title: The influence of chronic health problems and work-related factors on loss of paid employment among older workers.
abstract: BACKGROUND
  With an ageing society and increasing retirement ages, it is important to understand how employability can be promoted in older workers with health problems. The current study aimed to determine whether (1) different chronic health problems predict transitions from paid employment to disability benefits, unemployment and early retirement, and (2) how work-related factors modify these associations.
  
  
  METHODS
  Self-report questionnaire data was used from the Dutch longitudinal Study on Transitions in Employment, Ability and Motivation with 3 years of follow-up (2010-2013), among employees aged 45-64 years (N=8149). The influence of baseline chronic health problems and work-related factors on transitions from paid employment to disability benefits, unemployment and early retirement during follow-up was estimated in a competing risks proportional hazards model. Relative excess risk of transitions due to the interaction between chronic health problems and work-related factors was assessed.
  
  
  RESULTS
  Severe headache, diabetes mellitus and musculoskeletal, respiratory, digestive and psychological health problems predicted an increased risk of disability benefits (HR range 1.78-2.79). Circulatory (HR=1.35) and psychological health problems (HR=2.58) predicted unemployment, and musculoskeletal (HR=1.23) and psychological health problems (HR=1.57) predicted early retirement. Work-related factors did not modify the influence of health problems on unemployment or early retirement. Psychosocial work-related factors, especially autonomy, modified the influence of health problems on disability benefits. Specifically, among workers with health problems, higher autonomy, higher support and lower psychological job demands reduced the risk of disability benefits by 82%, 49%, and 11%, respectively.
  
  
  CONCLUSIONS
  All health problems affected disability benefits to a similar extent, but psychological health problems especially predicted unemployment and early retirement. For older workers with health problems, promoting an optimal work environment has the potential to contribute to sustainable employment.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands Netherlands Organisation for Applied Scientific Research TNO, Leiden, The Netherlands.
authors.forename: Fenna R M
authors.initials: FR
authors.lastname: Leijten
authors.affiliation: Netherlands Organisation for Applied Scientific Research TNO, Leiden, The Netherlands Department of Public and Occupational Health, The EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands Body@Work, Research Centre on Physical Activity, Work and Health, TNO-VUmc, Amsterdam, The Netherlands.
authors.forename: Astrid
authors.initials: A
authors.lastname: de Wind
authors.affiliation: Netherlands Organisation for Applied Scientific Research TNO, Leiden, The Netherlands.
authors.forename: Swenne G
authors.initials: SG
authors.lastname: van den Heuvel
authors.affiliation: Department of Social and Organisational Psychology, University of Utrecht, Utrecht, The Netherlands.
authors.forename: Jan Fekke
authors.initials: JF
authors.lastname: Ybema
authors.affiliation: Department of Public and Occupational Health, The EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands Body@Work, Research Centre on Physical Activity, Work and Health, TNO-VUmc, Amsterdam, The Netherlands.
authors.forename: Allard J
authors.initials: AJ
authors.lastname: van der Beek
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Suzan J W
authors.initials: SJ
authors.lastname: Robroek
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Alex
authors.initials: A
authors.lastname: Burdorf
mesh_terms: D000367:Age Factors; D002908:Chronic Disease / Q000453:epidemiology / Q000523:psychology*; D015331:Cohort Studies; D004522:Educational Status; D004651:Employment / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D018868:Insurance, Disability / Q000191:economics / Q000706:statistics & numerical data*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D017009:Professional Autonomy; D012179:Retirement / Q000523:psychology* / Q000706:statistics & numerical data; D057566:Self Report; D012737:Sex Factors; D012944:Social Support; D011795:Surveys and Questionnaires; D014478:Unemployment / Q000523:psychology / Q000706:statistics & numerical data
keywords: OCCUPATIONAL HEALTH; PUBLIC HEALTH; WORKPLACE