Occupational and educational inequalities in exit from employment at older ages: evidence from seven prospective cohorts

The association of sociodemographic characteristics with work disability trajectories during and following long-term psychotherapy: a longitudinal register study

PURPOSE

This register-based study examined the trajectories of depression or anxiety disorder-related work disability during and following long-term psychotherapy and identified sociodemographic factors that indicate membership in different trajectory groups.

METHODS

Data were drawn from national registers (Statistics Finland, Social Insurance Institution of Finland). Participants included a random sample of Finnish working-age individuals (18-55 years) who started psychotherapy treatment between 2011 and 2014 and were followed for 5 years: 1 year before and 4 years after the onset of psychotherapy (N = 3 605 individuals; 18 025 person-observations across five time points). Group-based trajectory modeling was applied to assign individuals to work disability trajectories by the number of annual mental health-related work disability months. Multinomial logistic regression was used to examine the associations between trajectory group membership and baseline sociodemographic factors of age, gender, occupational status, and geographical area of residence.

RESULTS

Four mental health-related work disability trajectories were identified: stable very low (72%), decrease (11%), persistent low (9%) and persistent high (7%). Those with older age, female gender, lower occupational status, and living in sparsely populated geographical areas were more likely to belong to the most unfavorable trajectory group of persistent high work disability. The presence of multiple risk characteristics substantially increased the probability of belonging to the most adverse trajectory group.

CONCLUSIONS

Sociodemographic factors were associated with the course of mental health-related work disability in association with psychotherapy. Rehabilitative psychotherapy does not function as an equal support resource for work ability in all parts of the population.

The adequacy of workplace accommodation and the incidence of permanent employment separations after a disabling work injury or illness

OBJECTIVE

This study aimed to estimate the influence of the adequacy of employer accommodations of health impairments in predicting permanent separation from the employment relationship in a cohort of workers disabled by a work-related injury or illness.

METHODS

The study used data from a retrospective, observational cohort of 1793 Ontario workers who participated in an interviewer-administered survey 18 months following a disabling injury or illness. The relative risks (RR) of a permanent employment separation associated with inadequate employer accommodations were estimated using inverse probability of treatment weights to reduce confounding.

RESULTS

Over the 18-month follow-up, the incidence of permanent separation was 30.1/100, with 49.2% of separations related to health status. Approximately 51% of participants experiencing a separation were exposed to inadequate workplace accommodations, compared to 27% of participants in continuing employment. The propensity score adjusted RR of a health-related separation associated with inadequate accommodation was substantial [RR 2.72; 95% confidence interval (CI) 2.20-3.73], greater than the RR of separations not related to health (RR 1.68; 95% CI 1.38-2.21).

CONCLUSIONS

Incidence of permanent separation in this cohort of Ontario labor force participants was approximately two times more frequent than would be expected. The adequacy of employer accommodation was a strong determinant of the risk of permanent separation. These findings emphasize the potential for strengthened workplace accommodation practices in this setting.

Comprehensive evaluation of the impact of workplace exposures on physician-certified sick leave in the general working population

BACKGROUND

Our objective was to quantify the prospective associations between work factors across chemical, physical, mechanical, and psychosocial domains and the onset of medically certified sick leave.

METHODS

Eligible respondents were interviewed in 2009, 2013, or 2016 and were registered in the national sick leave register with an employee relationship lasting more than 50 working days during the year of the survey interviews and the following year (n = 15,294 observations). To focus on the onset of high-level sick leave (HLSL; >16 days a year), we excluded individuals with HLSL during the survey year (baseline). We then used mixed-effect logistic regression models to assess prospective associations between self-reported work conditions and the occurrence of doctor-certified HLSL in the following year.

RESULTS

The average occurrence of HLSL was 13.1%. After adjusting for sex, age, level of education, chronic health problems, and smoking, we observed an exposure-response relationship between cumulative exposure to work factors within all domains and the occurrence of HLSL. When evaluating the impact of combined exposures, predicted odds ratios (OR) for employees exposed to 1, 2, and 3 or more work factors within all domains were 1.60 (95%CI 1.32 - 1.94), 2.56 (95%CI 1.73 - 3.74) and 4.09 (95%CI 2.28 - 7.25), compared to those not exposed.

CONCLUSIONS

The results support the notion that exposure to multiple work factors in various domains, including psychosocial, mechanical, chemical, and physical work conditions, is associated with an increased risk of high-level sick leave. Employers and occupational health professionals should consider the joint impact of these domains when designing interventions.

The associations of physical incapacity and wealth with remaining in paid employment after age 60 in five middle-income and high-income countries

Previous studies on health and socioeconomic determinants of later-life labour force participation have mainly come from high-income European countries and the United States of America (USA). Findings vary between studies due to different measures of socioeconomic status and labour force outcomes. This study investigated longitudinal associations of physical incapacity and wealth with remaining in paid employment after age 60 in middle- and high-income countries. Using harmonised cohort data in the USA, England, Japan, Mexico and China (N=32,132), multilevel logistic regression was applied for main associations. The age-related probabilities of remaining in paid employment by physical incapacity and wealth were estimated using marginal effects. This study found that physical incapacity predicted lower odds of remaining in paid employment in each country. Wealth was associated with higher odds of remaining in paid employment in the USA, England, and Japan, but not in Mexico. Probabilities of remaining in paid employment were high in Mexico but low in China. The absolute difference in the probability of remaining in paid employment between the richest and the poorest groups was greater in the USA than that in any other country. In the USA, England and Japan, the inverse association between physical incapacity and remaining in paid employment could be partially compensated by wealth only when physical incapacity was not severe. National policies, including considering older adults' changing capacities for job placement and prioritising the provision of supportive services for socioeconomically disadvantaged older adults, developing pathways for informal workers to access social security and pension coverage, and encouraging employers to hire socioeconomically disadvantaged older workers and enhancing their employability, could be facilitated. Future studies, such as exploring health and socioeconomic determinants of remaining in part-time and full-time paid employment separately in more countries, and the moderating effects of relevant policies on these associations, are needed.

Do early life factors explain the educational differences in early labour market exit? A register-based cohort study

BACKGROUND

Socioeconomic inequalities in labour market participation are well established. However, we do not fully know what causes these inequalities. The present study aims to examine to what extent factors in childhood and late adolescence can explain educational differences in early labour market exit among older workers.

METHODS

All men born in 1951-1953 who underwent conscription examination for the Swedish military in 1969-1973 (n = 145 551) were followed from 50 to 64 years of age regarding early labour market exit (disability pension, long-term sickness absence, long-term unemployment and early old-age retirement with and without income). Early life factors, such as cognitive ability, stress resilience, and parental socioeconomic position, were included. Cox proportional-hazards regressions were used to estimate the association between the level of education and each early labour market exit pathway, including adjustment for early life factors.

