Introduction With increasing retirement age, employed persons are more likely to suffer from chronic diseases, such as cardiovascular diseases, diabetes, inflammatory diseases, respiratory diseases, and psychological disorders, at later stage during their working career.

Objectives This study investigates the influence of the onset of a disease on the likelihood of exit from paid employment through different pathways (unemployment, disability benefits, economic inactivity, early retirement).

Methods For this longitudinal study with 11 years of follow-up (2009–2019), 4,276,770 persons were selected, who were employed between 2009 and 2010, and used no medication for the selected diseases in 2009. Register data from Statistics Netherlands on medication use, employment status, and socio-demographic factors were used. Exit from paid employment pathways were defined as: unemployment, disability benefits, economic inactivity, and early retirement. The following six disease categories were identified based on medication: cardiovascular diseases, diabetes mellitus, respiratory illness, psychological disorders, inflammatory disorders and psychotic disorders. Descriptive statistics and Cox Proportional Hazards analyses with competing risks were performed.

Results The onset of any disease increased the likelihood of exit from paid employment, with strongest effect observed for psychological disorders (Hazard Ratio [HR]=1.37, 95% confidence interval [CI] 1.34–1.40) and psychotic disorders (HR=1.49, 95% CI 1.41–1.58). Of all pathways out of paid employment, onset of a disease had the strongest effect on disability benefits, with HRs ranging from 1.75 (inflammatory diseases) to 9.30 (psychotic disorders).

Conclusion For the working age population, the onset of common disorders, especially psychological and psychotic disorders, is a risk for maintaining paid employment. Interventions are needed to prevent persons with these diseases from involuntary loss of paid employment.