Higher comorbidity rates in unemployed patients may significantly impact the cost of spine surgery

Chronic back pain is commonly associated with physical and mental comorbidities, which create a considerable burden on the healthcare system. We examined the differences in comorbidity rates of 619 spinal surgery patients of employment age, and the impact of comorbidity rates on length of hospital stay and cost. The charts of patients aged >25 years and <65 years were reviewed retrospectively. Type of surgery, employment status, comorbidities, length of stay and hospital charges were studied using chi-square, Fisher, Student’s t-test, Wilcoxon-Mann-Whitney test and multivariate analysis. The unemployment rate among employment-aged spinal surgery patients was 44.7%. Unemployed patients who underwent any of the three types of surgery (anterior cervical decompression and fusion, lumbar decompression and fusion, and lumbar microdiscectomy [LMD]) stayed longer in hospital but had higher hospital charges in the minimally invasive LMD group only. There were higher rates of some comorbidities in unemployed compared to employed patients: asthma (12.2% vs. 5.9%), coronary artery disease (20.4% vs. 12.8%), diabetes mellitus (58.0% vs. 47.3%), history of coronary artery bypass surgery or stent placement (18.2% vs. 11.6%), hypothyroidism (14.4% vs. 8.2%), knee joint disease (43.1% vs. 33.6%), chronic renal disease (12.9% vs. 2.9%) and opioid (55.2% vs. 45.9%) antidepressant (37.0% vs. 25.3%) anxiolytic (16.0% vs. 8.9%) use. Charlson comorbidity scores were significantly different (p < 0.001) between unemployed (1.72 ± 1.90) and employed patients (1.03 ± 1.55). Multivariate analysis showed that a history of coronary artery bypass/stent procedure, chronic renal disease or preoperative opioid use had a significant impact on length of stay and hospital charges in unemployed spine surgery patients. Thus, unemployment in spinal surgery candidates is associated with higher comorbidity rates with a significant impact on healthcare cost. More research is needed into the relationship between unemployment and consumption of healthcare resources.     

Chances of Employment in Women and Men after Surgery of Congenital Heart Disease: Comparisons between Patients and the General Population

Objective. It was examined whether women and men (17–45 years) with operated congenital heart disease differ with respect to chances of employment. Patients were compared with the general population. Design. Patients (n = 314) were classified by type of surgery (curative, reparative, palliative) as indicator of initial severity of disease. The second classification was performed according to a system proposed by the New York Heart Association in order to take reported impairments into account. Controls (n = 1165) consisted of a 10% random sample drawn from the German Socio‐Economic Panel. Results. Chances of full‐time employment decreased as disease severity increased. Chances of part‐time and minor employment were higher in patients than among controls. These general effects were because of male patients, while the employment patterns of women did not differ from the control group. Independent of patient status, women were more likely to have lower rates of full‐time employment, and the rates of part‐time and minor employment were higher. Conclusion. Long‐term adaptation to impairments as a result of congenital heart disease differs between women and men with respect to employment status. While female patients do not differ from the general population, males may lower their engagement in paid work.     

城市不在业者卫生服务利用及影响因素分析

目的探索城市不在业者卫生服务利用情况及其影响因素,为有关部门制定政策提供依据。方法从2003年国家卫生服务调查数据库中抽取8412名城市不在业者进行深入分析。结果影响城市不在业者卫生服务利用的主要因素有年龄、文化程度、医疗保障状况。结论需要提高城市不在业者的医疗保障覆盖率。     

The effect of recurrent involuntary job loss on the depressive symptoms of older US workers

Objectives: The objective of this study was to assess whether recurrent involuntary job loss among US workers nearing retirement resulted in increasingly less severe changes in depressive symptoms with successive job losses. Methods: With data drawn from the US Health and Retirement Survey (HRS), we used repeated measures longitudinal analysis to investigate the effect of recurrent job loss on follow-up depressive symptoms, measured up to 2 years following job loss. Study participants include 617 individuals, aged 51–61 years at the 1992 study baseline, who had at least one job loss between 1990 and 2000. Our primary outcome variable was a continuous measure of depressive symptoms, constructed from the 8-item Center for Epidemiologic Studies-Depression (CES-D) battery administered at every HRS wave. A second, dichotomous outcome, derived from the continuous measure, measured clinically relevant depressive symptoms. The exposure (recurrent job loss) was defined by binary dummy variables representing two and three/four job losses. All job losses were the result of either plant closing or layoff. Results: Our main finding indicates that, after relevant covariates are controlled, compared to one job loss, two job losses result in a modest increase in the level depressive symptoms (not significant) at two-year follow-up. Three or more job losses result, on average, in a decline in depressive symptoms to a level near pre-displacement assessment (not significant). Somewhat in contrast, two job losses were found to be associated with increased risk of clinically relevant depressive symptoms. Conclusions: The principal finding confirms our hypothesis that, among US workers nearing retirement, repeated exposure to job separation results in diminished effects on mental health. Adaptation to the job loss stressor may underlie the observed response, although other explanations, including macroeconomic developments, are possible.     

