Influence of poor health on exit from paid employment: a systematic review Rogier M van Rijn, 1 Suzan J W Robroek, 1 Sandra Brouwer, 2 Alex Burdorf 1 ▸ Additional material is published online only. To view please visit the journal online (http://dx.doi.org/10.1136/ oemed-2013-101591). 1 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands 2 Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands Correspondence to Rogier M van Rijn, Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Room Na-2202, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands; r.vanrijn@erasmusmc.nl Received 6 May 2013 Revised 30 September 2013 Accepted 9 October 2013 Published Online First 29 October 2013 ▸ http://dx.doi.org/10.1136/ oemed-2013-101945 To cite: van Rijn RM, Robroek SJW, Brouwer S, et al. Occup Environ Med 2014;71:295–301. ABSTRACT The objective was to provide a systematic literature review on associations between poor health and exit from paid employment through disability pension, unemployment and early retirement, and to estimate the magnitude of these associations using meta-analyses. Medline and Embase databases were searched for longitudinal studies on the relationship between health measures and exit from paid employment. Random- effects models were used to estimate the pooled effects. In total, 29 studies were included. Self-perceived poor health was a risk factor for transition into disability pension (relative risk (RR) 3.61; 95% CI 2.44 to 5.35), unemployment (RR 1.44; 95% CI 1.26 to 1.65) and early retirement (RR 1.27; 95% CI 1.17 to 1.38). Workers with mental health problems had an increased likelihood for transition into disability pension (RR 1.80; 95% CI 1.41 to 2.31) or unemployment (RR 1.61; 95% CI 1.29 to 2.01). Chronic disease was a risk factor for transition into disability pension (RR 2.11; 95% CI 1.90 to 2.33) or unemployment (RR 1.31; 95% CI 1.14 to 1.50), but not for early retirement. This meta-analysis showed that poor health, particularly self-perceived health, is a risk factor for exit from paid employment through disability pension, unemployment and, to a lesser extent, early retirement. To increase sustained employability it should be considered to implement workplace interventions that promote good health. INTRODUCTION In most Western countries a higher and prolonged labour force participation throughout a worker’s life is necessary to safeguard the social and eco- nomic realities of an aging society. In order to achieve this ambition, governments are developing policies to stimulate labour force participation, par- ticularly to keep workers in the workforce till older age. 1–4 The success of the developed policies depends on better understanding of the relationship between the impact of health on labour force par- ticipation. 5 In the past few years several studies have demonstrated that health status may have a profound impact on the ability of workers to be actively engaged in paid employment and to prolong their meaningful contribution to a pro- ductive society. There is evidence from different longitudinal studies that poor health plays a role in exit from paid employment, due to disability pension, 6–9 unemployment 8 10 11 and early retire- ment. 8 10 12 A community based survey in the UK found evidence for health related job loss, espe- cially in relation to musculoskeletal disorders and mental illness. 13 Pedersen et al 6 demonstrated that the risk of transition (from employment, unemployment or sickness absence) into disability pension was increased in those with a chronic disease. However, the risk of transition from work into unemployment was lower in those with a chronic disease. A prospective register study, with 15 years follow-up, in a cohort of nurses’ aides found that risk factors for disability pension were mainly health related (eg, low back pain, sick leave spells), whereas economic factors (eg, income of spouse) influence the decision to retire early. 14 A recent meta-analysis showed evidence for the asso- ciation between important health behaviour factors and exit from paid employment. Obese, and to a lesser extent overweight, workers had an increased likelihood of exit from paid employment through disability benefit. Workers with lack of physical activity had an increased risk of disability benefit and unemployment. 15 The impact of various health measures on exit from paid employment suggests that these measures differ between the main pathways of leaving the labour force, particularly between the involuntary (ie, disability pension, unemployment) and more voluntary routes (ie, early retirement) of exit from work. In order to understand and quantify the importance of different health measures on labour market exit pathways, the literature needs to be synthesised. Therefore, our aim was to provide a systematic literature review of the associations between different health measures and exit from paid employment through disability pension, unemployment and early retirement, and to esti- mate the magnitude of these associations using meta-analyses. MATERIALS AND METHODS Literature search Comprehensive literature searches were conducted by the first author (RMvR) in Medline, Embase and Web of Science (inception of databases to July 2013). The following keywords were used: health, work related, early-retirement, unemployment, disability pension, study design. The full search strategy is pre- sented in online supplementary appendix I. Based on title and abstract one reviewer (RMvR) selected the articles for full text appraisal. Two reviewers (RMvR, SJWR) independently selected articles for final inclusion. Each article had to fulfil all of the following criteria: (1) a health measure was described, (2) exit from paid employment was defined as receiving disability pension, unemploy- ment or early retirement, (3) the association between health and exit from paid employment was expressed in an OR, relative risk (RR) or HR, or sufficient raw data was available to calculate associations, (4) a longitudinal study design was Editor’s choice Scan to access more free content van Rijn RM, et al. Occup Environ Med 2014;71:295–301. doi:10.1136/oemed-2013-101591 295 Review on June 15, 2020 by guest. Protected by copyright. http://oem.bmj.com/ Occup Environ Med: first published as 10.1136/oemed-2013-101591 on 29 October 2013. Downloaded from