title: Why do those out of work because of sickness or disability have a high mortality risk? Evidence from a Scottish cohort.
abstract: BACKGROUND
  Existing evidence on the association between being out of work because of sickness or disability and high mortality risk suggests that most of the association cannot be explained by controlling for health, health behaviour or socio-economic position. However, studies are often based on administrative data that lack explanatory factors. Here, we investigate this high mortality risk using detailed information from a cohort study.
  
  
  METHODS
  Data from the West of Scotland Twenty-07 prospective cohort study were used to follow those (average age 56 years) employed, unemployed and out of work in 1988 to death or end of follow-up in 2011. Using a parametric survival model, mean survival was calculated for each employment group after adjustment for health behaviours, health and socio-economic position.
  
  
  RESULTS
  The difference in survival between those sick or disabled (30% survival at end of follow-up), and those unemployed (49%) or employed (61%) was mostly accounted for by adjusting for the higher levels of poor heath at baseline in the former group (49, 46 and 56%, respectively, after adjustment). After controlling for all variables, the difference between those sick or disabled (51%) and those employed (56%) was further attenuated slightly.
  
  
  CONCLUSIONS
  Our results suggest that the present health of those out of work and sick or disabled should be taken seriously, as their long-term survival prospects are considerably poorer than other employment groups.
authors.affiliation: MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK. f.popham@sphsu.mrc.ac.uk
authors.forename: Frank
authors.initials: F
authors.lastname: Popham
authors.forename: Kathryn
authors.initials: K
authors.lastname: Skivington
authors.forename: Michaela
authors.initials: M
authors.lastname: Benzeval
mesh_terms: D015331:Cohort Studies; D006233:Persons with Disabilities; D015438:Health Behavior; D006801:Humans; D009026:Mortality / Q000639:trends*; D012606:Scotland / Q000453:epidemiology; D018582:Sick Leave / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D014478:Unemployment / Q000706:statistics & numerical data*