title: Educational differences in trajectories of self-rated health before, during, and after entering or leaving paid employment in the European workforce.
abstract: OBJECTIVE
  This study aimed to investigate (i) the influence of entering or leaving paid employment on self-rated health trajectories before, during, and after this transition and (ii) educational differences in these health trajectories.
  
  
  METHODS
  In this prospective study, we used yearly measurements of self-rated health from the European Community Household Panel (ECHP) to establish how health is affected by employment transitions in or out of the workforce due to early retirement, unemployment or economic inactivity. Trajectories of self-rated health were analyzed among 136 556 persons with low, intermediate, or high educational level by repeated-measures logistic regression with generalized estimating equations.
  
  
  RESULTS
  Among low-educated workers, ill-health partly prompted their voluntary labor force exit through early retirement and becoming economically inactive, but thereafter these exit routes seemed to prevent further deterioration of their health. In contrast, among higher educated workers, early retirement had an adverse effect on their self-rated health. Becoming unemployed had adverse effects on self-rated health among all educational levels. Entering paid employment was predetermined by self-rated health improvement in the preceding years among intermediate and high educated workers, whereas, among low-educated workers, self-rated health improved in the year of entering paid employed and continued to improve in the following years.
  
  
  CONCLUSIONS
  Prolonging working life may have both adverse and beneficial effects on self-rated health. Health inequalities may increase when every person, independent of educational level, must perform paid employment until the same age before being able to retire.
authors.affiliation: Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. m.schuring@erasmusmc.nl.
authors.forename: Merel
authors.initials: M
authors.lastname: Schuring
authors.forename: Suzan J W
authors.initials: SJ
authors.lastname: Robroek
authors.forename: Hester F
authors.initials: HF
authors.lastname: Lingsma
authors.forename: Alex
authors.initials: A
authors.lastname: Burdorf
mesh_terms: D000293:Adolescent; D000328:Adult; D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012179:Retirement / Q000706:statistics & numerical data*; D057566:Self Report; D055815:Young Adult