Occupation as a Proxy for Job Exposures? Routine Data Analysis Using the Example of Rehabilitation

Abstract

Aim of the study Job exposures are associated with health-related outcomes including sick leave and reduction in earning capacity. Rehabilitation of persons in working age aims primarily to secure or restore work capacity. Information concerning job exposures is, however, not directly available in routine data of healthcare payers. Since exposures relate to specific occupations and the current occupation is part of routine data, job exposures may be determined indirectly via job-exposure matrices (JEM). The aim of the study is to describe the possibilities and challenges of the representation of job exposures by the occupation according to routine data using the example of rehabilitation.

Methods The Scientific Use File ‘SUFRSDLV15B’ of the German Pension Insurance was analysed. We used data from n=1 242 171 persons in work with at least one completed medical rehabilitation between 2008 and 2015 (dataset 1). The occupation is coded according to KldB 88 or KldB 2010 (German Classification of Occupations). In addition, data from a nationwide survey with 2530 rehabilitation patients was available (dataset 2). Job exposures are operationalized by the Job Exposure Index via JEM. The relationship to the return-to-work prognosis at the end of rehabilitation (dataset 1) and to patient reported outcome measures (dataset 2) is described.

Results Information concerning the occupation is available for about 91% of rehabilitation measures of employed patients for the year prior to rehabilitation. At high levels of job exposures, the proportion of persons with a predicted working capacity in the last job of fewer than 3 h per day increased by a factor of 4 compared to low-level job exposures (23.5 vs. 6.1%). On the other hand, there is a low association only to reduced working capacity in the general labour market (2.9 vs. 2.4%). High-level job exposures are associated with self-reported, work-related impairments.

Conclusion The Job Exposure Index may offer a valid approach to depict occupation-related exposures. The index can be used in the analysis of routine data of the pension insurance and other social security funds, as well as in the linkage of individual assessment data with routine data containing the occupation, without any additional data collection effort. Due to its construction based on job classifications, it will not replace the assessment of individual burdens.

Zusammenfassung

Ziel der Studie Arbeitsbelastungen sind mit verschiedenen Gesundheitsindikatoren wie Arbeitsunfähigkeit und Erwerbsminderung assoziiert. Primäres Ziel der Rehabilitation von Personen im erwerbsfähigen Alter ist meist die Sicherung bzw. Wiederherstellung der Erwerbsfähigkeit. Allerdings sind Arbeitsbelastungen in Routinedaten der Kostenträger nicht verfügbar. Da viele Belastungen typisch für einzelne Berufe sind und die Tätigkeit in Routinedaten dokumentiert ist, können Arbeitsbelastungen indirekt über die Berufstätigkeit dargestellt werden. Ziel der Arbeit ist es, Möglichkeiten und Grenzen der Abbildung von Arbeitsbelastungen durch die Tätigkeit gemäß Routinedaten am Beispiel der Rehabilitation zu beschreiben.

Methodik Das Scientific Use File „SUFRSDLV15B“ der Deutschen Rentenversicherung mit 1 242 171 Erwerbstätigen mit mindestens einer abgeschlossenen medizinischen Rehabilitation 2008–2015 wurde analysiert (Datensatz 1). Die Tätigkeit ist nach KldB 88 bzw. KldB 2010 (Klassifikation der Berufe) codiert. Zudem stehen Daten einer bundesweiten Befragung mit 2 530 Rehabilitanden zur Verfügung (Datensatz 2). Arbeitsbelastungen wurden mithilfe eines Index über die Berufstätigkeit durch Bildung von Job-Exposure-Matrizen operationalisiert. Der Zusammenhang zur Return-to-Work-Prognose am Ende der Rehabilitation (Datensatz 1) und zu selbstberichteten Beeinträchtigungen und Ressourcen (Datensatz 2) wird berichtet.

Ergebnisse Für etwa 91% der medizinischen Rehabilitationen bei Erwerbstätigen liegen für das Jahr vor Rehabilitation Informationen zur Berufstätigkeit und damit zum Arbeitsbelastungsindex vor. Bei hohen Arbeitsbelastungen war der Anteil mit einer prognostizierten Arbeitsfähigkeit im letzten Beruf von weniger als 3 Stunden täglich etwa um den Faktor 4 im Vergleich zu niedriger Arbeitsbelastung erhöht (23,5 vs. 6,1%). Hingegen besteht nur ein geringer Zusammenhang zur verminderten Leistungsfähigkeit auf dem allgemeinen Arbeitsmarkt (2,9 vs. 2,4%). Hohe Arbeitsbelastungen sind mit selbstberichteten, insbesondere berufsbezogenen Beeinträchtigungen assoziiert.

Schlussfolgerung Der Arbeitsbelastungsindex bietet die Möglichkeit, berufstypische Arbeitsbelastungen valide abzubilden. Der Index kann bei Analysen von Routinedaten der Sozialversicherungsträger sowie bei Verknüpfung von Primärdaten mit Routinedaten, welche die Berufstätigkeit enthalten, ohne zusätzlichen Erhebungsaufwand eingesetzt werden. Aufgrund seiner Konstruktion über die Berufstätigkeit kann der Index die Erhebung von individuellen Belastungen nicht ersetzen.

Key words

job demands - job exposures - medical rehabilitation - routine data - pension insurance - secondary data analysis

Schlüsselwörter

Arbeitsbelastung - Berufstätigkeit - Sekundärdaten - Routinedaten - medizinische Rehabilitation - Rentenversicherung

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