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Original research
Educational differences in the influence of health on early work exit among older workers
  1. Sascha De Breij1,
  2. Jana Mäcken2,
  3. Jeevitha Yogachandiran Qvist3,
  4. Daniel Holman4,
  5. Moritz Hess5,
  6. Martijn Huisman1,6,
  7. Dorly J H Deeg1
  1. 1 Epidemiology and Biostatistics, Amsterdam UMC - Locatie VUMC, Amsterdam, The Netherlands
  2. 2 Institute of Sociology and Social Psychology, University of Cologne, Koln, Germany
  3. 3 Centre for Comparative Welfare Studies, Department of Politics and Society, Aalborg University, Aalborg, Denmark
  4. 4 Department of Sociological Studies, University of Sheffield, Sheffield, UK
  5. 5 Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
  6. 6 Department of Sociology, VU University Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Ms Sascha De Breij, Epidemiology and Biostatistics, Amsterdam UMC - Locatie VUMC, 1081 HV Amsterdam, The Netherlands; s.debreij{at}


Objectives Previous research has shown that poor physical and mental health are important risk factors for early work exit. We examined potential differences in this association in older workers (50+) across educational levels.

Methods Coordinated analyses were carried out in longitudinal data sets from four European countries: the Netherlands (Longitudinal Aging Study Amsterdam), Denmark (Danish Longitudinal Study of Ageing), England (English Longitudinal Study of Ageing) and Germany (German Ageing Survey). The effect of poor self-rated health (SRH), functional limitations and depression on different types of early work exit (early retirement, economic inactivity, disability and unemployment) was examined using Cox regression analysis. We examined educational differences in these effects by testing interaction terms.

Results Poor physical and mental health were more common among the lower educated. Poor SRH, functional limitations, and depression were all associated with a higher risk of early work exit. These health effects were strongest for the disability exit routes (poor SRH: HRs 5.77 to 8.14; functional limitations: HRs 6.65 to 10.42; depression: HRs 3.30 to 5.56). In the Netherlands (functional limitations) and England (functional limitations and SRH), effects were stronger in the lower educated.

Conclusions The prevalence of health problems, that is, poor SRH, functional limitations and depression, was higher in the lower educated workers. All three health indicators increase the risk of early work exit. In some countries, health effects on early exit were stronger in the lower educated. Thus, lower educated older workers are an important target group for health policy and intervention.

  • longitudinal studies
  • gender
  • retired
  • mental health
  • epidemiology

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  • Contributors All authors made substantial contributions to conception and design of the study. SDB (LASA), JYQ (DLSA), DH (ELSA), and JM (DEAS) conducted the statistical analyses. SDB interpreted the data and drafted the methods, results, discussion and conclusion. JM drafted the introduction. All authors revised the manuscript critically. All authors read and approved the final manuscript.

  • Funding The research was conducted within the project 'EXTEND: Social inequalities in extending working lives of an ageing workforce' in the framework of the Joint Programming Initiative (JPI) ‘More Years, Better Lives – The Potential and Challenges of Demographic Change’. SDB was supported by The Netherlands Organisation for Health Research and Development (ZonMW) (grant number 208 060 002). DH was supported by the Economic and Social Research Council (grant number ES/P000177/1).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval EXTEND conducts secondary analyses on the data collected within the participating cohort studies. All participating cohort studies have originally received consent of the participants and ethical approval from their respected institutions.

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

  • Data availability statement Data are available in a public, open access repository. Data are available upon reasonable request. Data may be obtained from a third party and are not publicly available. Data from the Longitudinal Aging Study Amsterdam (LASA; are available for use for specific research questions provided that an agreement is made up. Data from the English Longitudinal Study of Ageing (ELSA) are available from the UK Data Archive ( Data from the Danish Longitudinal Study of Ageing (DLSA) are available from the Centre for Survey and Survey/Register data (CSSR) ( Data from the German Aging Study (DEAS) are available from the German Centre of Gerontology (

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