechanisms repairing damages Age correlated (latency) Long term diseases Injuries Incidence? Vulnerability to severity

30 Aging and functional abilities Physical Coordination, mobility, flexibility, strenght, sensorial… Cardiorespiratory Muscoloskeletal Obesity Mental and social Psicomotricity, cognitive, metacognitive, motivational Relational and role

31 MALATTIE MUSCOLO-SCHELETRICHE (MSDs) (I) infiammazioni osteo-tendinee e articolari (tenosinovite, epicondilite, borsite) disturbi da compressione nervosa (sindrome del tunnel carpale, lombosciatalgia) osteoartrosi mialgia, dolore lombare e sindromi dolorose regionali non attribuibili a patologie conosciute ampio spettro di patologie infiammatorie e degenerative a carico di muscoli, tendini, legamenti, articolazioni, nervi periferici, e strutture vascolari che includono: regioni più comunemente colpite: tratto lombo-sacrale del rachide collo spalla avambraccio mano

32 MALATTIE MUSCOLO-SCHELETRICHE (MSDs) (II) rappresentano il 67% di tutte le malattie da lavoro negli U.S.A. (BLS, 2001), il 71% in Svezia e il 39% in Danimarca (Westgaard & Winkel, 1997) negli U.S.A., Canada, Finlandia, Svezia e U.K. causano più assenteismo e più invalidità di qualsiasi altro gruppo di malattie da lavoro (Badley et al., 1994; Feeney et al., 1998; Leijon et al., 1998) dal 1990 al 2000 incremento di posture scomode o dolorose, movimentazione carichi e lavoro ad alta rapidita di esecuzione riferiti dai lavoratori europei (Paoli & Merlliè, 2001) Nel 2000 costituivano più del 50% delle malattie preofessionali riconosciute dallINAIL (Colombini et al., 2003) Circa il 50% dei soggetti con disturbi muscolo-scheletrici allarto superiore non ha segni obiettivi (Punnett, 1998, 2000) Nella maggior parte dei casi, i disturbi muscolo-scheletrici a carico dellarto superiore non possono essere classificati in specifiche categorie diagnostiche (Sluiter, 2000)

33 MALATTIE MUSCOLO-SCHELETRICHE (MSDs) – Fattori di rischio (da studi epidemiologici e sperimentali): elevato ritmo di lavoro e movimenti ripetuti tempo di recupero insufficiente sollevamento di pesi e intensi sforzi manuali posture del corpo non-neutrali (statiche o dinamiche) elevata pressione meccanica concentrata su una piccola superficie vibrazioni segmentali o diffuse esposizione locale o diffusa al freddo fattori psicosociali, come alte richieste psicologiche (high demand) e basso grado di controllo sul proprio lavoro (low control)

34 MALATTIE MUSCOLO-SCHELETRICHE (MSDs) – Frazione attribuibile allesposizione a rischi fisici sul lavoro Patologie del rachide National Research Council and Institute of Medicine, 2001

35 MALATTIE MUSCOLO-SCHELETRICHE (MSDs) – Frazione attribuibile allesposizione a rischi fisici sul lavoro Patologie dellarto superiore National Research Council and Institute of Medicine, 2001

36 MALATTIE MUSCOLO-SCHELETRICHE (MSDs) – Diffusione dellesposizione – Sollevare pesi eccessivi (CGIL, 1999) Settore produttivo% Sanità71.4 Prodotti a base di amianto, cemento amianto e altri minerali non metalliferi 70.0 Poste69.2 Industrie alimentari, bevande, tabacco64.9 Pubblica amministrazione, organizzazioni internazionali63.6 Legno, paglia, vimini62.5 Produzione e distribuzione di gas61.7 Concia60.9 Carta60.4 Laterizi, cemento, ceramica, vetro59.4 Produzione di elettrodomestici e di materiale elettrico e elettronico59.1 Tessile58.1 Energia elettrica55.8 Igiene pubblica e cimiteri, raccolta, depurazione e distribuzione acqua54.9 Stampa, editoria, laboratori fotografici, registrazione dischi e video54.5 Pneumatici e articoli in gomma54.1 Prodotti in plastica50.0

37 MALATTIE MUSCOLO-SCHELETRICHE (MSDs) – Stima del numero di casi attribuibili allesposizione a fattori ergonomici in Piemonte - Patologie del rachide Assumendo una prevalenza del 15% alla popolazione occupata e i valori della AF al limite inferiore del range: casi prevalenti dovuti alla movimentazione di materiale a frequente flessione e torsione del busto a sforzi molto intensi a posture incongrue a vibrazioni trasmesse al rachide Assumendo unincidenza del 4.5% alla popolazione occupata e i valori della AF al limite inferiore del range: nuovi casi allanno dovuti alla movimentazione di materiale a frequente flessione e torsione del busto a sforzi molto intensi a posture incongrue a vibrazioni trasmesse al rachide

38 MALATTIE MUSCOLO-SCHELETRICHE (MSDs) – Stima del numero di casi attribuibili allesposizione a fattori ergonomici in Piemonte - Patologie dellarto superiore Assumendo una prevalenza del 15% alla popolazione occupata e i valori della AF al limite inferiore del range: casi prevalenti dovuti a movimenti ripetuti a sforzi molto intensi a vibrazioni trasmesse allarto superiore Assumendo unincidenza del 6% alla popolazione occupata e i valori della AF al limite inferiore del range: nuovi casi allanno a movimenti ripetuti a sforzi molto intensi a vibrazioni trasmesse allarto superiore

