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Longitudinal examination of temporality in the association between chronic disease diagnosis and changes in work status and hours worked
  1. Arif Jetha1,2,
  2. Cynthia Chen1,
  3. Cameron Mustard1,2,
  4. Selahadin Ibrahim1,2,
  5. Amber Bielecky1,
  6. Dorcas Beaton1,3,
  7. Peter Smith1,2,4
  1. 1Institute for Work & Health, Toronto, Ontario, Canada
  2. 2Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  3. 3Mobility Program, Clinical Research Unit, St. Michaels Hospital, Toronto, Ontario, Canada
  4. 4School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
  1. Correspondence to Dr Arif Jetha, Institute for Work & Health, 481 University Avenue, Toronto, ON M5G 2E9, USA; ajetha{at}


Objectives To examine the longitudinal relationship between incidence of diagnosed chronic disease and work status and hours worked.

Methods A dynamic cohort approach was taken to construct our study sample using the Canadian National Population Health Survey. Participant inclusion criteria included being employed and without a chronic health condition in the survey cycle prior to diagnosis, and participation in consecutive surveys following diagnosis. Each respondent was matched with up to 5 respondents without a diagnosed health condition. The direct and indirect associations between chronic disease and work status and hours worked following diagnosis were examined using probit and linear regression path models. Separate models were developed for arthritis, back problems, diabetes, hypertension and heart disease.

Results We identified 799 observations with a diagnosis of arthritis, 858 with back pain, 178 with diabetes, 569 with hypertension and 163 with heart disease, which met our selection criteria. An examination of total effects at time 1 and time 2 showed that, excluding hypertension, chronic disease diagnosis was related to work loss. The time 2 effect of chronic disease diagnosis on work loss was mediated through time 1 work status. With the exception of heart disease, an incident case of chronic disease was not related to changes in work hours among observations with continuous work participation.

Conclusions Chronic disease can result in work loss following diagnosis. Research is required to understand how modifying occupational conditions may benefit employment immediately after diagnosis.

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