Introduction In Germany the statutory pension insurance fund covers the cost of rehabilitation treatment for employees whose working capacity is endangered due to health problems. The underlying principle called ”rehabilitation over retirement” is the concept to avoid early retirement due to health problems by rehabilitation.

Purpose To describe the utilisation of medical rehabilitation before the occurrence of early retirement in Germany from 2003 to 2014 and to investigate potential sociodemographic determinants.

Methods Analysis based on 20% random samples of administrative pension records from the Research Data Centre of the German Federal Pension Insurance. We used logistic regression models to investigate the risk for non-utilisation of medical rehabilitation during five years before the occurrence of early retirement. Age, sex, non-German citizenship, marital status, school and vocational education, annual income and diagnoses were considered as potential risk factors. Analyses were run with SAS software for statistical analyses (version 9.4).

Results Among all early-retired patients 47.9% (153.990 out of 321.275) did not utilised medical rehabilitation. Risk factors for non-utilisation were to be unmarried or widowed (vs. married, adjusted OR: 1.27; 95% CI: 1.25–1.29), non-German citizenship (vs. German citizenship, 1.28 [1.25–1.32]), unknown or low educational level (vs. median educational level, 1.51 [1.48–1.54]), as well as low annual income (1 st quartile vs. 4th quartile; 3.90 [3.81–3.99]). Also, risk was higher among men compared to women (1.35; 95% CI: 1.33–1.37).

Conclusions Among all early-retired patients almost 50% obtained no medical rehabilitation. Worst affected were deprived persons.