| Literature DB >> 30463351 |
Lucía Artazcoz1,2,3,4, Imma Cortès-Franch5,6,7,8, Vicenta Escribà-Agüir9,10, María López11, Fernando G Benavides12,13.
Abstract
Chronic extreme long working hours (LWH) have been found consistently associated with poor health status. However, the evidence for moderately LWH (41⁻60 h a week) is contradictory. Although poor job quality has been proposed as one of the mechanisms of this relationship, there are almost no studies about LWH and job quality. The objectives of this study were to analyze the association between moderately LWH and job quality in the EU27, as well as to examine differences by welfare regimes and gender. This is a cross-sectional study based on data from the 2010 European Working Conditions Survey. A subsample of employees from the EU27 aged 16⁻64 years who worked 30⁻60 h a week was selected (12,574 men and 8787 women). Overall, moderately LWH were not consistently associated with poor job quality except among women from Eastern European countries. Therefore, in the EU27 poor job quality does not seem to explain the relationship between moderately LWH and poor health status. The findings among women from Eastern European countries may be related to their weakened position in the labor market and to their work-family conflict resulting from a process of re-familisation that constrains their choices for a good job.Entities:
Keywords: gender; socioeconomic factors; working conditions; working time
Mesh:
Year: 2018 PMID: 30463351 PMCID: PMC6265898 DOI: 10.3390/ijerph15112592
Source DB: PubMed Journal: Int J Environ Res Public Health ISSN: 1660-4601 Impact factor: 3.390
General description of the population by sex and country group. Employees working 30–60 h a week. (%). 5th European Working Conditions Survey, 2010.
| Continental | Anglo-Saxon | Eastern European | Southern European | Nordic | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Men | Women | Men | Women | Men | Women | Men | Women | Men | Women | |
| Paid working hours (%) | ||||||||||
| 30–40 h | 78.3 c | 87.8 | 63.6 c | 80.6 | 65.4 c | 74.5 | 75.4 b | 79.9 | 79.6 | 84.0 |
| 41–50 h | 18.4 | 11.0 | 26.3 | 16.8 | 26.2 | 21.2 | 20.7 | 16.8 | 17.8 | 14.1 |
| 51–60 h | 3.3 | 1.2 | 10.1 | 2.6 | 8.4 | 4.4 | 3.9 | 3.3 | 2.7 | 1.9 |
| Occupational category (%) | ||||||||||
| Upper | 20.8 c | 23.1 | 36.7 c | 38.7 | 14.3 c | 19.8 | 11.7 c | 18.2 | 23.5 c | 33.4 |
