• LeijtenFenna R MFRDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands Netherlands Organisation for Applied Scientific Research TNO, Leiden, The Netherlands., Astrid de Wind, Swenne G van den Heuvel, Jan Fekke Ybema, Allard J van der Beek, Suzan J W Robroek, and Alex Burdorf.
• Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands Netherlands Organisation for Applied Scientific Research TNO, Leiden, The Netherlands.
• J Epidemiol Community Health. 2015 Nov 1; 69 (11): 1058-65.

BackgroundWith an ageing society and increasing retirement ages, it is important to understand how employability can be promoted in older workers with health problems. The current study aimed to determine whether (1) different chronic health problems predict transitions from paid employment to disability benefits, unemployment and early retirement, and (2) how work-related factors modify these associations.MethodsSelf-report questionnaire data was used from the Dutch longitudinal Study on Transitions in Employment, Ability and Motivation with 3 years of follow-up (2010-2013), among employees aged 45-64 years (N=8149). The influence of baseline chronic health problems and work-related factors on transitions from paid employment to disability benefits, unemployment and early retirement during follow-up was estimated in a competing risks proportional hazards model. Relative excess risk of transitions due to the interaction between chronic health problems and work-related factors was assessed.ResultsSevere headache, diabetes mellitus and musculoskeletal, respiratory, digestive and psychological health problems predicted an increased risk of disability benefits (HR range 1.78-2.79). Circulatory (HR=1.35) and psychological health problems (HR=2.58) predicted unemployment, and musculoskeletal (HR=1.23) and psychological health problems (HR=1.57) predicted early retirement. Work-related factors did not modify the influence of health problems on unemployment or early retirement. Psychosocial work-related factors, especially autonomy, modified the influence of health problems on disability benefits. Specifically, among workers with health problems, higher autonomy, higher support and lower psychological job demands reduced the risk of disability benefits by 82%, 49%, and 11%, respectively.ConclusionsAll health problems affected disability benefits to a similar extent, but psychological health problems especially predicted unemployment and early retirement. For older workers with health problems, promoting an optimal work environment has the potential to contribute to sustainable employment.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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