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The article focuses on the association between metabolic syndrome (MetS) and premature employment exit among middle-aged and older workers. Topics discussed include the identified risk factors, the importance of MetS interventions for prolonging working lives, and the need for awareness among employers and health professionals about the employment exit risks faced by workers with MetS.

OBJECTIVES: This study aims to estimate the influence of chronic diseases and poor working conditions – across educational levels – on working life expectancy (WLE) and working years lost (WYL) in the Dutch workforce after age 50. METHODS: Information on demographics, chronic diseases, and working conditions from 11 800 Dutch workers aged 50–66 years participating in the Study on Transitions in Employment, Ability and Motivation (STREAM) from 2010/2015 was enriched with monthly information on employment status from Statistics Netherlands up to 2018. In a multistate model, transitions were calculated between paid employment and involuntary exit (disability benefits, unemployment) and voluntary exit (economic inactivity, early retirement) to estimate the impact of education, chronic diseases, and working conditions on WLE and WYL between age 50 and 66. RESULTS: Workers with a chronic disease (up to 1.01 years) or unfavorable working conditions (up to 0.63 years) had more WYL due to involuntary pathways than workers with no chronic disease or favorable working conditions. The differences in WYL between workers with and without a chronic disease were slightly higher among workers with a lower education level (male: 0.85, female: 1.01 years) compared to workers with a high educational level (male: 0.72, female: 0.82 years). Given the higher prevalence of chronic diseases and unfavorable working conditions, WYL among lower educated workers were higher than among higher educated workers. CONCLUSIONS: The presence of a chronic disease or unfavorable working conditions, more prevalent among lower educated workers, contribute substantially to WYL among older workers. This will increase educational inequalities in working careers.eers.

Objectives This study investigates the influence of onset of disease on exit from paid employment and whether this differs across diseases and sociodemographic groups. Methods Register data from Statistics Netherlands on medication prescription was linked to information on employment status and demographics. Persons who were employed in 2009 and 2010 and who did not use medication for the selected disease in 2009 (N=5 889 036) were followed-up over nine years. Six diseases were identified based on medication prescription in 2010 and 2011: cardiovascular diseases, inflammatory diseases, diabetes mellitus, respiratory diseases, common mental disorders, and psychotic disorders. Four pathways out of paid employment were defined: disability benefits, unemployment, no income, and early retirement. Early exit from paid employment was defined as exiting paid employment before retirement age. Cause-specific Cox proportional hazards regression analyses were performed, with interaction terms for age, sex, and migration background. Results Onset of disease increased the likelihood of exit from paid employment, with the strongest associations for psychotic disorders [hazard ratio (HR) 2.88, 95% confidence interval (CI) 2.78-2.98] and common mental disorders (HR 2.00, 95% CI 1.97-2.03). Onset of disease was most strongly associated with disability benefits, followed by unemployment. The influence of common mental and psychotic disorders on disability increased until around middle-age, after which it decreased. The influence of mental health problems on exit from paid employment was stronger for persons with a non-native Dutch background and males. Conclusion Onset of diseases, especially mental health disorders, is a risk for exiting paid employment before the retirement age. Effective interventions are needed to enhance an inclusive workforce and prevent involuntary loss of paid employment. [ABSTRACT FROM AUTHOR]

Objectives This study aims to estimate the influence of chronic diseases and poor working conditions – across educational levels – on working life expectancy (WLE) and working years lost (WYL) in the Dutch workforce after age 50. Methods Information on demographics, chronic diseases, and working conditions from 11 800 Dutch workers aged 50–66 years participating in the Study on Transitions in Employment, Ability and Motivation (STREAM) from 2010/2015 was enriched with monthly information on employment status from Statistics Netherlands up to 2018. In a multistate model, transitions were calculated between paid employment and involuntary exit (disability benefits, unemployment) and voluntary exit (economic inactivity, early retirement) to estimate the impact of education, chronic diseases, and working conditions on WLE and WYL between age 50 and 66. Results Workers with a chronic disease (up to 1.01 years) or unfavorable working conditions (up to 0.63 years) had more WYL due to involuntary pathways than workers with no chronic disease or favorable working conditions. The differences in WYL between workers with and without a chronic disease were slightly higher among workers with a lower education level (male: 0.85, female: 1.01 years) compared to workers with a high educational level (male: 0.72, female: 0.82 years). Given the higher prevalence of chronic diseases and unfavorable working conditions, WYL among lower educated workers were higher than among higher educated workers. Conclusions The presence of a chronic disease or unfavorable working conditions, more prevalent among lower educated workers, contribute substantially to WYL among older workers. This will increase educational inequalities in working careers. [ABSTRACT FROM AUTHOR]