RESULTS

The lowest educated men had a higher risk of exit through disability pension (HR: 2.72), long-term sickness absence (HR: 2.29), long-term unemployment (HR: 1.45), and early old-age retirement with (HR: 1.29) and without income (HR: 1.55) compared to the highest educated men. Factors from early life explained a large part of the educational differences in disability pension, long-term sickness absence and long-term unemployment but not for early old-age retirement. Important explanatory factors were cognitive ability and stress resilience, whilst cardiorespiratory fitness had negligible impact.

CONCLUSIONS

The association between education and early exit due to disability pension, long-term sickness absence and long-term unemployment was to a large part explained by factors from early life. However, this was not seen for early old-age retirement. These results indicate the importance of taking a life-course perspective when examining labour market participation in later working life.

The contribution of work and health-related lifestyle to educational inequalities in physical health among older workers in Germany. A causal mediation analysis with data from the lidA cohort study

OBJECTIVES

The objective of the study was to investigate the contribution of work factors and health-related lifestyle to educational inequalities in physical health among older workers in Germany by applying causal mediation analysis with longitudinal data.

METHODS

Data from the German lidA study was used. 2653 persons (53% female, 47% male) aged 46 (born 1965) and 52 (born 1959) at baseline were followed up for seven years with exposure and outcome assessments in 2011 (t0), 2014 (t1) and 2018 (t2). The total effect of education on physical health was decomposed into a natural direct effect (NDE) and a natural indirect effect (NIE) by using a sex-stratified causal mediation analysis with an inverse odds weighting approach. Baseline health, partner status and working hours were entered as a first set of mediators preceding the putative mediators of interest. All analyses were adjusted for age and migrant status.

RESULTS

Independent of the first set of mediators, work factors explained 21% of educational inequalities in physical health between low and high educated women and 0% comparing moderate versus high educated women. The addition of health behaviors explained further 26% (low vs. high education) and 20% (moderate vs. high education), respectively. Among men, net of the first set of mediators, work factors explained 5% of educational inequalities in physical health between low and high educated and 6% comparing moderate versus high educated persons. Additional 24% (low vs. high education) and 27% (moderate vs. high education) were explained by adding health behaviors to the models.

CONCLUSIONS

To reduce educational inequalities in physical health among older workers in Germany, interventions to promote healthy behaviors are promising. Improving working conditions is likely an important prerequisite.

Does providing informal care in young adulthood impact educational attainment and employment in the UK?

Most research on the effects of caring has focused on older spouses or working-age carers providing care for older people, but providing care in early adulthood may have longer-term consequences, given the importance of this life stage for educational and employment transitions. This study aims to investigate the impact of informal care in early adulthood on educational attainment and employment in the UK and to test whether these associations differ by gender or socio-economic circumstances. Data are from young adults (age 16-29 at first interview, n = 27,209) in the UK Household Longitudinal Study wave 1 (2009/11) to wave 10 (2018/2020). Carers are those who provide informal care either inside or outside the household. We also considered six additional aspects of caring, including weekly hours spent caring, number of people cared for, relationship to care recipient, place of care, age at which caring is first observed, and duration of care. Cox regression was used to analyse the association between caring and educational qualifications and employment transitions. We found that young adult carers were less likely to obtain a university degree and enter employment compared to young adults who did not provide care. In terms of care characteristics, weekly hours spent caring were negatively associated with the likelihood of obtaining a university degree qualification and being employed. Providing care after full-time education age negatively influenced employment entry, but having a university degree buffered the negative influence of providing care on entering employment. The influence on unemployment may be stronger for female carers than for male carers. Our results highlight the importance of supporting the needs of young adults who are providing informal care while making key life course transitions.

Health check-ups as interventions for work disability management: supervisors and occupational healthcare follow the recommendations to a great extent

OBJECTIVES

Work disability management is a problem globally. This study was designed to find out whether the initiation, process and outcome of health check-ups (HCUs) follow the national legislation and whether supervisors and occupational healthcare (OHC) units act according to the legislation-based recommendations.

METHODS

Data of 1092 employees with reduced work ability were collected during 2013-2018 in 15 OHC units across Finland. Nine reasons for HCUs, eight process activities and three recommendations were analysed. Cross-tabulation and multinomial logistic regression analysis were used in the analyses.

RESULTS

Employees themselves initiated an HCU for early support more often (OR with 95% CI 2.37; 1.04 to 5.40) compared with supervisors. Personnel in OHC units initiated an HCU in musculoskeletal disorders more often (OR 1.58; 95% CI 1.05 to 2.37) and in mental disorders less often (OR 0.52; 95% CI 0.35 to 0.76) compared with supervisors. These findings were reflected in the recommendations after the HCU, where rehabilitation was recommended for employees with musculoskeletal disorders more often than for employees with mental disorders (ORs 5.48; 95% CI 1.91 to 15.67 and 1.59; 95% CI 0.74 to 3.43, respectively).

CONCLUSION

Supervisors and OHC units followed the recommendations for management of work disability to a great extent. Employees were active in looking for help early when they had problems with work ability. This positive finding should be promoted even more. OHC units did not initiate HCUs or recommend rehabilitation in mental disorders as actively as they did in musculoskeletal disorders. Support of employees with mental disorders should be improved and studied more. Registration of the study The study protocol was approved and registered on 22 September 2017 by the Doctoral Program of Health Sciences, Faculty of Medicine, University of Eastern Finland, registration no. 189067.

Adverse social behaviour at work and health-related employment exit: a prospective population-based four-wave survey

BACKGROUND

The level of evidence for various aspects of adverse social behaviour (ASB) at work as risk factors for exit from employment due to health problems or diseases is inconclusive.

METHODS

We obtained data from four consecutive surveys (2006/09/13/16) of the general population of Norway. Respondents who were interviewed in two consecutive surveys and employed at the first survey time point constituted the sample (n = 17 110 observations). We investigated associations of self-reported exposure to ASB (i.e. experiencing sexual harassment, bullying or violence/threats in the first survey) and health-related employment exit (i.e. individuals reporting exit from employment due to health problems or disease between two consecutive surveys) by means of mixed-effect logistic regression.

RESULTS

The prevalence of ASB and health-related employment exit was 10.8% (n = 1853) and 2.6% (n = 440), respectively. Adjusted for age, sex, level of education, occupation and weekly work hours, sexual harassment, bullying and violence/threats were associated with an increased risk of exit from employment. The odds ratios (ORs) for the association between exposure to any of the three aspects of ASB and employment exit was 1.78 [95% confidence interval (CI) 1.33-2.38]; the estimated corresponding population attributable risk was PAR% = 7.32 [95% CI 2.67-12.27]. Further adjustment of mental distress attenuated the observed association between exposure to any ASB and exit from employment (OR = 1.45 [95% CI 1.07-1.95], i.e. a reduction of 42% in the OR).

