Kristina Alexanderson

Purpose and aims: We aim to contribute to a better understanding of the role of psychosocial factors in the etiology and prognosis of heart failure (HF) and of patterns and predictors of work disability in HF patients of working age. The specific questions are:Are psychosocial factors, namely adverse life events in childhood and adulthood, work stress, social support, anger-behavior and a wider range of psychiatric disorders than depression associated with incident HF?Are psychosocial factors, namely stress and a wider range of psychiatric disorders than depression associated with HF prognosis?What are the patterns of work disability in HF patients of working age compared to healthy controls and what factors predict length of work disability?Project organization, time plan and methods: In this four-year project, we will analyze data from a register cohort involving all born in Denmark (1973-2020) and Sweden (1973-2014) (N=7.2 million) and their parents (N=6.7 million), the Norwegian Nord-Trøndelag Health Study conducted in 1995-97 (N=65237) and 2006-08 (N=50807) (aim 1), a register-based cohort of HF patients in the National Patient Register (1987-2019) and/or patients in the HF quality registry (2003-2019) (aim 2) and Insurance Medicine All Sweden database (aim 3).Relevance: A better understanding of the role of psychosocial factors in the etiology and prognosis of HF and the patterns and predictors of work disability will be informative for HF prevention strategies.

With more people living much longer, extending working lives into older ages is a concern in many countries, including Sweden. There are two hypotheses about who stays in work at older ages: those with better health and high incomes (the ‘status maintenance hypothesis’) or those with low pension incomes (the ‘compensation hypothesis’). Both of these have implications for gender differences in paid work after age 65 and 70, respectively. Moreover, it is not known to what extent the association between morbidity and labour market withdrawal after age 65 differs between women and men.The aim is to gain more knowledge on gender differences in labour market transitions in later working life, and how this relates to morbidity, sickness absence, types of income, birth country, educational level, type of living area, family composition, occupation (blue-collar/white-collar), branch of industry, and psychosocial job demands and control.We will conduct at least five studies within this interdisciplinary project. We will use microdata from several nationwide high-quality registers from Statistics Sweden, the Social Insurance Agency, and the Board of Health and Welfare, linked at individual level for all people living in Sweden in 2015 who were aged 66-70 years (n=588 716) and ≥71 years (n=1 227 541) years, respectively, and follow them prospectively for 5 years or until death. We will use epidemiological analyses to determine to what extent there are gender differences in having paid work and, among those in paid work, in having different levels of sickness absence, among the two groups.We will also use advanced statistical modelling to study future patterns of labour market statuses over 17 years among those aged 55-64 at baseline in 2001 (n=616 818), related to prior morbidity, SA, sociodemographics and job-related factors. All analyses will be stratified by sex, to analyse whether associations differ between women and men and if there are different mechanisms.