| Middle | 33.8 | 64.9 | 28.8 | 50.8 | 26.1 | 55.1 | 34.8 | 61.9 | 36.8 | 54.7 |
| Lower | 45.4 | 12.0 | 34.4 | 10.4 | 59.6 | 25.1 | 53.5 | 19.8 | 39.7 | 11.9 |
| Intrinsic job quality (mean; SD) | ||||||||||
| Time pressure | 4.0 (1.7) c | 3.7 (1.8) | 3.8 (1.8) | 3.8 (1.9) | 3.5 (1.8) c | 3.3 (1.9) | 3.7 (1.8) c | 3.3 (1.8) | 3.8 (1.5) | 4.0 (1.7) |
| Physical demands | 3.3 (1.5) | 3.2 (1.5) | 3.2 (1.5) | 2.8 (1.3) | 3.4 (1.6) c | 3.0 (1.5) | 3.7 (1.6) | 3.3 (1.4) | 3.2 (1.4) | 3.1 (1.4) |
| Skill discretion | 0.8 (0.3) | 0.7 (0.3) | 0.8 (0.3) | 0.8 (0.3) | 0.7 (0.3) | 0.7 (0.3) | 0.7 (0.3) c | 0.6 (0.3) | 0.9 (0.2) | 0.8 (0.2) |
| Autonomy | 0.6 (0.4) a | 0.7 (0.3) | 0.7 (0.4) a | 0.7 (0.4) | 0.5 (0.4) | 0.5 (0.4) | 0.6 (0.4) | 0.6 (0.4) | 0.8 (0.3) | 0.8 (0.3) |
| Participation | 3.0 (1.1) b | 2.9 (1:1) | 3.3 (1.3) | 3.3 (1.1) | 3.0 (1.1) b | 2.9 (1.1) | 2.8 (1.2) b | 2.7 (1.2) | 3.5 (1.0) | 3.5 (0.9) |
| Support | 3.6 (1.0) | 3.7 (1.0) | 4.1 (0.9) a | 4.2 (0.8) | 3.9 (0.9) | 3.8 (1.0) | 3.8 (1.0) | 3.8 (1.0) | 4.0 (0.8) | 4.0 (0.9) |
| Prospects | ||||||||||
| Non-permanent contract (%) | 11.1 c | 11.9 | 15.1 b | 12.9 | 15.0 b | 16.3 | 10.7 c | 14.6 | 9.6 | 10.7 |
| Employer-funded training (mean; SD) | 0.4 (0.4) | 0.4 (0.4) | 0.5 (0.4) | 0.5 (0.4) | 0.3 (0.4) | 0.3 (0.4) | 0.3 (0.4) | 0.3 (0.4) | 0.6 (0.4) | 0.6 (0.4) |
| Rewards (%) | 2.6 (0.8) c | 2.7 (0.8) | 2.5 (0.8) c | 2.4 (0.8) | 2.8 (0.8) a | 2.9 (0.8) | 2.8 (0.8) a | 2.9 (0.7) | 2.5 (0.7) | 2.5 (0.7) |
| Working time quality | ||||||||||
| Changing schedules | 27.6 | 25.9 | 23.8 c | 17.1 | 27.3 c | 19.3 | 21.0 b | 16.9 | 12.7 | 15.2 |
| Work-life conflict | 18.8 | 19.0 | 17.1 c | 11.2 | 19.0 b | 15.5 | 26.2 | 24.8 | 12.0 | 11.3 |
| Age (mean; SD) | 41.3 (10.9) c | 40.1 (10.9) | 39.7 (11.7) a | 38.5 (11.6) | 39.3 (11.1) | 39.7(10.4) | 40.5 (10.7) a | 39.8 (10.2) | 42.4 (10.9) | 43.5 (11.2) |
ap < 0.05. b p < 0.01.c p < 0.001. p-values compare men and women in each country typology.
Association of working time with poor job quality by country group among men. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Employees working 30–60 h a week. 5th European Working Conditions Survey, 2010.
| Continental | Anglo-Saxon | Eastern European | Southern European | Nordic | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| % | aOR | 95%CI | % | aOR | 95%CI | % | aOR | 95%CI | % | aOR | 95%CI | % | aOR | 95%CI | |
|
| |||||||||||||||
| High time pressure | |||||||||||||||
