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Can favourable psychosocial working conditions in midlife moderate the risk of work exit for chronically ill workers? A 20-year follow-up of the Whitehall II study
  1. Maria Fleischmann1,
  2. Ewan Carr1,2,
  3. Stephen A Stansfeld3,
  4. Baowen Xue1,
  5. Jenny Head1
  1. 1 Department of Epidemiology and Public Health, University College London, London, UK
  2. 2 Institute of Psychiatry, King’s College London, London, UK
  3. 3 Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
  1. Correspondence to Dr Maria Fleischmann, Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK; m.fleischmann{at}


Objectives To investigate if favourable psychosocial working conditions can reduce the risk of work exit and specifically for workers with chronic disease.

Methods Men and women (32%) aged 35–55, working and having no chronic disease at baseline of the Whitehall II study of London-based civil servants were selected (n=9040). We observed participants’ exit from work through retirement, health-related exit and unemployment, new diagnosis of chronic disease (ie, coronary heart disease, diabetes, stroke and cancer) and their psychosocial working conditions in midlife. Using cause-specific Cox models, we examined the association of chronic disease and favourable psychosocial working conditions and their interaction, with the three types of work exit. We adjusted for gender, occupational grade, educational level, remaining in civil service, spouse’s employment status and mental health.

Results Chronic disease significantly increased the risk of any type of work exit (HR 1.27) and specifically the risk of health-related exit (HR 2.42). High skill discretion in midlife reduced the risk of any type of work exit (HR 0.90), retirement (HR 0.91) and health-related exit (HR 0.68). High work social support in midlife decreased the risk of health-related exit (HR 0.79) and unemployment (HR 0.71). Favourable psychosocial working conditions in midlife did not attenuate the association between chronic disease and work exit significantly.

Conclusions The chronically ill have increased risks of work exit, especially through health-related exit routes. Chronic disease is an obstacle to extended working lives. Favourable working conditions directly relate to reduced risks of work exit.

  • chronic disease
  • psychosocial working conditions
  • retirement
  • older workers
  • work exit

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  • Contributors MF cleaned and analysed the data, drafted and revised the paper. EC, BX and SAS commented on several versions of the manuscript and revised draft and revision. JH advised on methods and analyses, commented on several versions of the manuscript and revised draft and revision.

  • Funding This work was jointly funded by the UK Economic and Social Research Council and the UK Medical Research Council, under the Lifelong Health and Wellbeing Cross-Council Programme initiative (ES/L002892/1). SAS was (in part) supported by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Bart’s Health NHS Trust.

  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval University College London Medical School Committee on the ethics of human research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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