Differences in Mortality and Health Care Use by Occupation
Abstract
Health inequalities and their determinants have a long research tradition at occupational class level. By studying the differences by more detailed occupations, we can identify the risk groups and factors that affect high mortality more accurately.
The aim of this study was to identify specific manual occupations with high mortality and to examine whether the contributions of socioeconomic and occupational factors to mortality differ in these occupations. We also examined the role of alcohol-related mortality in the excess mortality in these occupations and the use of outpatient and inpatient health services by occupational groups. The mortality of seafarers in comparison to all other employees was explored in more detail.
The study was based on longitudinal, individual-level, register-based data of employees in Finland. Cox proportional hazard models, negative binomial models, and logistic regression models were used in the analyses.
In comparison to all employees, men had 31 and women had 11 manual occupations with high mortality. High-mortality occupations were identified from every field, including clerks, service workers, craft and metalworkers, plant and machine operators, and elementary occupations. High mortality was largely explained by education, income, unemployment, and industry. However, the magnitude varied. High income did not always protect from high mortality. An example of such an occupation was male seafarers. Alcohol-related mortality mostly increased the total excess mortality among high-mortality manual occupations, but these deaths alone did not explain the differences in mortality compare to all employees. High alcohol-related mortality did not always mean a high role of alcohol-related mortality in total mortality.
Compared to all employees, manual workers typically had more outpatient visits to health care, and non-manual workers had fewer visits. Some occupations differed from the gradient, indicating that the use of health care services seems to be affected not only by occupational hazards but also by differences in disease identification, knowledge and attitudes towards health care, and access to occupational health services. The differences in inpatient care services were smaller than those in outpatient care.
In addition to broader socioeconomic characteristics, occupation is an important factor for understanding health inequalities.
Author
Hanna Rinne
Additional Information
- Peer-Reviewed: yes.
- Open Access: yes.
- Cite as: Rinne, H. (2022). Differences in mortality and health care use by occupation [väitöskirja, Helsingin yliopisto]. Helda.
http://urn.fi/URN:ISBN:978-951-51-7066-8
