Prolungamento della vita lavorativa: salute e problemi correlati

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

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

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

5. Occupational inequalities in mortality in eleven European countries. Men, 45-59 years 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. Kunst A, et al. Mortality by occupational classamong men 30–64 years in 11 Europeancountries. Soc Sci Med 1998.

6. Mortality Rate Ratios in lower occupational groups as compared to higher occupational groups: men Mackenbach JP, et al. Widening socio-economicinequalities in mortality in six Western Europeancountries. Int J Epidemiol2003.

7. Mortality Rate Ratios in lower occupational groups as compared to higher occupational groups: men large relative occupational inequalities widened during the last two decades Mackenbach JP, et al. Widening socio-economicinequalities in mortality in six Western Europeancountries. Int J Epidemiol2003.

8. As was the case with mortality, rates of morbidity are usually higher amongthose with a lower educational level, occupational class or income level • (Cavelaars A, et al.Morbiditydifferences by occupational class among men inseven European countries: an application of theErikson-Goldthorpe social class scheme. Int JEpidemiol 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 Europeancountries. 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 positionhave been rather stable • (Kunst AE, et al. Trends in socio-economic inequalities in self-assessed health in 10 Europeancountries. Int J Epidemiol 2005; 34: 295–305). • Together with inequalities in mortality, inequalities in morbidity contributeto large inequalities in ‘healthy life expectancy’ (number of years lived in goodhealth) • (Sihvonen A, et al. Socio-economic inequalities in health expectancy in Finland and Norway in thelate 1980s. Soc Sci Med 1998; 47(3): 303–315).

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

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

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

12. Impact of poor health on social mobility within the labour market Statistical model: Analysis of variance Dependent variable: Social Mobility Metrical Index (SMMI) R2 = .14 Cardano M et al.Social Science & Medicine 58 (2004): 1563–1574

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

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

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

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

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

23. Effect of neighbourhood unemployment on mortality Males aged 15-75 2,00 II vs. I quartile III vs. I quartile Most unempl. vs. I quartile 1,50 1,00 USA Netherlands London Helsinki Turin Madrid

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

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

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

27. % variation in 1991-2005 mortality among adults(30-59 yrs) that have improved their education btw 1981 and 1991 SLT, unpublished data, 2006

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

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) ampio spettro di patologie infiammatorie e degenerative a carico di muscoli, tendini, legamenti, articolazioni, nervi periferici, e strutture vascolari che includono: • 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 • 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 dall’INAIL (Colombini et al., 2003) • Circa il 50% dei soggetti con disturbi muscolo-scheletrici all’arto superiore non ha segni obiettivi (Punnett, 1998, 2000) • “Nella maggior parte dei casi, i disturbi muscolo-scheletrici a carico dell’arto 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 all’esposizione a rischi fisici sul lavoro Patologie del rachide National Research Council and Institute of Medicine, 2001

35. MALATTIE MUSCOLO-SCHELETRICHE (MSDs) – Frazione attribuibile all’esposizione a rischi fisici sul lavoro Patologie dell’arto superiore National Research Council and Institute of Medicine, 2001

36. MALATTIE MUSCOLO-SCHELETRICHE (MSDs) – Diffusione dell’esposizione – Sollevare pesi eccessivi (CGIL, 1999)

37. MALATTIE MUSCOLO-SCHELETRICHE (MSDs) – Stima del numero di casi attribuibili all’esposizione 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: • 27.000 casi prevalenti dovuti alla movimentazione di materiale • 47.000 a frequente flessione e torsione del busto • 77.000 a sforzi molto intensi • 35.000 a posture incongrue • 45.000 a vibrazioni trasmesse al rachide • Assumendo un’incidenza del 4.5% alla popolazione occupata e i valori della AF al limite inferiore del range: • 8.000 nuovi casi all’anno dovuti alla movimentazione di materiale • 14.000 a frequente flessione e torsione del busto • 23.000 a sforzi molto intensi • 10.000 a posture incongrue • 13.000 a vibrazioni trasmesse al rachide

38. MALATTIE MUSCOLO-SCHELETRICHE (MSDs) – Stima del numero di casi attribuibili all’esposizione a fattori ergonomici in Piemonte - Patologie dell’arto superiore • Assumendo una prevalenza del 15% alla popolazione occupata e i valori della AF al limite inferiore del range: • 132.000 casi prevalenti dovuti a movimenti ripetuti • 195.000 a sforzi molto intensi • 110.000 a vibrazioni trasmesse all’arto superiore • Assumendo un’incidenza del 6% alla popolazione occupata e i valori della AF al limite inferiore del range: • 53.000 nuovi casi all’anno a movimenti ripetuti • 78.000 a sforzi molto intensi • 44.000 a vibrazioni trasmesse all’arto 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 l’esperienza 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 dell’organizzazione • 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 dell’esposizione a ripetitività, forza, posture incongrue e impatti ripetuti • Indicazioni per la sorveglianza sanitaria

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

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

43. employability retirability workability Believes Values Attitudes Satisfaction Competences Knowledge Abilities Working conditions Material hazards Psychosocial hazards Health Lifestyles 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. retirability employability workability Believes Values Attitudes Satisfaction Competences Knowledge Abilities Working conditions Material hazards Psychosocial hazards Health Lifestyles Core Periphery

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

49. Healthy life expectancy by occupation, males

50. Healthy life expectancy by occupation, females