CONCLUSIONS

ASB at work increases the risk of health-related exit from employment in the Norwegian workforce.

Informal sector employment and the health outcomes of older workers in India

A large proportion of the older population in India constitutes an undeniable share of workforce after the retirement age. This stresses the need to understand the implications of working at older ages on health outcomes. The main objective of this study is to examine the variations in health outcomes by formal/informal sector of employment of older workers using the first wave of the Longitudinal Ageing Study in India. Using binary logistic regression models, the results of this study affirm that type of work does play a significant role in determining health outcomes even after controlling socio-economic, demographic, life-style behaviour, childhood health and work characteristics. The risk of Poor Cognitive Functioning (PCF) is high among informal workers, while formal workers suffer greatly from Chronic Health Conditions (CHC) and Functional Limitations (FL). Moreover, the risk of PCF and/or FL among formal workers increases with the increase in risk of CHC. Therefore, the present research study underscores the relevance of policies focusing on providing health and healthcare benefits by respective economic activity and socio-economic position of older workers.

Employment Characteristics and Risk of Hospitalization Among Older Adults Participating in the Mayo Clinic Biobank

Objective

To determine the relationship between characteristics of employment and future hospitalization in older adults.

Patients and Methods

We conducted a survey of adults aged 65 years or older participating in the Mayo Clinic Biobank. Using a frequency-matched, case-control design, we compared patients who were hospitalized within 5 years of biobank enrollment (cases) with those who were not hospitalized (controls). We assessed the duration of work, age at first job, number of jobs, disability, retirement, and reasons for leaving work. We performed logistic regression analysis to assess the association of these factors with hospitalization, accounting for age, sex, comorbid conditions, and education level.

Results

Among 3536 participants (1600 cases and 1936 controls; median age, 68.5 years; interquartile range, 63.4-73.9 years), cases were older, more likely to be male, and had lower education levels. Comorbid illnesses had the largest association with hospitalization (odds ratio [OR], 4.09; 95% CI, 3.37-4.97 [highest vs lowest quartile]). On adjusted analyses, odds of hospitalization increased with the presence of disability (OR, 1.31; 95% CI, 1.01-1.69) and decreased with having 1 or 2 lifetime jobs vs no employment (OR, 0.77; 95% CI, 0.60-1.00). The length of work, furlough, age of retirement, childcare issues, and reasons for leaving a job were not associated with hospitalization.

Conclusion

This study reports an association between disability during work and hospitalization. On the basis of our findings, it may be important to obtain a more detailed work history from patients because it may provide further insight into their future health.

Educational inequalities in employment of Finns aged 60-68 in 2006-2018

The aim of this study was to explore the employment of 60-68-year-old men and women by educational level over the period 2006-2018 and the magnitude of educational inequalities in employment. We used individual-level register data from Statistics Finland including all Finns aged 60-68 over a period of 13 years. In addition to calculating employment rates for men and women by educational levels, we estimated the relative index of inequality (RII) and slope index of inequality (SII) to measure the magnitude of relative and absolute educational inequalities in employment. The results show that the employment rates increased in all educational levels over the period 2006-2018. Relative educational inequalities in employment remained stable mainly among the 63-65-year-olds but decreased among the 60-62-year-olds and the 66-68-year-olds. However, absolute educational inequalities in employment increased in all age groups for both men and women.

Social inequalities in early exit from employment in Germany: a causal mediation analysis on the role of work, health, and work ability

OBJECTIVE

The aim of this study was to investigate the contribution of work factors, health, and work ability to social inequalities in early exit from employment among older employees in Germany.

METHODS

Longitudinal data from the representative German lidA Cohort study was linked with employment register data to obtain maximum information on exit routes out of paid employment. Information of N=2438 respondents, aged 46 and 52 at baseline, were obtained for a follow-up of six years (2011-2017). Causal mediation analysis with inverse odds weighting was conducted using discrete-time survival outcomes and baseline measurements of the socioeconomic status (SES: education), work factors, health, and work ability.

RESULTS

Older employees with low SES were at an increased risk of exiting employment early by receiving disability pension and through long-term unemployment but not through an unspecified labor market exit when compared to those with high and moderate SES. Low work ability accounted for up to 38% of the social inequalities in work exits into disability pension. Less-than-good physical health accounted for up to 59% of inequalities in work exits into long-term unemployment. Work factors contributed considerably to inequalities in exits through unemployment but not disability pension.

CONCLUSIONS

This study finds social inequalities in early exits through disability pension and long-term unemployment among older employees in Germany, predominantly attributable to differences in work ability (disability pension) and physical health (unemployment). Investments in work ability and promotion of physical health may constitute promising approaches to counteract an increase of these inequalities.

The Implication of Physically Demanding and Hazardous Work on Retirement Timing

The need to retain individuals longer in the workforce is acknowledged in many high-income countries. The present study therefore aimed to examine the importance of physically demanding work tasks (PDWT) and physically hazardous work environment (PHWE) in relation to retirement timing among pensionable workers (≥61 years). A particular question was whether PDWT and PHWE increased in importance with age. Six waves (2008–2018) of the Swedish Longitudinal Occupational Survey of Health (SLOSH) were used (n = 5201; 56% women and 44% men; mean age at first survey was 61.0 (SD 2.0) years). Discrete time-event history analysis, stratified by socioeconomic position and gender, showed that among blue-collar workers, PDWT and PHWE were associated with an increased likelihood of retiring within the next two years. With increasing age, high-level PHWE was associated with higher probability of retiring among blue-collar men, whereas heavy PDWT was associated with lower probability of retiring among blue-collar women. Among white-collar workers, having at least some PDWT compared to no PDWT was associated with a lower likelihood of retiring within the next two years. With increasing age, exposure to PHWE was associated with higher probability of retiring among white-collar women. These results suggest that to delay retirements, organizations could offer their older employees, especially blue-collar workers and the oldest white-collar women, alternatives to PDWT and PHWE.

Epidemiologic evaluation of clinical outcomes in ethnic minorities with myelodysplastic syndromes

Since race/ethnicity and socioeconomic status (SES), including economic and educational disadvantage (EED), may impact overall survival (OS) in primary myelodysplastic syndromes (MDS), we analyzed the impact of these characteristics on OS in Non-Hispanic White (NHW), Non-Hispanic Black (NHB) and Hispanic patients. In this retrospective review using the SEER US population and American Community Survey data between 2001 and 2016, factor analysis was used for 23 county-level SES indicators to identify groups of interrelated measures of EED. For the 52,739 patients identified, increased age at diagnosis, male sex, higher prognostic risk category and higher EED were all associated with reduced OS. The most prominent SES factor extracted by factor analysis was EED. NHB patients had the highest OS compared to NHW and Hispanics. For all patients, EED analysis showed lower OS for most compared to least disadvantaged, most notably in lower-risk disease and Hispanics. More NHB and Hispanics (51% and 49%) were in the most disadvantaged category compared with NHW (30%). No significant differences were noted for causes of death by race/ethnicity. In conclusion, these data indicate that in addition to standard clinical measures for analyzing OS, race/ethnicity, SES and EED are critical determinants for assessing clinical outcomes in MDS patients.

