Department of Epidemiology and Public Health, University College London, London, UK.
Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, SE5 8AF, UK.
Occup Environ Med. 2018 May;75(5):369-377. doi: 10.1136/oemed-2017-104619. Epub 2018 Mar 12.
Past studies have identified socioeconomic inequalities in the timing and route of labour market exit at older ages. However, few studies have compared these trends cross-nationally and existing evidence focuses on specific institutional outcomes (such as disability pension and sickness absence) in Nordic countries. We examined differences by education level and occupational grade in the risks of work exit and health-related work exit.
Prospective longitudinal data were drawn from seven studies (n=99 164). Participants were in paid work at least once around age 50. Labour market exit was derived based on reductions in working hours, changes in self-reported employment status or from administrative records. Health-related exit was ascertained by receipt of health-related benefit or pension or from the reported reason for stopping work. Cox regression models were estimated for each study, adjusted for baseline self-rated health and birth cohort.
There were 50 003 work exits during follow-up, of which an average of 14% (range 2-32%) were health related. Low level education and low occupational grade were associated with increased risks of health-related exit in most studies. Low level education and occupational grade were also associated with an increased risk of any exit from work, although with less consistency across studies.
Workers with low socioeconomic position have an increased risk of health-related exit from employment. Policies that extend working life may disadvantage such workers disproportionally, especially where institutional support for those exiting due to poor health is minimal.
既往研究已经确定了在老年时劳动力市场退出的时间和途径方面存在社会经济不平等现象。然而，很少有研究在跨国层面上比较这些趋势，现有的证据主要集中在北欧国家的特定制度结果（如残疾养恤金和病假）上。我们检验了教育程度和职业等级差异对工作退出和与健康相关的工作退出风险的影响。
前瞻性纵向数据来自于七项研究（n=99164）。参与者在 50 岁左右至少有一次从事有偿工作。劳动力市场退出是根据工作时间减少、自我报告的就业状况变化或从行政记录中得出的。与健康相关的退出是通过获得与健康相关的福利或养恤金或从报告的停止工作原因来确定的。对每个研究都进行了 Cox 回归模型估计，调整了基线自我评估的健康状况和出生队列。
在随访期间发生了 50003 次工作退出，其中平均有 14%（范围 2-32%）与健康相关。在大多数研究中，低水平教育和低职业等级与与健康相关的退出风险增加有关。低水平教育和职业等级也与任何工作退出的风险增加有关，但在不同研究中的一致性较低。
社会经济地位较低的工人有较高的与健康相关的就业退出风险。延长工作寿命的政策可能会不成比例地使这些工人处于不利地位，特别是在制度上对因健康状况不佳而退出的人支持最小的情况下。