| 30–40 h | 37.9 | 1 f | 42.5 | 1 d | 57.2 | 1 f | 48.2 | 1 f | 46.2 | 1 e | |||||
| 41–50 h | 31.6 | 0.7 | 0.59–0.82 c | 42.5 | 1.06 | 0.85–1.35 | 38.6 | 0.46 | 0.38–0.56 c | 31.9 | 0.51 | 0.43–0.63 c | 27 | 0.38 | 0.22–0.65 c |
| 51–60 h | 27.5 | 0.53 | 0.36–0.76 b | 28.4 | 0.56 | 0.37–0.75 b | 33.3 | 0.41 | 0.29–0.56 c | 27.3 | 0.37 | 0.25–0.59 c | 35.7 | 0.44 | 0.14–1.44 |
| High physical demands | |||||||||||||||
| 30–40 h | 51.2 | 1 | 57 | 1 | 50.1 | 1 d | 52.3 | 1 | 57.4 | 1 | |||||
| 41–50 h | 41.5 | 0.86 | 0.72–1.02 | 44.4 | 0.48 | 0.37–0.63 c | 52.4 | 1.14 | 0.92–1.41 | 54.3 | 1.17 | 0.96–1.42 | 42.7 | 0.79 | 0.46–1.36 |
| 51–60 h | 43.5 | 1.01 | 0.70–1.47 | 59.8 | 1.7 | 1.17–2.46 b | 62.2 | 1.43 | 1.01–2.03 a | 50 | 1.06 | 0.64–1.64 | 30.8 | 0.82 | 0.22–3.05 |
| Low skill discretion | |||||||||||||||
| 30–40 h | 31.6 | 1 f | 46.1 | 1 | 41 | 1 e | 37.9 | 1 e | 42.2 | 1 | |||||
| 41–50 h | 24.2 | 0.82 | 0.69–0.98 a | 43.2 | 0.9 | 0.71–1.15 | 36.9 | 0.88 | 0.66–0.99 a | 47.5 | 1.53 | 1.27–1.84 c | 28.1 | 0.59 | 0.35–1.01 |
| 51–60 h | 13.7 | 0.4 | 0.25–0.64 c | 32 | 0.7 | 0.49–1.01 | 34.4 | 0.68 | 0.49–0.95 a | 27.3 | 0.72 | 0.46–1.11 | 28.6 | 0.77 | 0.22–2.71 |
| Low autonomy | |||||||||||||||
| 30–40 h | 45.4 | 1 | 50.8 | 1 | 51.3 | 1 | 45.9 | 1 | 38.9 | 1 | |||||
| 41–50 h | 39 | 1.02 | 0.85–1.22 | 49.4 | 1.03 | 0.80–1.32 | 48.7 | 0.88 | 0.71–1.10 | 42 | 0.83 | 0.68–1.02 | 37.1 | 1.2 | 0.71–2.02 |
| 51–60 h | 36.6 | 0.81 | 0.55–1.18 | 41.8 | 1.06 | 0.74–1.52 | 47.5 | 0.77 | 0.55–1.09 | 41.2 | 0.95 | 0.62–1.46 | 28.6 | 1.13 | 0.31–4.16 |
| Low participation | |||||||||||||||
| 30–40 h | 43.4 | 1 f | 49.1 | 1 d | 45 | 1 e | 50.1 | 1 | 53.1 | 1 | |||||
| 41–50 h | 29 | 0.64 | 0.54–0.76 c | 39.8 | 0.74 | 0.56–0.97 a | 39.9 | 0.78 | 0.64–0.96 a | 52.1 | 1.12 | 0.93–1.34 | 44.2 | 0.98 | 0.57–1.68 |
| 51–60 h | 34.8 | 0.82 | 0.58–1.17 | 36.1 | 0.79 | 0.53–1.17 | 41.5 | 0.75 | 0.54–1.03 | 40 | 0.82 | 0.55–1.23 | 41.7 | 1.2 | 0.35–4.12 |
| Low support | |||||||||||||||
| 30–40 h | 49.6 | 1 | 31.8 | 1 | 39.8 | 1 | 40.3 | 1 f | 33.9 | 1 | |||||
| 41–50 h | 49.8 | 1.04 | 0.89–1.21 | 28.4 | 0.89 | 0.69–1.54 | 42.9 | 1.13 | 0.93–1.37 | 45.6 | 1.24 | 1.02–1.48 a | 35.2 | 1.01 | 0.61–1.69 |
| 51–60 h | 41.3 | 0.74 | 0.53–1.02 | 29.1 | 0.96 | 0.66–1.39 | 44.9 | 1.19 | 0.87–1.63 | 50 | 1.71 | 1.17--2.49 b | 46.2 | 1.39 | 0.45–4.30 |
|
| |||||||||||||||
| Non-permanent contract | |||||||||||||||