Educational qualification differences and early labor market exit among men: the contribution of labor market marginalization measured across the working life

BACKGROUND

The present study aims to investigate the association between educational qualification and early labor market exit among men and to examine the contribution of labor market marginalization measured across the working life on this association.

METHOD

A register-linked cohort study was conducted including men who completed military service in 1969/70 (born between 1949 and 1951) and were alive at age 55 and not disability pension beneficiaries (n = 40 761). Information on the highest level of educational qualification and the outcome of early exit (disability pension, sickness absence, unemployment, and early old-age pension) was obtained from Swedish nationwide registers between the ages of 55 and 64 years. Labor market marginalization was defined as periods of long-term unemployment and sickness absence over the working life and up to follow-up. Cox regression analyses were used to obtain hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

Low-educated men were more likely to leave the labor force early due to disability pension or sickness absence (HR: 2.48), unemployment (HR: 2.09), and early old-age pension with- (HR:1.25) and without -income (HR: 1.58). Labor market marginalization across the working life explained a large part of the association for the more involuntary early exit routes (disability pensions, sickness absence, unemployment) and explained very little with regards to the more voluntary early exit routes (early old-age pension with and without income).

CONCLUSION

Exposure to labor market marginalization across the working life was important in explaining educational differences in early labor market exit due to disability pension or sickness absence and unemployment. This study underscores the importance of identifying and implementing preventive measures in the workplace (e.g. adaptions) to prevent new spells of sickness absence and unemployment, especially among low educated individuals.

The differentiated roles of health in the transition from work to retirement - conceptual and methodological challenges and avenues for future research

OBJECTIVES

The aim of this discussion paper is to (i) identify the differentiated roles of health in the work-retirement transition, and, with respect to these, (ii) highlight topics related to conceptual and methodological problems and challenges in research, and (iii) present avenues for future research.

METHODS

This discussion paper summarizes an OMEGA-NET working group discussion ongoing from November 2018 to September 2021 with face-to-face and online meetings as well as a written online discourse.

RESULTS

'Health' and 'retirement' are ambiguous concepts. With respect to both, in retirement research, the choice of concept and indicator influences the findings. In addition, the impact of health on retirement is not necessarily a direct one, but can be influenced by further factors such as the ability, motivation and opportunity to work. The strong overall association of poor health with retiring early (path 1) bears the risk of masking distinct and deviating mechanisms in subgroups. In fact, there is evidence that also good health may lead to early retirement (path 2), while both poor health (path 3) and good health (path 4) may also make people retire later.

CONCLUSIONS

An increased awareness of the differentiated roles that health may have in the work-retirement transition as outlined in this discussion paper may support research to address questions relevant for policy and practice and increase the impact of research. Recommendations for occupational health and social research are given.

Changes in labour market histories and their relationship with paid work around state pension age: evidence from three British longitudinal studies

Many countries have implemented policies to extend working lives in response to population ageing, yet there remains little understanding of what drives paid work in later life, nor how this is changing over time. This paper utilises the 1988/89 Survey of Retirement and Retirement Plans, the 1999 British Household Panel Survey and the 2008 English Longitudinal Study of Ageing, to investigate drivers of paid work in the ten years surrounding state pension age (SPA) for women and men in, comparing cohorts born in the 1920s, 1930s and 1940s. Using optimal matching analysis with logistic and multinomial regression models, the study assesses the relative importance of lifecourse histories, socio-economic circumstances and contemporaneous factors, in determining paid work in mid- and later life. Participation in paid work in the five years preceding and beyond SPA increased markedly for men and women across cohorts, with women's lifecourses and engagement with paid work changing considerably in these periods. However, for women, a lifetime history of paid work remained a crucially important predictor of paid work in later life, and this relationship has strengthened over time. Experiencing divorce has also become an important driver of paid work around SPA for the youngest cohort. Having children later, and still having a mortgage, also independently predict labour force participation for women and men. Across all cohorts and for women and men, working at these older ages was a function of higher income and better health. These findings suggest that policies which enable people to maintain ties to paid work across the lifecourse may be more effective at encouraging later-life employment than those concerned only with postponing the retirement transition.

Do good psychosocial working conditions prolong working lives? Findings from a prospective study in Sweden

Due to an ageing population, governments in European countries are striving to keep older workers longer in the workforce. Remarkably few studies have paid attention to the influence of psychosocial working conditions on timing of retirement for older workers in and beyond normative retirement age. The aim of the present study was to examine whether good psychosocial working conditions contribute to prolonged working lives among older workers (59 years and above). A particular question was whether such conditions increase in importance with age. Seven waves (2006–2018) of the Swedish Longitudinal Occupational Survey of Health (SLOSH) were used (N = 6000, observations = 10,632). Discrete-time event history analyses showed that higher levels of job resources (decision authority [OR 1.13, 95% CI 1.06–1.22], skill use [OR 1.17, 95% CI 1.07–1.29], learning opportunities [OR 1.22, 95% CI 1.13–1.31], social support [OR 1.29 (95% CI 1.16–1.42], work-time control [OR 1.07, 95% CI 1.01–1.13], and reward [OR 1.40, 95% CI 1.24–1.57])—but not lower levels of job demands (quantitative and emotional demands or effort)—were associated with working longer (continued work two years later). Also, low effort-reward imbalance (OR 0.84 [95% CI 0.73–0.96]) was associated with working longer. In addition, skill use, work-time control, reward, and low effort-reward imbalance increased in importance with age for continued work. These results suggest that providing older workers with control over their work tasks, giving opportunities for learning and using their skills, as well as rewarding and acknowledging their achievements, may keep them in the workforce longer. Especially, job resources may grow in importance with age.

Educational Inequalities in Ill-Health Retirement Among Middle- and Older-Aged Workers in Korea: The Korean Longitudinal Study of Aging (2006-2016)

OBJECTIVES

To identify differences in risk of ill-health retirement (IHR) between groups with different levels of education and examine this difference with respect to working conditions and health-related factors.

METHODS

This study analysed the longitudinal data of 1691 paid workers aged 45 to 79 years from the Korean Longitudinal Study of Aging. Multivariate Cox regression analyses were conducted to identify the predictors and build a prediction model for IHR according to different final education levels.

RESULTS

Over the 10-year follow-up, 208 workers exited work because of poor health. Clear educational inequalities in reason of retirement and increased risk of IHR in low, intermediate, and high educational groups were observed.