Long term health-related quality of life after burns is strongly dependent on pre-existing disease and psychosocial issues and less due to the burn itself

Background

Health-related quality of life (HRQoL) is reduced after a burn, and is affected by coexisting conditions. The aims of the investigation were to examine and describe effects of coexisting disease on HRQoL, and to quantify the proportion of burned people whose HRQoL was below that of a reference group matched for age, gender, and coexisting conditions.

Method

A nationwide study covering 9 years and examined HRQoL 12 and 24 months after the burn with the SF-36 questionnaire. The reference group was from the referral area of one of the hospitals.

Results

The HRQoL of the burned patients was below that of the reference group mainly in the mental dimensions, and only single patients were affected in the physical dimensions. The factor that significantly affected most HRQoL dimensions (n = 6) after the burn was unemployment, whereas only smaller effects could be attributed directly to the burn.

Conclusion

Poor HRQoL was recorded for only a small number of patients, and the decline were mostly in the mental dimensions when compared with a group adjusted for age, gender, and coexisting conditions. Factors other than the burn itself, such as mainly unemployment and pre-existing disease, were most important for the long term HRQoL experience in these patients.     

The importance of full-time work for urban adults' mental and physical health

Unemployment and underemployment have adverse mental and physical health consequences, such as increased stress and depression. Health damaging behaviors like unhealthy eating, smoking, and alcohol use may be used to cope, contributing to chronic disease risk. In this adverse economic climate, it is vital to understand the health implications of unemployment and underemployment as well as underlying mechanisms. A randomized household survey of adults in six low resource communities was conducted in New Haven, Connecticut in 2009, yielding a sample of 1205 (73% participation) racially diverse adults (61% Black, 20% Latino, 12% White) ages 18-65 (61% women). We used ANOVA to test group differences and structural equation modeling to test mediation. 14.5% were unemployed and looking for work, 18.4% worked part-time, 38.2% worked full-time. Those employed full-time reported the least damaging psychological factors and health behaviors: lowest levels of stress and depression, most healthy and least unhealthy eating, most physical activity, and lowest levels of smoking and drinking. Those employed part-time fell in the middle, and those unemployed fell on the unhealthy end of all psychological and behavioral factors. Stress significantly mediated the associations of full-time employment with frequency of unhealthy eating and physical activity, and amount of cigarette smoking and alcohol consumption. Depression significantly mediated the association of full-time employment with frequency of healthy eating. Compared to <10% nationwide, rates of unemployment in this sample were high. Both those unemployed and employed part-time reported adverse health behaviors as compared to those employed full-time, partially mediated by heightened stress and depression. It is vital for the health and well-being of the nation to increase not simply employment, but specifically full-time employment. Provision of mental health services to those unemployed and underemployed should be a priority to promote healthier lifestyles and prevent costly future chronic disease.     

Inequality and the association between involuntary job loss and depressive symptoms

Although socioeconomic status (SES) has been to shown to be associated with susceptibility to involuntary job loss as well as with health, the ways in which individual SES indicators may moderate the job loss-health association remain underexplored. Using data from the Americans' Changing Lives study, we estimate the ways in which the association between job loss and depressive symptoms depends on five aspects of SES: education, income, occupational prestige, wealth, and homeownership. Our findings indicate that higher SES prior to job loss is not uniformly associated with fewer depressive symptoms. Higher education and lower prestige appear to buffer the health impacts of job loss, while financial indicators do not. These results have a number of implications for understanding the multidimensional role that social inequality plays in shaping the health effects of job loss.     

How does the business cycle affect eating habits?

As economic expansions raise employment and wages, associated shifts in income and time constraints would be expected to also impact individuals' health. This study utilizes information from the US Behavioral Risk Factor Surveillance System (1990-2009) to explore the relationship between the state unemployment rate and the consumption of various healthy and unhealthy foods in the United States. Estimates, based on fixed effects methodologies, indicate that unemployment is associated with reduced consumption of fruits and vegetables and increased consumption of "unhealthy" foods such as snacks and fast food. Heterogeneous responses are also identified through detailed sample stratifications and by isolating the effect for those predicted to be at highest risk of unemployment based on their socioeconomic characteristics. Among individuals predicted to be at highest risk of being unemployed, a one percentage point increase in the resident state's unemployment rate is associated with a 3-6% reduction in the consumption of fruits and vegetables. The impact is somewhat higher among younger, low-educated, and married adults. Supplementary analyses also explore specific mediating pathways, and point to reduced family income and adverse mental health as significant channels underlying the procyclical nature of healthy food consumption.     

Estado del bienestar y salud pública,una relación que debe ser actualizada

Human health has improved throughout the 20th century, at the same time that the Welfare State was consolidated. This paper explores the current relationship between the welfare state and public health. The essential functions of public health are exercised as part of the State, and currently the main challenge is to ensure that health is protected and promoted through different public policies, including employment. Studies assessing the health effect of different types of welfare state are contradictory, but when the impact of specific policies, such as unemployment benefits, is considered, the results are positive and consistent. However, the current crisis of the Welfare State hampers its continuity, largely due to changes in the labour market, with more flexible and insecure jobs.