Objectives The aim of this discussion paper is to (i) identify the differentiated roles of health in the work-retirement transition, and, with respect to these, (ii) highlight topics related to conceptual and methodological problems and challenges in research, and (iii) present avenues for future research. Methods This discussion paper summarizes an OMEGA-NET working group discussion ongoing from November 2018 to September 2021 with face-to-face and online meetings as well as a written online discourse. Results 'Health' and 'retirement' are ambiguous concepts. With respect to both, in retirement research, the choice of concept and indicator influences the findings. In addition, the impact of health on retirement is not necessarily a direct one, but can be influenced by further factors such as the ability, motivation and opportunity to work. The strong overall association of poor health with retiring early (path 1) bears the risk of masking distinct and deviating mechanisms in subgroups. In fact, there is evidence that also good health may lead to early retirement (path 2), while both poor health (path 3) and good health (path 4) may also make people retire later. Conclusions An increased awareness of the differentiated roles that health may have in the work-retirement transition as outlined in this discussion paper may support research to address questions relevant for policy and practice and increase the impact of research. Recommendations for occupational health and social research are given. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study investigated the effects of a national early retirement reform, which was implemented in 2006 and penalized early retirement, on paid employment and different exit pathways and examined whether these effects differ by gender, income level and health status. METHODS: This study included all Dutch individuals in paid employment born six months before (control group) and six months after (intervention group) the cut-off date of the reform (1 January 1950) that fiscally penalized early retirement. A regression discontinuity design combined with restricted mean survival time analysis was applied to evaluate the effect of penalizing early retirement on labor force participation from age 60 until workers reached the retirement age of 65 years, while accounting for secular trends around the threshold. RESULTS: The intervention group postponed early retirement by 7.41 months [95% confidence interval (CI) 6.11–8.72], and partly replaced this by remaining 4.87 months (95% CI 3.60–6.24) longer in paid employment. Workers born after the threshold, annually earning €25 000–40 000, spent 1.24 months (95% CI 0.31–2.18) more in economic inactivity than those born before. The working months lost to unemployment increased by 1.50 months (95% CI 0.30–2.71) for female workers and 1.99 months (95% CI 0.06–3.92) for workers reporting multiple chronic diseases. CONCLUSIONS: The national reform successfully prolonged working lives of older workers. However, workers with a middle income, female workers, and workers with chronic diseases were more vulnerable to premature exit from the labor market through unemployment or being without any income or benefit.

Objectives This study investigated the effects of a national early retirement reform, which was implemented in 2006 and penalized early retirement, on paid employment and different exit pathways and examined whether these effects differ by gender, income level and health status. Methods This study included all Dutch individuals in paid employment born six months before (control group) and six months after (intervention group) the cut-off date of the reform (1 January 1950) that fiscally penalized early retirement. A regression discontinuity design combined with restricted mean survival time analysis was applied to evaluate the effect of penalizing early retirement on labor force participation from age 60 until workers reached the retirement age of 65 years, while accounting for secular trends around the threshold. Results The intervention group postponed early retirement by 7.41 months [95% confidence interval (CI) 6.11-8.72], and partly replaced this by remaining 4.87 months (95% CI 3.60-6.24) longer in paid employment. Workers born after the threshold, annually earning €25 000-40 000, spent 1.24 months (95% CI 0.31-2.18) more in economic inactivity than those born before. The working months lost to unemployment increased by 1.50 months (95% CI 0.30-2.71) for female workers and 1.99 months (95% CI 0.06-3.92) for workers reporting multiple chronic diseases. Conclusions The national reform successfully prolonged working lives of older workers. However, workers with a middle income, female workers, and workers with chronic diseases were more vulnerable to premature exit from the labor market through unemployment or being without any income or benefit. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The aim of this study was to examine the association between co-occurring work stressors and risk of disability pension. METHODS: The work stressors job strain, effort−reward imbalance (ERI), and organizational injustice were measured by a survey in 2008 of 41 862 employees linked to national records of all-cause and cause-specific disability pensions until 2011. Co-occurring work stressors were examined as risk factors of work disability using Cox regression marginal models. RESULTS: Work stressors were clustered: 50.8% had no work stressors [observed-to-expected ratio (O/E)=1.2], 27.4% were exposed to one stressor (O/E=0.61–0.81), 17.7% to two stressors (O/E=0.91–1.73) and 6.4% to all three stressors (O/E=2.59). During a mean follow-up of 3.1 years, 976 disability pensions were granted. Compared to employees with no work stressors, those with (i) co-occurring strain and ERI or (ii) strain, ERI and injustice had a 1.9–2.1-fold [95% confidence interval (CI) 1.7–2.6] increased risk of disability retirement. The corresponding hazard ratios were 1.2 and 1.5 (95% CI 1.0–1.8) for strain and ERI alone. Risk of disability pension from depressive disorders was 4.4–4.7-fold (95% CI 2.4–8.0) for combinations of strain+ERI and strain+ERI+injustice, and 1.9–2.5-fold (95% CI 1.1–4.0) for strain and ERI alone. For musculoskeletal disorders, disability risk was 1.6–1.9-fold (95% CI 1.3–2.3) for strain+ERI and ERI+injustice combinations, and 1.3-fold (95% CI 1.0–1.7) for strain alone. Supplementary analyses with work stressors determined using work-unit aggregates supported these findings. CONCLUSIONS: Work stressors tend to cluster in the same individuals. The highest risk of disability pension was observed among those with work stressor combinations strain+ERI or strain+ERI+injustice, rather than for those with single stressors.