CONCLUSIONS

Our results suggest an educational gradient for IHR among Korean male workers and revealed gender differences in the risk of IHR.

Indicators and determinants of the years of working life lost: a narrative review

Objective:

This narrative review summarizes the available indicators for working life expectancy and years of working life lost (YWLL) and their determinants.

Methods:

We searched PubMed and Embase databases from their inception until August 2020 and screened all studies proposing an indicator for working life expectancy or YWLL. We also reviewed studies focusing on sociodemographic, lifestyle and work-related determinants of working life expectancy and YWLL. The results were synthesized narratively.

Results:

We identified 13 different indicators for the length of working life or YWLL. The most frequently used indicators were ‘working life expectancy’, ‘healthy working life expectancy’, and YWLL. Working life expectancy and healthy working life expectancy are longer for men than women. Working life expectancy at the age of 50 has been increasing since the mid-90s, and the increase has been larger for women, reducing the sex difference. Working life is shorter for people with a low level of education, in lower occupational classes, for people exposed to high physical work demands, those living in the most socioeconomically deprived areas, people with overweight or obesity, smokers, people who are inactive during leisure time and in people with a chronic health problem.

Conclusions:

Despite increasing interest in understanding the determinants of YWLL, only a few studies have simultaneously considered multiple exit routes from the labour market. We propose a new measure for total YWLL considering all relevant exit routes from employment. This comprehensive measure can be used to assess the effect of given policy changes on prolonging working life.

Does Work Disability Contribute to Trajectories of Work Participation before and after Vocational Labour Market Training for Job Seekers?

The contribution of ill-health to labour market participation in relation to vocational training is unclear. Using nationally representative Finnish register data on 42,691 vocational labour market trainees in 2008-2010, we constructed latent trajectory groups of work participation in the open labour market three years before and after training, identifying groups called "High-High", "High-Low", "Low-High", and "Low-Low". We plotted further patterns of labour market participation within these trajectory groups and, using multinomial logistic regression, examined assignment to these groups focusing on previous work disability status. Those with compared to those without previous work disability had previous employment more often and spent less time in economic inactivity within the two trajectory groups with low pre-training levels of work participation. Having a previous work disability was associated with assignment to the "High-Low" trajectory group of work participation instead of the "High-High" comparison group. The associations of other background factors with the assignment to the different trajectory groups were relatively similar amongst those with and without previous work disability. However, some of these associations were weaker amongst the former. Along with other key background factors, previous work disability should be accounted for when assessing the effects of vocational training.

Girls' transition to adulthood and their later life socioeconomic attainment: Findings from the English longitudinal study of ageing

Transitions to adulthood represent a sensitive period for setting young people into particular life course trajectories, and the nature of these transitions have varied more for girls, historically, than for boys. We aim to investigate the long-term significance of different transitions out of full-time education for socioeconomic attainment in later life amongst postwar young women in England. Our data are from the English Longitudinal Study of Ageing for girls born during World War II and the post-war period (1939-1952, n = 1798). Using sequence analysis, we identified six types of transition out of full-time education between ages 14 and 26: Early-Work, Mid-Work, Late-Work, Early-Domestic, Late-Domestic, and Part-time Mixed. We used linear and multinomial regression models to examine associations between transition types and socioeconomic attainment outcomes from age 50, including individual income, household income and wealth, and occupational class. Our study found that later transitions into employment (Mid-Work and Late-Work) were associated with higher socioeconomic attainment after age 50 compared with women who made early transitions from education to employment (Early-Work); much of the advantage of making later transitions to employment was due to higher educational attainment. We also found that early transitions to domestic work (Early-Domestic) set young women onto trajectories of lower socioeconomic attainment than compared with those who made early transitions to employment, suggesting the nature of the transition from full-time education is as important as the timing, perhaps uniquely for women. A pathway of cumulative advantage/disadvantage is also evident in our study; results suggest a partial mediating role for educational attainment in associations between childhood social class and later life socioeconomic attainment.

Educational differences in labor market marginalization among mature-aged working men: the contribution of early health behaviors, previous employment histories, and poor mental health

BACKGROUND

Social inequalities in labor force participation are well established, but the causes of these inequalities are not fully understood. The present study aims to investigate the association between educational qualification and labor market marginalization (LMM) among mature-aged working men and to examine to what extent the association can be explained by risk factors over the life course.

METHOD

The study was based on a cohort of men born between 1949 and 1951 who were examined for Swedish military service in 1969/70 and employed in 2000 (n = 41,685). Data on educational qualification was obtained in 2000 and information on the outcome of LMM (unemployment, sickness absence, and disability pension) was obtained between 2001 and 2008. Information on early health behaviors, cognitive ability, previous employment histories, and mental health was collected from conscription examinations and nationwide registers.

RESULTS

Evidence of a graded association between years of education and LMM was found. In the crude model, compared to men with the highest level of education men with less than 12 years of schooling had more than a 2.5-fold increased risk of health-related LMM and more than a 1.5-fold increased risk of non-health-related LMM. Risk factors measured across the life course explained a large part of the association between education and health-related LMM (33-61%) and non-health-related LMM (13-58%).

CONCLUSIONS

Educational differences remained regarding LMM among mature-aged workers, even after considering several important risk factors measured across the life course. Previous health problems and disrupted employment histories explained the largest part of the associations.

Work participation and risk factors for health-related job loss among older workers in the Health and Employment after Fifty (HEAF) study: Evidence from a 2-year follow-up period

INTRODUCTION

Rapidly increasing population old age dependency ratios create a growing economic imperative for people to work to older ages. However, rates of older worker employment are only increasing slowly. Amongst a cohort of contemporary older workers, we investigated risk factors for health-related job loss (HRJL) over 2 years of follow-up.

METHODS

HEAF is a population based cohort study of adults in England (aged 50-64 years at baseline) who provided information about socio-demographic characteristics, lifestyle, and work at baseline and annual follow-ups. Exits from paid work were mapped and risk factors for HRJL explored in a multiple-record survival dataset by Cox proportional hazards models.

RESULTS

2475 (75%) men and 2668 (66%) women were employed; 115 (4.6%) men and 182 (6.8%) women reported HRJL. Employment as road transport drivers/in vehicle trades (men), or as teaching/education/nursing/midwifery professionals or in caring personal services (women), was more frequent among people exiting work for health-related versus non-health-related reasons. Principal socio-demographic and lifestyle risk factors for HRJL were: struggling financially (men and women); low physical activity (men); being overweight or obese, and current smoking (women). Mutually adjusted work-related risk factors for HRJL were job dissatisfaction, and not coping with the physical (hazard ratio [95% confidence interval]: men 5.34[3.40,8.39]; women 3.73[2.48,5.60]) or mental demands (women only, 2.02[1.38,2.96]) of work.