| 30–40 h | 10.1 | 1 | 14.6 | 1 | 14 | 1 | 18.5 | 1 f | 9 | 1 | |||||
| 41–50 h | 9.7 | 1.04 | 0.81–1.34 | 13.5 | 0.89 | 0.64–1.24 | 17.7 | 1.33 | 1.03–1.73 a | 27.6 | 1.51 | 1.22–1.86 c | 12.4 | 1.22 | 0.56–2.65 |
| 51–60 h | 10.6 | 1.25 | 0.74–2.12 | 21.9 | 1.73 | 1.14–2.64 a | 14.4 | 0.98 | 0.64–1.53 | 27.3 | 1.45 | 0.93–2.27 | 14.3 | 1.89 | 0.36–9.50 |
| Low employer-funded training | |||||||||||||||
| 30–40 h | 50.3 | 1 e | 37.5 | 1 | 51.2 | 1 | 61.4 | 1 | 30.9 | 1 | |||||
| 41–50 h | 41.6 | 0.8 | 0.69–0.94 b | 33.3 | 0.79 | 0.62–1.00 | 55.7 | 1.2 | 0.98–1.46 | 58 | 0.9 | 0.76–1.09 | 30.7 | 1.26 | 0.75–2.12 |
| 51–60 h | 40.4 | 0.71 | 0.51–1.00 a | 30.2 | 0.77 | 0.54–1.11 | 54.3 | 1 | 0.73–1.37 | 53.7 | 0.92 | 0.62–1.35 | 15.4 | 0.55 | 0.13–2.43 |
|
| |||||||||||||||
| 30–40 h | 40.6 | 1 | 46.5 | 1 e | 42.9 | 1 | 46.2 | 1 | 45.2 | 1 | |||||
| 41–50 h | 42.3 | 0.99 | 0.85–1.15 | 58.3 | 1.55 | 1.22–1.95 c | 41.7 | 0.97 | 0.80–1.19 | 40.1 | 0.76 | 0.63–0.91 b | 56.2 | 1.25 | 0.77–2.02 |
| 51–60 h | 48.4 | 1.22 | 0.88–1.69 | 55.6 | 1.24 | 0.88–1.75 | 40.6 | 0.95 | 0.69–1.31 | 52.5 | 1.17 | 0.80–1.71 | 61.5 | 1.49 | 0.47–4.70 |
|
| |||||||||||||||
| Changing schedules | |||||||||||||||
| 30–40 h | 26.1 | 1 f | 21.2 | 1 f | 22.6 | 1 f | 19.1 | 1 f | 14.1 | 1 | |||||
| 41–50 h | 33.8 | 1.65 | 1.40–1.97 c | 25.9 | 1.42 | 1.06–1.82 a | 33.4 | 1.72 | 1.39–2.13 c | 25.9 | 1.41 | 1.15–1.74 b | 5.7 | 0.49 | 0.19–1.23 |
| 51–60 h | 29.8 | 1.46 | 1.02–2.08 a | 34.7 | 2.48 | 1.71–3.59 c | 45.4 | 2.79 | 2.03–3.85 c | 30 | 1.78 | 1.18–2.69 b | 15.4 | 1.91 | 0.39–9.26 |
| Work-life conflict | |||||||||||||||
| 30–40 h | 14.3 | 1 f | 12.8 | 1 f | 13.7 | 1 f | 20.6 | 1 f | 10.6 | 1 e | |||||
| 41–50 h | 31 | 3 | 2.52–3.57 c | 18.1 | 1.72 | 1.24–2.34 b | 25.5 | 2.15 | 1.69–2.74 c | 40.9 | 2.7 | 2.23–3.26 c | 15.7 | 1.74 | 0.89–3.43 |
| 51–60 h | 57.8 | 9.11 | 6.59–12.79 c | 45 | 6.75 | 4.67–9.76 c | 40.7 | 4.18 | 2.99–5.85 c | 57.9 | 5.87 | 3.99–8.64 c | 30.8 | 6.05 | 1.71–21.33 b |
Note: % refers to the prevalence of poor job quality dimensions. a p < 0.05; b p < 0.01; c p < 0.001; d Wald test with p < 0.05; e Wald test with p < 0.01; f Wald test with p < 0.001. Odds ratios are adjusted for age and occupational category.
Association of working time with poor job quality by country group among women. Adjusted odds ratios (aOR) and 95% confidence intervals (95% CI). Employees working 30–60 h a week. 5th European Working Conditions Survey, 2010.
