Inequalities in the impact of having a chronic disease on entering permanent paid employment: a registry-based 10-year follow-up study

Abstract

BackgroundThis study aimed to investigate among unemployed persons (1) the impact of having a chronic disease on entering paid employment and obtaining a permanent contract and (2) whether these associations differed by educational attainment.MethodsRegister data from Statistics Netherlands on employment status, contract type, medication and sociodemographic characteristics were linked. Dutch unemployed persons between 18 and 64 years (n=667 002) were followed up for 10 years (2011–2020). Restricted mean survival time analyses (RMSTs) were used to investigate differences in average months until entering paid employment and until obtaining a permanent contract between persons with and without cardiovascular diseases, inflammatory conditions, diabetes, respiratory illness, common mental disorders and psychotic disorders. Interaction terms were included for education.ResultsOne-third of the unemployed persons at baseline entered paid employment during follow-up. Persons with chronic diseases spent more months in non-employment compared with persons without chronic diseases (difference ranging from 2.50 months (95% CI 1.97 to 3.03 months) to 10.37 months (95% CI 9.98 to 10.77 months)), especially for persons with higher education. Conditional on entering paid employment, the time until a permanent contract was longer for persons with cardiovascular diseases (4.42 months, 95% CI 1.85 to 6.99 months), inflammatory conditions (4.80 months, 95% CI 2.02 to 7.59 months) and diabetes (8.32 months, 95% CI 4.26 to 12.37 months) than for persons without these diseases. These latter differences were similar across educational attainment.ConclusionsHaving a chronic disease is a barrier to entering permanent paid employment. The findings underline the need to prevent chronic diseases and promote an inclusive workforce.

Worker and workplace determinants of employment exit: a register study

“…This could imply that the low employment rates among people with chronic health problems are driven not by chronically ill workers’ labour market exits, but potentially due to these workers experiencing a high threshold for entering employment. Nevertheless, we find some worker and workplace covariates that significantly correlate with the risk of labour market exit: Men, workers of young age, workers with mental health problems, workers with part-time contracts, unmarried workers and workers with a low skill level are at higher risk of exit; these are findings that support previous research 16 26–28. A notable point here is that the robust association between mental health problems and employment exit indicates that mental health problems affect work ability across all skill levels, branches and other workplace characteristics.…”

“…Nevertheless, we find some worker and workplace covariates that significantly correlate with the risk of labour market exit: Men, workers of young age, workers with mental health problems, workers with part-time contracts, unmarried workers and workers with a low skill level are at higher risk of exit; these are findings that support previous research. 16 26–28 A notable point here is that the robust association between mental health problems and employment exit indicates that mental health problems affect work ability across all skill levels, branches and other workplace characteristics. Government actors as well as employers should consider measures targeted towards employees’ mental health.…”

“…One is workers' required skill level or achieved education, which indicates the actual tasks the workers are set to do, for example, manual or sedentary work. 5 14-16 There is also evidence of heterogeneity between different chronic conditions, 16 with a recent study emphasising mental and substance disorders as the number one cause of health-related productivity loss in Norway. 17 Second, there may be branch-specific characteristics that impact workers' prospects of participation.…”

“…Previous research has suggested some worker characteristics that could influence the risk of employment exit for people with health problems. One is workers’ required skill level or achieved education, which indicates the actual tasks the workers are set to do, for example, manual or sedentary work 5 14–16. There is also evidence of heterogeneity between different chronic conditions,16 with a recent study emphasising mental and substance disorders as the number one cause of health-related productivity loss in Norway 17…”