CONCLUSIONS

Employment characteristics of contemporary older workers differ by sex. Job satisfaction and perceived ability to cope with the physical and mental demands of work are key determinants of HRJL which employers could potentially influence to enable work to older ages.

The influence of occupational class and physical workload on working life expectancy among older employees

Objective:

This study investigates the impact of physical workload factors and occupational class on working life expectancy (WLE) and working years lost (WYL) in a sample of older Finnish workers.

Methods:

A 70% random sample of Finns in 2004 was linked to a job exposure matrix for physical workload factors and register information on occupational class and labor market status until 2014. Transitions between being at work, time-restricted work disability, unemployment, economic inactivity, disability retirement, retirement and death were estimated. A multistate Cox regression model with transition-specific covariates was used to estimate the WLE and WYL at age 50 up to 63 years for each occupational class and physical workload factor for men and women (N=415 105).

Results:

At age 50, male and female manual workers had a WLE of 10.13 and 10.14 years, respectively. Among both genders, manual workers had one year shorter WLE at age 50 than upper non-manual employees. This difference was largely attributable to unemployment (men: 0.60, women: 0.66 years) and disability retirement (men: 0.28, women: 0.29 years). Self-employed persons had the highest WLE (11.08 years). Men and women exposed to four or five physical workload factors had about one year lower WLE than non-exposed workers. The difference was primarily attributable to ill-health-related reasons, including disability retirement (men: 0.45 years, women: 0.53 years) and time-restricted work disability (men: 0.23, women: 0.33 years).

Conclusions:

Manual workers and those exposed to physical workload factors had the lowest WLE. The differences in WYL between exposure groups can primarily be explained by ill-health-based exit routes.

Inequalities in extending working lives beyond age 60 in Canada, Denmark, Sweden and England-By gender, level of education and health

Background

Keeping older workers in employment is critical for societies facing the challenge of an ageing population. This study examined the association between types of health conditions and differentials in the probability of employment by level of education among men and women between 60–69 years of age in Canada, Denmark, Sweden and England.

Methods

Data were drawn from the Canadian Community Health Survey, Survey of Health, Ageing and Retirement in Europe and English Longitudinal Study of Ageing. We combined country data, applied logistic regression, adjusted for educational level, and stratified the analysis by sex to calculate the odds ratio (OR) of employment (>15 hours work per week) for persons with physical health conditions, mental health conditions (depression) and physical-mental health comorbidity.

Results

The odds of employment among men and women with physical-mental health comorbidity were lower compared to those with no/other conditions (men: OR 0.32, 95% CI: 0.25–0.42, women: OR 0.38 95% CI: 0.30–0.48). Women with low education had lower odds of employment compared to their counterparts with high education (OR 0.66, 95% CI: 0.57–0.76). The odds of employment at older ages was lower in Canada, Denmark and England compared with Sweden (e.g. English men: OR 0.48 95% CI 0.40–0.58; English women OR 0.33 95% CI 0.27–0.41).

Conclusions

The odds of employment beyond age 60 is lower for groups with low education, particularly women, and those with physical-mental health co-morbidities. As such, policies to extend working lives should not be ‘one size fits all’ but instead consider subgroups, in particular, these groups that we have shown to be most vulnerable on the labour market.

Does reduced employment protection increase the employment disadvantage of workers with low education and poorer health?

BACKGROUND

Declines in employment protection may have disproportionate effects on employment opportunities of workers with low education and poorer health. This study investigates the impact of changes in employment protection levels on employment rates according to education and health in 23 European countries.

METHODS

Data were taken from the 4-year rotating panel European Union Statistics on Income and Living Conditions study. Employed participants aged 29-59 years (n = 334 999) were followed for 1 year over an 11-year period, from 2003 up to 2014. A logistic regression model with country and period fixed effects was used to estimate the association between changes in the Organisation for Economic Co-operation and Development (OECD) employment protection index and labour market outcomes, incorporating interaction terms with education and health.

RESULTS

15 of the 23 countries saw their level of employment protection decline between 2003 and 2014. Reduced employment protection of temporary workers increased odds of early retirement (OR 6.29, 95% CI 3.17 to 12.48) and unemployment (OR 1.37, 95% CI 1.07 to 1.76). Reduced employment protection of permanent workers increased odds of early retirement more among workers in poor health (OR 4.46, 95% CI 2.26 to 8.78) than among workers in good health (OR 2.58, 95% CI 1.30 to 5.10). The impact of reduced employment protection of temporary workers on unemployment was stronger among lower-educated workers (OR 1.47, 95% CI 1.13 to 1.90) than among higher-educated workers (OR 1.21, 95% CI 0.95 to 1.54).

CONCLUSION

Reduced employment protection increased the odds of early exit from paid employment, especially among workers with lower education and poorer health. Employment protection laws may help reduce the employment disadvantage of workers with low education and poorer health.

Interventions across the Retirement Transition for Improving Well-Being: A Scoping Review

(1) Background: The work-to-retirement transition involves a process of psychologically and behaviorally distancing oneself from the workforce that is often accompanied by other social changes, which can influence health and well-being. However, research on interventions targeting the work-to-retirement transition to improve health status is limited. Our objective was to summarize and describe interventions aiming to improve well-being across the retirement transition; (2) Methods: We conducted a scoping review following the methodological framework described by Arksey and O'Malley; the Joanna Briggs Institute guidelines as well as the PRISMA-ScR statements; we systematically searched articles and gray literature to identify interventions and policies that aimed to improve well-being across the retirement transition. (3) Results: 15 publications were included, which comprised both experimental designs (n = 10) and systematic reviews (n = 5). (4) Conclusions: More research on how to promote overall well-being during the work-to-retirement transition is needed. The results of this scoping review show that most reported interventions address one single lifestyle behavior, and that relevant social determinants of health have been barely considered in their design. Future investigations need to consider vulnerable groups and country-specific structural conditions. Adopting a patient and public involvement approach will contribute to developing interventions that address the significant needs of those in the transition to retirement.

Social inequalities in medical rehabilitation outcomes-a registry-based study on 219 584 insured persons in Germany

BACKGROUND

Given limited knowledge on the extent of social inequalities in longer-term work ability of people with a chronic disease, this study analyzes social inequalities of three consecutive indicators of work ability following medical rehabilitation in a large sample of insured employees.

METHODS

Based on data from the German statutory pension insurance, a representative 20% random sample of all employed persons undergoing medical rehabilitation between 2006 and 2008 was included in a longitudinal analysis (n=219 584 persons). Three measures of consecutive work-related outcomes (physicians' assessment of work ability at discharge; return to work in the year thereafter; disability pension during follow-up) and socioeconomic position (SEP) (education, occupational position and income) were assessed. Adjusted relative risks (RRs) for each outcome were calculated according to SEP, applying Poisson regression analysis.

