Katarina Kjellberg

For decades, JEMs have been used to classify occupational exposures in large scale epidemiological studies, where the study participants were too many to be able to carry out individual exposure measurements, or where exposure backwards in time had to be assessed. With a Job Exposure Matrix (JEM), one can assess the exposure of several different occupational exposures in a cohort or registry study, using only an occupational code and knowledge of the time period of the exposure. SweJEM is a Swedish infrastructure that contains JEMs for chemicals, particles, metals, noise, vibrations, physical (ergonomic) strain, psychosocial working conditions, and low employment quality. SweJEM was launched externally in autumn 2023, https://ki.se/imm/swejem and JEMs has since then been sent out to research groups around the country. In addition, the JEMs have formed the basis for regions and authorities´ risk assessment of the work environment. Already during the development phase, it has followed exposure trends in over time in Sweden and have evaluated occupational exposures during pregnancy and health effects in the mother and child as well as occupational exposures in relation to our most common public diseases such as cardiovascular disease and cancer. The first version of this unique national infrastructure now needs further development to become more detailed and more comprehensive than before. To achieve this, we need funds to collect new data from workplaces in Sweden. New data increases the relevance of the infrastructure by adding new later years of exposure, as well as improving the exposure history going back in time. In addition, we want to receive data from different types of employers, in order to e.g. be able to observe difference in exposure between large and small companies or for different demographic groups so that we can study differences in exposure patterns between men and women and between different age groups. Right now, this is only covered in parts of SweJEM. Finally, we also want to collect new occupational exposures such as UV-light, heat and cold in order to better cover the climate changes that affect the working environment. The aim is to keep the relevance of the infrastructure so that research groups, occupational and environmental medicine clinics, regions, occupational health care and authorities around Sweden can have access to the best possible exposure classification.

Research problem and specific questionsDespite the overall decrease in cardiovascular (CV) mortality there is, especially among women, an increasing social gradient in Sweden. The explanation is not known. Our aim is to analyse to what extent this gradient can be explained by the increasingly unsecure labour market. The research questions are: How large a proportion of the effect of education on CV health is mediated through weak labour market attachment (LMA, unemployment and precarious employment)? What are the other possible work-related mechanisms?Data and methodFour life-course cohorts, born 1965 and 1973, will be used. Two of them are based on extensive register data about all Swedish inhabitants. Two are based on repeated questionnaires and extensive register data on all school-leavers from grade 9, in a middle-sized town. One contains repeated clinical data for 40 years. Data on exposure to LMA are available from school to midlife. Incident CV diagnoses and metabolic risks will be measured around age 56 and 51. All cohorts will be controlled for reverse causation and other confounders.While the register cohorts are complete and provide power and national representativity, the school cohorts provide rich data of high validity for analysing mechanisms and clinical outcomes. A qualitative study about possible mechanisms will be performed among those with highest risk of weak LMA who have been followed during 40 years with interviews.Sociatal relevance and utilisationElimination of avoidable health inequalities is a major goal in the Swedish public health policy. To reach the goal, knowledge is needed about the mechanisms behind. The increasingly insecure labour market is our focus, a priority also in policies around EU. Our results can be used in health promotion and by work environmental actors to support targeted interventions aiming at improved equality in health and sustainable work conditions during life.Plan for project realisationRegister update will be made of one school cohort. Advanced mediation analyses of work conditions will be made for the educational gradient in CV health, using latest methods for selecting confounders.  Several mediators can be included at the same time, so the effect of structural factors on health behaviour can be analysed. Follow-up interviews will be performed with the early unemployed group. The theoretical development aim at developing a working life-course theory. The budget cover salaries and register updates.

The retirement age is being raised gradually to counteract the financial consequences of an increasingly older population. However, with increasing age, and in particular after 50 years of age, an increasing number of persons are excluded from the labour market due to health problems. There are also increasing difficulties for young people and people in marginalized labor market positions to establish in the labor market. The research program addresses major challenges to create opportunities for a sustainable working life for all groups on the labor market by strengthening and updating the research on risk factors for poor health, and labor market marginalization and exclusion over the life-span among young, middle aged, and older male and female workers.The aims of the program are to extend knowledge on risk factors for labor market marginalisation and exclusion over the life course (WP1-3), and to identify policies and measures at workplaces that support a long working life (WP4). In four work packages we will study:WP1. Effects of long-term and accumulated poor working conditions on preterm labor-market exit, and potentially risk-reducing effects of occupational change and reduced occupational exposure WP2 Working-life expectancy among different occupational and socioeconomic groups WP3. Determinants and consequences of labor market marginalization over the life courseWP4. Work organizational structures promoting a sustainable working life for all The program is based on research and research collaborations that we have been involved in for many years, in an established environment now under expansion and development. The research team consists of both established and junior researchers from Sweden, the Netherlands, Norway, and the USA. A large, compiled register-based cohort (SWIP) that includes the entire Swedish population, born around 1990 or earlier, will be used in WP1-3. Data from surveys and qualitative interviews will also be collected (WP4).