The development of working life expectancy without musculoskeletal diseases against the backdrop of extended working lives.

Musculoskeletal diseases (MSDs) are a major predictor of early retirement. Against the backdrop of the extension of working life, we investigated time trends and educational inequalities in years spent in the labour market free of MSD. Based on German statutory health insurance data (N = 3,405,673), total life years free of MSD (Healthy Life Expectancy, HLE) and years spent in the labour force free of MSD (Healthy Working Life Expectancy, HWLE) were estimated for three periods (2006-2008, 2011-2013, 2016-2018) using multistate analyses. Educational inequalities (8 to 11 vs. 12 or more years of schooling) are reported for 2011-2013. HLE decreased slightly over time in all genders. HWLE in women increased, while it remained rather constant in men. Over time, the share of years in the labour force spent free of MSD declined continuously. People with lower education had lower HLE and HWLE than individuals with higher education. With respect to musculoskeletal diseases, the increase in disease-free working life years cannot keep pace with the extension of working life, resulting in an increasing proportion of years spent in impaired musculoskeletal health in the labour market. Effective prevention strategies are needed, focusing especially on individuals with lower educational attainment.