RESULTS

The measures of SEP were associated with all three outcomes of work ability in the fully adjusted models. Relatively strongest relationships were observed for education as SEP measure, and they were particularly pronounced for 'low work ability' (RR=2.38 for lower secondary education compared to tertiary education; 95% CI: 2.26-2.51). Based on average marginal effects, absolute differences of work ability by SEP indicate a socially graded pattern, with only few exceptions.

CONCLUSIONS

Despite Germany's universal access to medical and vocational rehabilitation social inequalities in longer-term work ability following chronic disease persist, thus calling for targeted programmes of prevention and occupational health promotion.

Educational differences in the influence of health on early work exit among older workers

Objectives

Previous research has shown that poor physical and mental health are important risk factors for early work exit. We examined potential differences in this association in older workers (50+) across educational levels.

Methods

Coordinated analyses were carried out in longitudinal data sets from four European countries: the Netherlands (Longitudinal Aging Study Amsterdam), Denmark (Danish Longitudinal Study of Ageing), England (English Longitudinal Study of Ageing) and Germany (German Ageing Survey). The effect of poor self-rated health (SRH), functional limitations and depression on different types of early work exit (early retirement, economic inactivity, disability and unemployment) was examined using Cox regression analysis. We examined educational differences in these effects by testing interaction terms.

Results

Poor physical and mental health were more common among the lower educated. Poor SRH, functional limitations, and depression were all associated with a higher risk of early work exit. These health effects were strongest for the disability exit routes (poor SRH: HRs 5.77 to 8.14; functional limitations: HRs 6.65 to 10.42; depression: HRs 3.30 to 5.56). In the Netherlands (functional limitations) and England (functional limitations and SRH), effects were stronger in the lower educated.

Conclusions

The prevalence of health problems, that is, poor SRH, functional limitations and depression, was higher in the lower educated workers. All three health indicators increase the risk of early work exit. In some countries, health effects on early exit were stronger in the lower educated. Thus, lower educated older workers are an important target group for health policy and intervention.

Considerations for physical employment standards in the aging workforce

BACKGROUND

If current population and health trends continue, workplace demographics will look significantly different by the turn of the century. Organizations will no longer have a steady pipeline of younger workers and will likely need to rely on older workers to remain competitive in the global marketplace. The future multi-generational workforce will bring with it the challenge of maximizing contributions from each generation whilst at the same time addressing the health, safety and wellbeing needs of all workers.

OBJECTIVE

This review provides an insight into aging and older workers, and presents recommendations to promote worker longevity.

METHODS

This narrative review draws on evidence from 108 published sources.

RESULTS

The relationship between age and work is not simple; factors including the physical nature of the job and worker's health and fitness interact with age to either increase or decrease the potential effect of age. Evidence suggests that the issues arising from an aging workforce can be managed through polices that focus on active aging through: attitude management; flexible working and the provision of occupational health.

CONCLUSION

The integration of such interventions would require company and organizational commitment from the top down with educational programs at all levels to ensure understanding and participation.

Self-reported health problems in a health risk appraisal predict permanent work disability: a prospective cohort study of 22,023 employees from different sectors in Finland with up to 6-year follow-up

Purpose

Work disability (WD) as a medico-legal concept refers to disability benefits (DB) that are granted due to diseases that permanently reduce work ability. We studied whether an occupational healthcare instrument for the prediction of sickness absence (SA) risk—a health risk appraisal (HRA)—also predicts permanent WD.

Methods

HRA results were combined with registry data on DB of 22,023 employees from different industry sectors. We analysed how the HRA risk categories predict DB and considered occupational group, gender, age, and prior SA as confounding variables. Cumulative incidence function illustrates the difference between the HRA risk categories, and the Fine–Gray model estimates the predictors of WD during 6-year follow-up.

Results

The most common primary reasons for permanent WD were musculoskeletal (39%) and mental disorders (21%). Self-reported health problems in the HRA, labelled as “WD risk factors”, predicted DB when controlling for age and prior SA. Hazard ratios were 10.9 or over with the lower limit of the 95% confidence interval 3.3 or over among those with two simultaneous WD risk factors. 14% of the females and 17% of the males with three or more simultaneous WD risk factors had received a DB, whereas the respective figures among those without findings were 1.9% and 0.3%.

Conclusions

Self-reported health problems in the HRA, especially multiple simultaneous WD risk factors, predict permanent WD among both genders across occupational groups. Screening WD risk with a self-administered questionnaire is a potential means for identifying high-risk employees for targeting occupational healthcare actions.

Inequalities in time from stopping paid work to death: findings from the ONS Longitudinal Study, 2001-2011

BACKGROUND

UK state pension eligibility ages are linked to average life expectancy, which ignores wide socioeconomic disparities in both healthy and overall life expectancy.

OBJECTIVES

Investigate whether there are occupational social class differences in the amount of time older adults live after they stop work, and how much of these differences are due to health.

METHODS

Participants were 76 485 members of the Office for National Statistics Longitudinal Study (LS), who were 50-75 years at the 2001 census and had stopped work by the 2011 census. Over 10 years of follow-up, we used censored linear regression to estimate mean differences in years between stopping work and death by occupational social class.

RESULTS

After adjustment for age, both social class and health were independent predictors of postwork duration (mean difference (95% CI): unskilled class vs professional: 2.7 years (2.4 to 3.1); not good vs good health: 2.4 years (1.9 to 2.9)), with LS members in the three manual classes experiencing ~1 additional year of postwork duration than professional workers (interaction p values all <0.001). Further adjustment for gender and educational qualifications was reduced but did not eliminate social class and postwork duration associations. We estimate the difference in postwork years between professional classes in good health and unskilled workers not in good health as 5.1 years for women (21.0 vs 26.1) and 5.5 years for men (19.5 vs 25.0).

CONCLUSIONS

Lower social class groups are negatively affected by uniform state pension ages, because they are more likely to stop work at younger ages due to health reasons.

Educational inequalities in the impact of chronic diseases on exit from paid employment among older workers: a 7-year prospective study in the Netherlands

OBJECTIVES

The study aimed to investigate the relative and absolute risks of early exit from paid employment among older workers with a chronic disease, and to assess whether these risks differ across educational groups.

METHODS

Data on chronic diseases and demographics from 9160 Dutch workers aged 45-64 years were enriched with monthly information on employment status from Statistics Netherlands. Subdistribution hazard ratios (SHR) and 7-year probabilities among workers with a chronic disease of exit from paid employment through disability benefits, unemployment benefits, early retirement benefits or economic inactivity were estimated using competing risks regression analyses based on Fine and Gray's models.