| Continental | Anglo-Saxon | Eastern European | Southern European | Nordic | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| % | aOR | 95%CI | % | aOR | 95%CI | % | aOR | 95%CI | % | aOR | 95%CI | % | aOR | 95%CI | |
|
| |||||||||||||||
| High time pressure | |||||||||||||||
| 30–40 h | 46.5 | 1 f | 42.1 | 1 | 59.2 | 1 f | 55.9 | 1 f | 39.9 | 1 d | |||||
| 41–50 h | 32.2 | 0.52 | 0.40–0.67 c | 35.9 | 0.81 | 0.56–1.15 | 44.4 | 0.5 | 0.41–0.64 c | 49.3 | 0.76 | 0.40–0.98 a | 26.2 | 0.55 | 0.29–1.02 |
| 51–60 h | 36.1 | 0.59 | 0.29–1.20 | 25 | 0.47 | 0.18–1.22 | 44.7 | 0.52 | 0.34–0.83 b | 30.4 | 0.33 | 0.18–0.57 c | 12.5 | 0.12 | 0.01–1.34 |
| High physical demands | |||||||||||||||
| 30–40 h | 48.8 | 1 e | 55.8 | 1 | 49.7 | 1 f | 51.7 | 1 | 55.6 | 1 | |||||
| 41–50 h | 55.3 | 1.35 | 1.06–1.72 b | 53.6 | 0.93 | 0.65–1.31 | 63.6 | 1.97 | 1.55–2.50 c | 48.6 | 0.86 | 0.66–1.12 | 40.3 | 0.84 | 0.47–1.51 |
| 51–60 h | 61.1 | 1.54 | 0.76–3.15 | 45.8 | 0.76 | 0.33–1.71 | 70.6 | 2.49 | 1.52–4.09 c | 69.6 | 1.88 | 1.01–3.50 a | 25 | 0.27 | 0.05–1.57 |
| Low skill discretion | |||||||||||||||
| 30–40 h | 34.6 | 1:00 AM | 49.8 | 1 f | 41.1 | 1:00 AM | 48.7 | 1 | 46.7 | 1 | |||||
| 41–50 h | 23.8 | 0.67 | 0.51–0.89 b | 33.8 | 0.53 | 0.36–0.79 b | 43 | 1.07 | 0.86–1.37 | 55.4 | 1.33 | 1.02–1.75 a | 36.1 | 1.09 | 0.61–1.98 |
| 51–60 h | 33.3 | 1.01 | 0.41–2.08 | 16.7 | 0.25 | 0.08–0.77 a | 57 | 1.8 | 1.16–2.87 a | 38.2 | 0.51 | 0.28–0.94 a | 37.5 | 0.91 | 0.20–4.18 |
| Low autonomy | |||||||||||||||
| 30–40 h | 42.6 | 1 | 49.8 | 1 e | 48.7 | 1 e | 42.5 | 1 | 39.9 | 1 | |||||
| 41–50 h | 30.7 | 0.67 | 0.50–0.91 a | 30.7 | 0.47 | 0.33–0.69 c | 54.3 | 1.27 | 0.99–1.64 | 46 | 1.03 | 0.77–1.38 | 44.3 | 1.57 | 0.89–2.79 |
| 51–60 h | 27.6 | 0.42 | 0.17–1.05 | 43.5 | 0.86 | 0.37–2.00 | 63.5 | 1.62 | 1.10–3.02 a | 51.2 | 1.43 | 0.74–2.76 | 25 | 0.77 | 0.17–3.57 |
| Low participation | |||||||||||||||
| 30–40 h | 44.3 | 1 | 49.8 | 1 f | 46 | 1 | 49.8 | 1 | 52.8 | 1 | |||||
| 41–50 h | 38.8 | 0.87 | 0.70–1.15 | 28.1 | 0.45 | 0.28–0.64 c | 45.1 | 0.94 | 0.73–1.17 | 46.8 | 0.89 | 0.67–1.23 | 41.5 | 0.87 | 0.47–1.60 |
| 51–60 h | 36.1 | 0.6 | 0.30–1.29 | 45.8 | 1.12 | 0.48–2.48 | 62.4 | 1.87 | 1.16–3.00 a | 38.2 | 0.51 | 0.27–0.96 a | 37.5 | 0.59 | 0.12–2.84 |
| Low support | |||||||||||||||
| 30–40 h | 46.7 | 1 | 27.7 | 1 | 38.3 | 1 f | 40.3 | 1 | 32.7 | 1 | |||||
| 41–50 h | 45.4 | 0.96 | 0.75–1.23 | 20.1 | 0.72 | 0.47–1.10 | 48.1 | 1.46 | 1.17–1.82 c | 38.8 | 0.97 | 0.74–1.87 | 35.5 | 1.25 | 0.68–2.28 |
