Multimorbidity and exit from paid employment: the effect of specific combinations of chronic health conditions

• Published in: European journal of public health 2022-06, Vol.32 (3), p.392-397
• Main Authors: Gurgel do Amaral, Gabriel S, Ots, Patricia, Brouwer, Sandra, van Zon, Sander K R
• Format: Article
• Language: English
• Subjects: Arthritis; Cardiovascular diseases; Chronic diseases; Chronic illnesses; Chronic obstructive pulmonary disease; Comorbidity; Confidence intervals; Diabetes; Diabetes mellitus (non-insulin dependent); Disability recipients; Disease; Early retirement; Economic aspects; Employment; Health aspects; Heart diseases; Lung diseases; Multimorbidity; Netherlands; Obstructive lung disease; Public health; Retirement; Rheumatoid arthritis; Risk; Risk factors; Statistical models; Statistics; Unemployment; Work and Health; Workers; Workplaces
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/ckac018

Abstract Background This study aimed to assess the association between multimorbidity and exit from paid employment, and which combinations of chronic health conditions (CHCs) have the strongest association with exit from paid employment. Methods Data from 111 208 workers aged 18–64 years from Lifelines were enriched with monthly employment data from Statistics Netherlands. Exit from paid employment during follow-up was defined as a change from paid employment to unemployment, disability benefits, economic inactivity or early retirement. CHCs included cardiovascular diseases (CVD), chronic obstructive pulmonary disease (COPD), rheumatoid arthritis (RA), type 2 diabetes (T2DM) and depression. Cox-proportional hazards models were used to examine the impact of multimorbidity and combinations of CHCs on exit from paid employment. Results Multimorbidity increased the risk of exiting paid employment compared with workers without CHCs (hazard ratio (HR): 1.52; 95% confidence interval (CI): 1.35–1.71) or one CHC (HR: 1.14; 95% CI: 1.01–1.28). The risk for exit from paid employment increased among workers with COPD if they additionally had CVD (HR: 1.39; 95% CI: 1.03–1.88), depression (HR: 1.46; 95% CI: 1.10–1.93) or RA (HR: 1.44; 95% CI: 1.08–1.91), for workers with T2DM if they additionally had CVD (HR: 1.43; 95% CI: 1.07–1.91) or depression (HR: 2.09; 95% CI: 1.51–2.91) and for workers with depression who also had T2DM (HR: 1.68; 95% CI: 1.21–2.32). Conclusion This study showed that workers with multimorbidity, especially having a combination of COPD and depression or T2DM and depression, have a higher risk for early exit from paid employment and, therefore, may need tailored support at the workplace.