Article Text

Download PDFPDF
Chronic diseases as predictors of labour market attachment after participation in subsidised re-employment programme: a 6-year follow-up study
  1. Chioma A Nwaru1,
  2. Laura Peutere1,
  3. Mika Kivimäki2,3,4,
  4. Jaana Pentti3,
  5. Jussi Vahtera5,
  6. Pekka J Virtanen1
  1. 1 Faculty of Social Sciences, School of Health Sciences, University of Tampere, Tampere, Finland
  2. 2 Department of Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland
  3. 3 Department of Occupational Health, Finnish Institute of Occupational Health, Turku, Finland
  4. 4 Department of Epidemiology and Public Health, University College London, London, UK
  5. 5 Department of Public Health, University of Turku and Turku University Hospital, Turku, Finland
  1. Correspondence to Chioma A Nwaru, Faculty of Social Sciences, School of Health Sciences, University of Tampere, Tampere, Finland; Nwaru.Chioma.A{at}


Background Little is known about the work patterns of re-employed people. We investigated the labour market attachment trajectories of re-employed people and assessed the influence of chronic diseases on these trajectories.

Methods The study was based on register data of 18 944 people (aged 18–60 years) who participated in a subsidised re-employment programme in Finland. Latent class growth analysis with zero-inflated Poisson was used to model the labour market attachment trajectories over a 6-year follow-up time. Multinomial logistic regression was used to examine the associations between chronic diseases and labour market attachment trajectories, adjusting for age, gender, educational level, size of town and calendar year in subsidised re-employment programme.

Results We identified four distinct labour market attachment trajectories, namely: strengthening (a relatively stable attachment throughout the follow-up time; 77%), delayed (initial weak attachment increasing later; 6%), leavers (attachment declined with time; 10%) and none-attached (weak attachment throughout the study period; 7%). We found that severe mental problems strongly increased the likelihood of belonging in the leavers (OR 3.61; 95% CI 2.23 to 5.37) and none-attached (OR 3.41; 95% CI 1.91 to 6.10) trajectories, while chronic hypertension was associated with none-attached (OR 1.37; 95% CI 1.06 to 1.77) trajectory. The associations between other chronic diseases (diabetes, heart disease, asthma and arthritics) and labour market attachment trajectories were less evident.

Conclusions Re-employed people appear to follow distinct labour market attachment trajectories over time. Having chronic diseases, especially mental disorders appear to increase the risk for relatively poor labour market attachment.

  • chronic di
  • employment
  • social And life-course epidemiology

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors MK, JP, JV and PJV designed the study and provided the study data. CN, LP and PJV designed the data analysis plan and analysed the data. CN drafted the manuscript with different rounds of critical comments from MK, JP, JV, PJV and LP.

  • Funding This project was supported by the funding from the doctoral school of health sciences, university of Tampere and by the academy of Finland (grant number 267727). MK is supported by Nordforsk, the nordic program on health and welfare and the UK medical research council (K013351).

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval The Ethics Committee of the hospital district of helsinki and uusimaa.

  • Provenance and peer review Not commissioned; externally peer reviewed.