OBJECTIVE: This study examines the impact of organizational change and psychosocial work environment on non-disability early retirement among senior public service employees. METHODS: In January and February 2011, Danish senior public service employees aged 58–64 years (N=3254) from the Capital Region of Denmark responded to a survey assessing psychosocial work environment (ie, social capital, organizational justice, and quality of management). Work-unit organizational changes (ie, change of management, merging, demerging, and relocation) were recorded from January 2009 to March 2011. Weekly data on non-disability early retirement transfer were obtained from the DREAM register database, which holds weekly information about all public benefit payments in Denmark. Hazard ratios (HR) for early retirement following employees’ 60^th birthday were estimated with Cox regression adjusted for age, gender, and socioeconomic status. RESULTS: Exposure to change of management [HR 1.37, 95% confidence interval (95% CI) 1.13–1.66], mergers (HR 1.23, 95% CI 1.02–1.48), and relocation of work unit (HR 1.24, 95% CI 1.01–1.54) increased rate of non-disability early retirement, while demerging of work unit did not (HR 1.03, 95% CI 0.79–1.33). Work units with lower levels of social capital (HR 1.22, 95% CI 1.05–1.41), organizational justice, (HR 1.18, 95% CI 1.04–1.32), and quality of management (HR 1.14, 95% CI 1.02–1.25) increased rate of early retirement. CONCLUSION: Organizational change and poor psychosocial work environment contribute to non-disability early retirement among senior public service employees, measured at work-unit level.

OBJECTIVES: The study aimed to (i) determine the influence of poor health on competing exit routes from paid employment among older workers in Europe, (ii) assess whether these risks are different among welfare state regimes in Europe, and (iii) evaluate differences in estimates between two different competing risk approaches. METHODS: The study population consisted of 5273 respondents (6-years follow-up) from the Survey of Health, Ageing, and Retirement in Europe (SHARE). The effect of poor health on exit routes from paid employment was assessed with a cause-specific Cox model and a Fine & Gray (F&G) model. These two competing risk analyses were used to calculate absolute risks of labor force exit among welfare state regimes in Europe. RESULTS: In both models, poor health was a risk factor for disability benefit [hazard ratio (HR) 3.36; subdistribution hazard ratio (SHR) 3.22], and unemployment (HR 1.43, SHR 1.32). Both models produced similar absolute risks. In countries with a Bismarckian welfare state regime, low-educated older workers living alone and in poor health had an 11% risk of disability benefit, 7% of unemployment, 46% of early retirement, and 7% of becoming economically inactive. In countries with a Scandinavian welfare state regime, the risks were 10%, 7%, 29%, and 3%, respectively, and in Southern European welfare state regimes 4%, 5%, 35%, and 7%. CONCLUSIONS: Workers with poor health are more likely to leave the labor force than workers with good health. The absolute risks of early retirement and becoming economically inactive were lowest in countries with a Scandinavian welfare state regime. For disability benefit and unemployment, absolute risks were lowest in Southern European welfare state regimes. The direct estimation of absolute risks of leaving the labor force in the presence of competing exit routes is an appealing feature of the F&G model.