| 51–60 h | 60 | 1.55 | 0.74–3.27 | 27.3 | 1.23 | 0.48–3.13 | 52.4 | 1.74 | 1.11–2.72 a | 31.4 | 0.67 | 0.36–1.26 | 37.5 | 1.75 | 0.42–7.26 |
|
| |||||||||||||||
| Non-permanent contract | |||||||||||||||
| 30–40 h | 11.6 | 1 e | 12.5 | 1 | 16 | 1 d | 22.1 | 1 f | 10.4 | 1 | |||||
| 41–50 h | 13.4 | 1.37 | 0.96–1.95 | 14.4 | 1.29 | 0.78–2.12 | 19.3 | 1.09 | 0.81–1.45 | 35.5 | 1.57 | 1.18–2.08 c | 12.9 | 1.29 | 0.59–2.82 |
| 51–60 h | 25 | 2.16 | 0.93–5.00 | 16.7 | 1.49 | 0.49–4.53 | 29.4 | 2.05 | 1.23–3.42 b | 53.6 | 3.88 | 2.16–7.00 c | 12.5 | 2.04 | 0.39–10.81 |
| Low employer-funded training | |||||||||||||||
| 30–40 h | 46.7 | 1 | 36 | 1 | 51.1 | 1 | 64 | 1 | 29.6 | 1 | |||||
| 41–50 h | 46.9 | 1.06 | 0.83–1.35 | 28.8 | 0.8 | 0.54–1.13 | 51.8 | 1 | 0.80–1.25 | 60.1 | 0.81 | 0.62–1.06 | 25.8 | 1.08 | 0.57–2.04 |
| 51–60 h | 34.3 | 0.52 | 0.25–1.18 | 62.5 | 3.3 | 1.42–7.62 b | 64 | 1.63 | 1.03–2.59 a | 60 | 0.73 | 0.41–1.32 | 25 | 1.17 | 0.25–5.52 |
|
| |||||||||||||||
| 30–40 h | 50.3 | 1 | 40.1 | 1 | 41.1 | 1 e | 37.6 | 1 | 40.4 | 1 | |||||
| 41–50 h | 47.2 | 0.88 | 0.70–1.12 | 49 | 1.4 | 1.02–2.06 a | 35.4 | 0.8 | 0.63–1.01 | 46.3 | 1.43 | 1.10–1.85 a | 54.1 | 1.44 | 0.81–2.55 |
| 51–60 h | 44.4 | 0.85 | 0.43–1.69 | 41.7 | 1 | 0.47–2.48 | 29.4 | 0.65 | 0.40–1.05 | 35.7 | 0.96 | 0.54–1.70 | 62.5 | 2.37 | 0.55–10.22 |
|
| |||||||||||||||
| Changing schedules | |||||||||||||||
| 30–40 h | 25.5 | 1 | 14.6 | 1 f | 16.7 | 1 f | 16.2 | 1 | 15.8 | 1 | |||||
| 41–50 h | 29.4 | 1.23 | 0.95–1.59 | 26.8 | 2.43 | 1.59–3.71 c | 27.5 | 1.78 | 1.38–2.30 c | 19.4 | 1.17 | 0.84–1.63 | 9.8 | 0.65 | 0.27–1.58 |
| 51–60 h | 22.2 | 0.69 | 0.29–1.61 | 33.3 | 3.28 | 1.32–8.15 b | 23.5 | 1.47 | 0.88–2.47 | 21.4 | 1.7 | 0.88–3.29 | 12.5 | 1.04 | 0.15–6.97 |
| Work-life conflict | |||||||||||||||
| 30–40 h | 16.9 | 1 f | 8.1 | 1 f | 11.9 | 1 f | 22.2 | 1 f | 10.4 | 1 | |||||
| 41–50 h | 33.1 | 2.76 | 2.13–3.57 c | 23.4 | 3.6 | 2.28–5.71 c | 21.6 | 2.08 | 1.57–2.76 c | 33.8 | 1.98 | 1.46–2.55 c | 14.5 | 1.76 | 0.77–4.05 |
| 51–60 h | 45.7 | 4.02 | 2.02–8.08 c | 29.2 | 4.41 | 1.72–11.26 b | 48.2 | 6.98 | 4.41–11.07 c | 40 | 2.82 | 1.61–4.92 b | 25 | 4.14 | 0.86–19.95 |
Note: % refers to the prevalence of poor job quality dimensions. a p < 0.05; b p < 0.01; c p < 0.001; d Wald test with p < 0.05; e Wald test with p < 0.01; f Wald test with p < 0.001. Odds ratios are adjusted for age and occupational category.