Erasmus MC Department of Public Health, Rotterdam, The Netherlands
Work, Health & Technology, Netherlands Organisation of Applied Scientific Research TNO, Leiden, The Netherlands.
Occup Environ Med. 2019 Oct;76(10):718-725. doi: 10.1136/oemed-2019-105788. Epub 2019 Aug 13.
The study aimed to investigate the relative and absolute risks of early exit from paid employment among older workers with a chronic disease, and to assess whether these risks differ across educational groups.
Data on chronic diseases and demographics from 9160 Dutch workers aged 45-64 years were enriched with monthly information on employment status from Statistics Netherlands. Subdistribution hazard ratios (SHR) and 7-year probabilities among workers with a chronic disease of exit from paid employment through disability benefits, unemployment benefits, early retirement benefits or economic inactivity were estimated using competing risks regression analyses based on Fine and Gray's models.
Workers with one chronic disease had a higher risk to exit paid employment through disability benefits (SHR 4.48 (95%CI 3.22 to 6.25)) compared with workers without chronic disease, and this risk further increased for multiple chronic diseases (SHR 8.91 (95%CI 6.33 to 12.55)). As occurrence of chronic diseases was highest among low educated workers, the 7-year probabilities to exit paid employment through disability benefits were highest among this group. Cardiovascular, musculoskeletal, psychological and respiratory diseases were associated with disability benefits (SHRs ranging from 2.11 (95%CI 1.45 to 3.07) to 3.26 (95%CI 2.08 to 5.12)), whereas psychological diseases were also related to unemployment (SHR 1.78 (95%CI 1.33 to 2.38)).
Older workers with a chronic disease have a higher risk to exit paid employment through disability benefits. As multimorbidity has an additive effect, addressing multimorbidity as a risk factor for sustainable employment is needed.
本研究旨在调查患有慢性病的老年工人提前退出有薪工作的相对风险和绝对风险，并评估这些风险是否因教育程度而异。
从荷兰 9160 名 45-64 岁的工人那里获取了慢性病和人口统计学数据，并从荷兰统计局获取了关于就业状况的每月信息。使用 Fine 和 Gray 模型的竞争风险回归分析，估计了患有慢性病的工人通过残疾福利、失业福利、提前退休福利或非经济活动退出有薪工作的亚分布风险比（SHR）和 7 年的可能性。
患有一种慢性病的工人通过残疾福利退出有薪工作的风险高于没有慢性病的工人（SHR 4.48（95%CI 3.22 至 6.25）），而多种慢性病的风险进一步增加（SHR 8.91（95%CI 6.33 至 12.55））。由于低学历工人慢性病的发生率最高，因此他们通过残疾福利退出有薪工作的 7 年概率最高。心血管、肌肉骨骼、心理和呼吸系统疾病与残疾福利相关（SHR 范围为 2.11（95%CI 1.45 至 3.07）至 3.26（95%CI 2.08 至 5.12）），而心理疾病也与失业有关（SHR 1.78（95%CI 1.33 至 2.38））。
患有慢性病的老年工人提前退出有薪工作的风险更高。由于多种合并症具有累加效应，因此需要将多种合并症作为可持续就业的风险因素加以解决。