39 MALATTIE MUSCOLO-SCHELETRICHE (MSDs) – Prevenibilità Conclusioni dello studio del National Academy of Science (National Research Council & Institute of Medicine, 2001) la prevenzione di queste malattie mediante la riduzione delle esposizioni e possibile produce significativi risparmi per i datori di lavoro riduce lesperienza di disabilita dei lavoratori Maggiori possibilità di ridurre il rischio di MSDs per mezzo di interventi multipli, che comprendano (Silverstein & Clark, 2004; Karsh et al., 2001; Amell & Kumar, 2002; Westgaard & Winkel, 1997): riprogettazione di postazioni di lavoro cambiamenti dellorganizzazione interventi di promozione della salute Documento di consenso ISPESL-EPM su MSDs arto superiore (Colombini et al., 2003): Lista di lavorazioni a rischio Indicatori per lo screening dellesposizione a ripetitività, forza, posture incongrue e impatti ripetuti Indicazioni per la sorveglianza sanitaria

40 Assegnazione di punteggi da 0 a 3 ad una serie di caratteristiche del rischio allinterno di ogni settore produttivo: frequenza e gravità delle patologie considerate nella popolazione generale, forza dellassociazione tra esposizione professionale e occorrenza delle patologie, diffusione e livello dellesposizione nei diversi settori, proporzione di addetti impiegati in ogni comparto sul totale degli occupati sul territorio regionale, prevenibilità dellesposizione, fattibilità delleffettuazione di interventi preventivi nel settore. Scelta di priorità

41

42 Tabella 11 – Ranghi di priorità dei più rappresentati settori produttivi, totali e per patologia

43 workability Competences Knowledge Abilities Health Lifestyles Working conditions Material hazards Psychosocial hazards Believes Values Attitudes Satisfaction employability retirability Commitment to adapt working conditions to aging?

44 Low physical exercise by social class - Italian males 2000 %

45 Tabella 1. Differenze in prevalenza (%) di fattori di modificazione della capacità lavorativa tra lavoratori anziani e lavoratori giovani (sopra o sotto i 45 anni) in Italia nel 1996 (Kauppinen 1998) *(almeno per metà di orario lavoro)

46 workability Competences Knowledge Abilities Health Lifestyles Working conditions Material hazards Psychosocial hazards Believes Values Attitudes Satisfaction employability retirability

47 Aging (and cohort?) ? ? ?? workability Competences Knowledge Abilities Health Lifestyles Working conditions Material hazards Psychosocial hazards Believes Values Attitudes Satisfaction employability retirability ?

48

49 Healthy life expectancy by occupation, males

50 Healthy life expectancy by occupation, females

51 Differences in life expectancy at 35 yrs by social class, Turin males

52 Anticipating retirement age?

53 Mortality by social class among healthy retired High classClerksSelf employed Working class males 1,14 1,381,13 females 0,951,541,081,34 RRs age adjusted ; reference : still employed

54 Differences in life expectancy at 35 yrs by income deciles, Turin males

55 Adjusting benefits according to life expectancy? to life expectancy?

56 downward mobility Inter-generational through life-course in adult age (healthy w. effect) material morbidity health care outcomes behaviours support psychosocial dem/contr ff/rew selection income societal/neighbourhood context DIRECT RESPONSIBILITY phys/chem/ erg hazards

57 downward mobility Inter-generational through life-course in adult age (healthy w. effect) material morbidity health care outcomes behaviours support psychosocial dem/contr ff/rew selection income societal/neighbourhood context CONTRIBUTING RESPONSIBILITY phys/chem/ erg hazards

58 downward mobility Inter-generational through life-course in adult age (healthy w. effect) material morbidity health care outcomes behaviours support psychosocial dem/contr ff/rew selection income societal/neighbourhood context INDIRECT RESPONSIBILITY phys/chem/ erg hazards

59 downward mobility Inter-generational through life-course in adult age (healthy w. effect) material morbidity health care outcomes behaviours support psychosocial dem/contr ff/rew selection income societal/neighbourhood context EQUITY AUDIT phys/chem/ erg hazards

60 downward mobility Inter-generational through life-course in adult age (healthy w. effect) material morbidity health care outcomes behaviours support psychosocial dem/contr ff/rew selection income societal/neighbourhood context ADVOCACY phys/chem/ erg hazards

61 downward mobility Inter-generational through life-course in adult age (healthy w. effect) material morbidity health care outcomes behaviours support psychosocial dem/contr ff/rew selection income societal/neighbourhood context SUPPORT IN SOCIETY phys/chem/ erg hazards

62 Turin Longitudinal Study Municipality population registry Life status migration Reproductive history... Demographical events Census 1971 Census 1981 Census 1991 Socio-economic status Census 2001 Causes of death cod. A.S.L cod. Istat Drug prescriptions Hospital discharges Ambulatory services and emergency care Cancer Incidence Drug addiction treatments Occupational injuries, dyalisis treatments, diabete diagnoses… social-health events/status Social assistance (2005) income deprivation … Area indices Census tracts and their aggregations Population registry identification key Master data file Population registry identification key

63 TLS population: cohorts 1971 census census 1981 census emigration deathemigration death emigration death birth immigration birth immigration birth immigration Causes of death Cancer incidence Hospitalization Diabetes Drug prescriptions

64 * Population registry uncomplete update TLS census-population registry linkage

65 TLS longitudinal dimension


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