RESULTS

Workers with one chronic disease had a higher risk to exit paid employment through disability benefits (SHR 4.48 (95%CI 3.22 to 6.25)) compared with workers without chronic disease, and this risk further increased for multiple chronic diseases (SHR 8.91 (95%CI 6.33 to 12.55)). As occurrence of chronic diseases was highest among low educated workers, the 7-year probabilities to exit paid employment through disability benefits were highest among this group. Cardiovascular, musculoskeletal, psychological and respiratory diseases were associated with disability benefits (SHRs ranging from 2.11 (95%CI 1.45 to 3.07) to 3.26 (95%CI 2.08 to 5.12)), whereas psychological diseases were also related to unemployment (SHR 1.78 (95%CI 1.33 to 2.38)).

CONCLUSIONS

Older workers with a chronic disease have a higher risk to exit paid employment through disability benefits. As multimorbidity has an additive effect, addressing multimorbidity as a risk factor for sustainable employment is needed.

Health-related educational inequalities in paid employment across 26 European countries in 2005-2014: repeated cross-sectional study

OBJECTIVE

The study investigates the trends in health-related inequalities in paid employment among men and women in different educational groups in 26 countries in 5 European regions.

DESIGN

Individual-level analysis of repeated cross-sectional annual data (2005-2014) from the EU Statistics on Income and Living Conditions.

SETTING

26 European countries in 5 European regions.

PARTICIPANTS

1 844 915 individuals aged 30-59 years were selected with information on work status, chronic illness, educational background, age and gender.

OUTCOME MEASURES

Absolute differences were expressed by absolute differences in proportion in paid employment between participants with and without a chronic illness, using linear regression. Relative differences were expressed by prevalence ratios in paid employment, using a Cox proportional hazard model. Linear regression was used to examine the trends of inequalities.

RESULTS

Participants with a chronic illness had consistently lower labour force participation than those without illnesses. Educational inequalities were substantial with absolute differences larger within lower educated (men 21%-35%, women 10%-31%) than within higher educated (men 5%-13%, women 6%-16%). Relative differences showed that low-educated men with a chronic illness were 1.4-1.9 times (women 1.3-1.8 times) more likely to be out of paid employment than low-educated persons without a chronic illness, whereas this was 1.1-1.2 among high-educated men and women. In the Nordic, Anglo-Saxon and Eastern regions, these health-related educational inequalities in paid employment were more pronounced than in the Continental and Southern region. For most regions, absolute health-related educational inequalities in paid employment were generally constant, whereas relative inequalities increased, especially among low-educated persons.

CONCLUSIONS

Men and women with a chronic illness have considerable less access to the labour market than their healthy colleagues, especially among lower educated persons. This exclusion from paid employment will increase health inequalities.

Inequalities in employment rates among older men and women in Canada, Denmark, Sweden and the UK

Background

In most developed countries, governments are implementing policies encouraging older persons to work past 65 years to reduce the burden on societies related to disability benefits and pension payments. Despite this push to extend working lives, we know little about who already works past this age and any inequalities that may exist. Our study investigates the employment rates of those aged 65–75 years of age by educational level, health status and sex in Canada (CAN), Denmark (DK), Sweden (SE) and the United Kingdom (UK). Secondly, we aim to relate findings on employment rates to prevailing policies in the different countries, to increase the understanding on how to further extend working lives.

Methods

We used nationally representative cross-sectional survey data from the 2012–2013 Canadian Community Health Survey, 2013/14 Survey of Health, Ageing and Retirement in Europe for Denmark and Sweden and the 2013 English Longitudinal Study of Ageing to examine employment rates for those aged 65–75 years by sex, educational level and health status (having limiting longstanding illness (LLI) or not).

Results

Employment rates decline by age, but we see a linear decline in CAN and the UK compared to an initial decline then a plateau of employment rates from 66 to 68 years in DK and SE. Employment rates among persons aged 65–75 years were lower in the UK than in CAN, DK and SE. Among women, employment rates were highest in SE. Women with low education and a LLI had considerably lower employment rates than men with low education and a LLI (employment rates for men ranged from 27% to 12% compared with employment rates for women which ranged from 12% to 0%).

Conclusions

Our results suggest that educational level, sex and health all play a role in extending working lives. The variation in employment rates between the four countries implies that policies do matter, but that social differentials show that policies cannot be ‘one size fits all’. Policy-makers must consider different groups (i.e. low-educated women with a LLI) when designing policies to extend working lives.

Influence of chronic diseases on societal participation in paid work, volunteering and informal caregiving in Europe: a 12-year follow-up study

Background

This study aims to provide insight into (1) the associations between having a chronic disease and participation in paid work, volunteer activities or informal care, (2) the associations between the onset of a chronic disease and these forms of societal participation, and (3) whether these associations differ across educational level and gender.

Methods

The study population consisted of n=21 875 respondents of the Survey of Health, Ageing and Retirement in Europe aged between 50 years and the country-specific retirement age. The influence of having and the onset of a chronic disease on societal participation was analysed using a hybrid Poisson regression model, combining fixed and random effects, and presented by relative risks (RRs).

Results

Individuals with a chronic disease were less likely to participate in paid work (RR: 0.69; 95% CI 0.67 to 0.71) and volunteer activities (RR: 0.92; 95% CI 0.88 to 0.97), but more likely to give informal care (RR: 1.05; 95% CI 1.01 to 1.08). Onset of a chronic disease was associated with a higher likelihood to quit paid work (RR: 0.91; 95% CI 0.86 to 0.97) and to give informal care (RR: 1.08; 95% CI 1.01 to 1.16). Lower educated individuals with a chronic disease or with the onset of a chronic disease were less likely to have paid work than higher educated individuals.

Conclusion

Individuals with a chronic disease were less likely to participate in paid work and volunteer activities, and more likely to provide informal care. Educational inequalities were present for paid work. More insight into which factors hinder societal participation among individuals with a chronic disease is needed.

Employment status transitions in employees with and without chronic disease in the Netherlands

Objectives

Objectives were to: (1) longitudinally assess transitions in employment status of employees with and without chronic disease; and (2) assess predictors of exit from paid employment.

Methods

Transitions in employment status at 1- and 2-year follow-up were assessed in a longitudinal cohort study of employees aged 15–63 years. Generalised estimating equations (GEE) and logistic regression analyses were performed to analyse differences in transitions and identify sociodemographic, health- and work-related predictors.

Results

At 1- and 2-year follow-up, 10,038 employees (37% with chronic disease) and 7636 employees responded. Employees with chronic disease had higher probability of leaving paid employment [OR 1.4 (1.1–1.6)] and unemployment, disability pension and early retirement. Employees without chronic disease had higher chance of moving into self-employment or study. At 2-year follow-up, employees with cardiovascular disease (15%), chronic mental disease (11%), diabetes (10%) and musculoskeletal disease (10%), had left paid employment most often. Higher age, poor health, burnout, low co-worker support and chronic disease limitations were predictors for leaving paid employment.

Conclusions

Employees with chronic disease leave paid work more often for unfavourable work outcomes.