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Original article
Educational inequalities in the impact of chronic diseases on exit from paid employment among older workers: a 7-year prospective study in the Netherlands
  1. Karen Oude Hengel1,2,
  2. Suzan J W Robroek1,
  3. Iris Eekhout2,
  4. Allard J van der Beek3,
  5. Alex Burdorf1
  1. 1 Erasmus MC Department of Public Health, Rotterdam, The Netherlands
  2. 2 Work, Health & Technology, Netherlands Organisation of Applied Scientific Research TNO, Leiden, The Netherlands
  3. 3 Department of Public and Occupational Health, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Dr Karen Oude Hengel, Erasmus MC Department of Public Health, Rotterdam 3000 CA, The Netherlands; k.oudehengel{at}


Objectives The study aimed to investigate the relative and absolute risks of early exit from paid employment among older workers with a chronic disease, and to assess whether these risks differ across educational groups.

Methods Data on chronic diseases and demographics from 9160 Dutch workers aged 45–64 years were enriched with monthly information on employment status from Statistics Netherlands. Subdistribution hazard ratios (SHR) and 7-year probabilities among workers with a chronic disease of exit from paid employment through disability benefits, unemployment benefits, early retirement benefits or economic inactivity were estimated using competing risks regression analyses based on Fine and Gray’s models.

Results Workers with one chronic disease had a higher risk to exit paid employment through disability benefits (SHR 4.48 (95%CI 3.22 to 6.25)) compared with workers without chronic disease, and this risk further increased for multiple chronic diseases (SHR 8.91 (95%CI 6.33 to 12.55)). As occurrence of chronic diseases was highest among low educated workers, the 7-year probabilities to exit paid employment through disability benefits were highest among this group. Cardiovascular, musculoskeletal, psychological and respiratory diseases were associated with disability benefits (SHRs ranging from 2.11 (95%CI 1.45 to 3.07) to 3.26 (95%CI 2.08 to 5.12)), whereas psychological diseases were also related to unemployment (SHR 1.78 (95%CI 1.33 to 2.38)).

Conclusions Older workers with a chronic disease have a higher risk to exit paid employment through disability benefits. As multimorbidity has an additive effect, addressing multimorbidity as a risk factor for sustainable employment is needed.

  • chronic disease
  • educational inequalities
  • employment
  • disability benefits

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  • Contributors KOH and AB conceived the study and the design of the study. KOH and IE contributed to the analysis of the study. KOH drafted the initial manuscript. All authors were involved in the conception of this study, made critical revisions and approved the final manuscript.

  • Funding This study is financially supported by a VENI grant from The Netherlands Organisation for Scientific Research (NWO), project number 451-16-031, and by the Joint Programming Initiative More Years Better Lives (WORKLONG project).

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are stored at Statistics Netherlands. Data are available upon reasonable request, following the guidelines of the Statistics Netherlands.

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