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

Carr, Ewan; Fleischmann, Moritz; Goldberg, Marcel; Kuh, Diana; Murray, Emily; Stafford, Mai; Stansfeld, Stephen; Vahtera, Jussi; Xue, Baowen; Zaninotto, Paola; Zins, Marie; Head, Jenny

doi:10.1136/oemed-2017-104619

Cited by 62 publications

(92 citation statements)

References 36 publications

(39 reference statements)

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“…The HRs for DBs were highest among the blue-collar employees in the present study. This is in line with a previous study, in which the data were drawn from seven independent studies in Finland, France, the UK and the USA, and which reported an association with a low occupational grade and increased risks of health-related exit from work (Carr et al 2018). A Finnish cohort study found that higher occupational classes are two times more likely to continue working beyond retirement age than lower occupational classes, while another cohort study found that hospitalization was slightly more associated with increased DB in the lower occupational classes.…”

Section: Discussionsupporting

confidence: 93%

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

Pihlajamäki

Uitti

Arola

et al. 2019

Int Arch Occup Environ Health

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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.

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Section: Discussionsupporting

confidence: 93%

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

Pihlajamäki

Uitti

Arola

et al. 2019

Int Arch Occup Environ Health

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“…A recently published study showed that persons with a lower socioeconomic position were more likely to exit paid employment into disability benefits (6). However, educational inequalities in exit from paid employment can be the result of a higher prevalence of poor health among lower-educated workers or a stronger association between poor health and exit from paid employment.…”

Section: Schuring Et Almentioning

confidence: 99%

“…A recent study using longitudinal data from seven cohort studies in Finland, France, the UK, and the USA provided evidence for socioeconomic inequalities in the risk of health-related exit from paid employment among older workers (6). Low education was associated with an increased risk of leaving paid employment for health reasons in six out of seven cohort studies.…”

mentioning

confidence: 99%

“…However, most studies used a cross-sectional study design, focused on a single country, or investigated single exit routes (3,6). There is a need for longitudinal studies across a large variety of countries, addressing not only associations between poor health and exit from paid employment, but also educational differences in the risk of exit from paid employment for those in poor health and in the prevalence of poor health.…”

mentioning

confidence: 99%

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The contribution of health to educational inequalities in exit from paid employment in five European regions

Schuring¹,

Schram²,

Robroek³

et al. 2019

Scand J Work Environ Health

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In all European regions, lower-educated workers have higher risks of leaving paid employment due to disability benefits and unemployment than those with higher education. This disadvantaged position of lower-educated persons is primarily due to a higher prevalence of poor health. Given the presence of health problems, the risk of exit from paid employment is comparable across educational levels.Objectives The primary aim of this study was to investigate educational inequalities in health-related exit from paid employment through different pathways in five European regions. A secondary objective was to estimate the proportion of different routes out of paid employment that can be attributed to poor health across educational groups in five European regions. MethodsLongitudinal data from 2005 up to 2014 were obtained from the four-year rotating panel of the European Union Statistics on Income and Living Conditions (EU-SILC), including 337 444 persons with 1 056 779 observations from 25 countries. Cox proportional hazards models with censoring for competing events were used to examine associations between health problems and exit from paid employment. The population attributable fraction was calculated to quantify the impact of health problems on labor force exit. ResultsIn all European regions, lower-educated workers had higher risks of leaving paid employment due to disability benefits [relative inequality (RI) 3.3-6.2] and unemployment (RI 1.9-4.5) than those with higher education. The fraction of exit from paid employment that could be attributed to poor health varied between the five European regions among lower-educated persons from 0.06-0.21 and among higher-educated workers from 0.03-0.09. The disadvantaged position of lower-educated persons on the labor market was primarily due to a higher prevalence of poor health. ConclusionIn all European regions, educational inequalities exist in health-related exclusion from paid employment. Policy measures are needed to reduce educational inequalities in exit from paid employment due to poor health.

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“…On the one hand, compared with lower educated workers, higher educated workers tend to have lower physical work demands, 22 a stronger attachment to work, 23…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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ObjectivesPrevious 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.MethodsCoordinated 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.ResultsPoor 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.ConclusionsThe 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.

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

Cited by 62 publications

References 36 publications

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

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

The contribution of health to educational inequalities in exit from paid employment in five European regions

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

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