title: The importance of illness duration, age at diagnosis and the year of diagnosis for labour participation chances of people with chronic illness: results of a nationwide panel-study in The Netherlands.
abstract: BACKGROUND
  Compared to participation rates among general populations, participation of people with chronic illness in the labour market lags behind. This is undesirable, both from the perspective of individuals' well-being as from a macro-economic perspective for western countries where concerns exist about labour supply and sustainability of social security in the near future. To help develop successful policy measures to prevent early drop-out and support reintegration, we aimed to gain insight into the role of three age related characteristics that may relate to labour participation chances of people with chronic illness: the duration of their illness, how old they were when the chronic disease was diagnosed and the historical year in which the diagnosis was established.
  
  
  METHODS
  We analyzed data of one (first) measurement of several cohorts of people diagnosed with a somatic chronic disease, who (had) participated in the Dutch 'National Panel of people with Chronic illness or Disability' since 1998 (N = 4634 in total). Multi-level logistic regression analyses were conducted to estimate random effects of the age at diagnosis and the year of diagnosis and fixed effects of illness duration on labour participation, while correcting for the effects of socio-demographic and disease characteristics and socio-economic indicators.
  
  
  RESULTS
  A significant part of the variation in labour participation among people with chronic illness relates to the age they had when they were diagnosed. Furthermore, a longer illness duration is significantly associated with a lower chance of being economically active. This is more the case for men than for women. Labour participation of cancer survivors depends on the phase of the illness they find themselves in. No evidence was found that the year in which the diagnosis was established matters for employment chances later in life.
  
  
  CONCLUSIONS
  Age at diagnosis and illness duration relate to chronically ill people's chances to participate in the labour market, but how and how strong they relate to labour participation depend on gender and the type of chronic disease at stake. Prospective studies are needed to assess illness trajectories of specific diagnostic groups along with the development of their school and work careers.
authors.affiliation: NIVEL (Netherlands institute for health services research), P,O, Box 1568, 3500 BN, Utrecht, The Netherlands. m.rijken@nivel.nl.
authors.forename: Mieke
authors.initials: M
authors.lastname: Rijken
authors.forename: Peter
authors.initials: P
authors.lastname: Spreeuwenberg
authors.forename: Joop
authors.initials: J
authors.lastname: Schippers
authors.forename: Peter P
authors.initials: PP
authors.lastname: Groenewegen
mesh_terms: D000367:Age Factors; D002908:Chronic Disease / Q000453:epidemiology; D003710:Demography; D006233:Persons with Disabilities; D004651:Employment; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D009786:Occupational Health Services; D011446:Prospective Studies; D017741:Survivors / Q000706:statistics & numerical data*