title: Educational Inequalities in Exit from Paid Employment among Dutch Workers: The Influence of Health, Lifestyle and Work.
abstract: BACKGROUND
  Individuals with lower socioeconomic status are at increased risk of involuntary exit from paid employment. To give sound advice for primary prevention in the workforce, insight is needed into the role of mediating factors between socioeconomic status and labour force participation. Therefore, it is aimed to investigate the influence of health status, lifestyle-related factors and work characteristics on educational differences in exit from paid employment.
  
  
  METHODS
  14,708 Dutch employees participated in a ten-year follow-up study during 1999-2008. At baseline, education, self-perceived health, lifestyle (smoking, alcohol, sports, BMI) and psychosocial (demands, control, rewards) and physical work characteristics were measured by questionnaire. Employment status was ascertained monthly based on tax records. The relation between education, health, lifestyle, work-characteristics and exit from paid employment through disability benefits, unemployment, early retirement and economic inactivity was investigated by competing risks regression analyses. The mediating effects of these factors on educational differences in exit from paid employment were tested using a stepwise approach.
  
  
  RESULTS
  Lower educated workers were more likely to exit paid employment through disability benefits (SHR:1.84), unemployment (SHR:1.74), and economic inactivity (SHR:1.53) but not due to early retirement (SHR:0.92). Poor or moderate health, an unhealthy lifestyle, and unfavourable work characteristics were associated with disability benefits and unemployment, and an unhealthy lifestyle with economic inactivity. Educational differences in disability benefits were explained for 40% by health, 31% by lifestyle, and 12% by work characteristics. For economic inactivity and unemployment, up to 14% and 21% of the educational differences could be explained, particularly by lifestyle-related factors.
  
  
  CONCLUSIONS
  There are educational differences in exit from paid employment, which are partly mediated by health, lifestyle and work characteristics, particularly for disability benefits. Health promotion and improving working conditions seem important measures to maintain a productive workforce, particularly among workers with a low education.
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: Anne
authors.initials: A
authors.lastname: Rongen
authors.affiliation: Statistics Netherlands, Heerlen, the Netherlands.
authors.forename: Coos H
authors.initials: CH
authors.lastname: Arts
authors.affiliation: Statistics Netherlands, Heerlen, the Netherlands.
authors.forename: Ferdy W H
authors.initials: FW
authors.lastname: Otten
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Alex
authors.initials: A
authors.lastname: Burdorf
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
authors.forename: Merel
authors.initials: M
authors.lastname: Schuring
mesh_terms: D004522:Educational Status; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008962:Models, Theoretical; D009426:Netherlands; D012307:Risk Factors; D012959:Socioeconomic Factors; D014937:Work / Q000706:statistics & numerical data*