OBJECTIVE: Policy in many industrialized countries increasingly emphasizes extended working life. We examined associations between physical and cognitive capability in mid-adulthood and work in late adulthood. METHODS: Using self-reported physical limitations and performance-based physical and cognitive capability at age 53, assessed by trained nurses from the Medical Research Council (MRC) National Survey of Health and Development, we examined prospective associations with extended working (captured by age at and reason for retirement from main occupation, bridge employment in paid work after retirement from the main occupation, and voluntary work participation) up to age 68 among >2000 men and women. RESULTS: Number of reported physical limitations at age 53 was associated with higher likelihood of retiring for negative reasons and lower likelihood of participating in bridge employment, adjusted for occupational class, education, partner’s employment, work disability at age 53, and gender. Better performance on physical and cognitive tests was associated with greater likelihood of participating in bridge or voluntary work. Cognitive capability in the top 10% compared with the middle 80% of the distribution was associated with an odds ratio of bridge employment of 1.71 [95% confidence interval (95% CI) 1.21–2.42]. CONCLUSIONS: The possibility for an extending working life is less likely to be realized by those with poorer midlife physical or cognitive capability, independently of education, and social class. Interventions to promote capability, starting in mid-adulthood or earlier, could have long-term consequences for extending working.

OBJECTIVES: We analyzed the work ability index (WAI) and its first item (work ability score, WAS) – and subsequent four-year changes thereof – as predictors of disability pension (DP). METHODS: We linked survey responses of 5251 Finnish municipal employees, aged 44–58 years, to pension and death register data until 2009. Job content (physical, mental, or mixed) was based on observation. Baseline (1981) WAI was divided into poor (37) and WAS into poor (0–5), moderate (6–7), and good/excellent (8–10). Four-year changes in these scores were classified as strong decline (

OBJECTIVES: Using Swedish population-based register data, we examined the extent to which comorbid conditions contribute to the risk of disability pension among people with diabetes. METHODS: We carried out Cox proportional hazard analyses with comorbid conditions as time-dependent covariates among 14 198 people with newly diagnosed diabetes in 2006, and 39 204 people free from diabetes during the follow-up from 2007–2010. The average follow-up times were 46 and 48 months for those with and without diabetes, respectively. RESULTS: For those with diabetes only, the incidence of all-cause disability pension was 9.5 per 1000 person-years. The highest incidence of disability pension were for those with: diabetes and depression (23.6); diabetes and musculoskeletal disorder (30.6), and those with diabetes and more than one comorbid condition (36.5). The incidence rate was 5.8 for those without diabetes. Diabetes was associated with a 2.30 times [95% confidence interval (95% CI) 2.09–2.54] higher risk of disability pension (adjusted for sociodemographic factors). This association attenuated by 41% after further adjustment for comorbid chronic conditions. While diabetes was a risk factor for disability pension due to musculoskeletal disorders and diseases of the circulatory system, even after accounting for the above-mentioned conditions, the association between disability pension due to mental disorders and diabetes was diluted after adjustment for mental disorders. CONCLUSIONS: Although diabetes is an independent risk factor for disability pension, comorbid conditions contribute to this risk to a large degree.

OBJECTIVES: This study aimed to investigate (i) the influence of entering or leaving paid employment on self-rated health trajectories before, during, and after this transition and (ii) educational differences in these health trajectories. METHODS: In this prospective study, we used yearly measurements of self-rated health from the European Community Household Panel (ECHP) to establish how health is affected by employment transitions in or out of the workforce due to early retirement, unemployment or economic inactivity. Trajectories of self-rated health were analyzed among 136 556 persons with low, intermediate, or high educational level by repeated-measures logistic regression with generalized estimating equations. RESULTS: Among low-educated workers, ill-health partly prompted their voluntary labor force exit through early retirement and becoming economically inactive, but thereafter these exit routes seemed to prevent further deterioration of their health. In contrast, among higher educated workers, early retirement had an adverse effect on their self-rated health. Becoming unemployed had adverse effects on self-rated health among all educational levels. Entering paid employment was predetermined by self-rated health improvement in the preceding years among intermediate and high educated workers, whereas, among low-educated workers, self-rated health improved in the year of entering paid employed and continued to improve in the following years. CONCLUSIONS: Prolonging working life may have both adverse and beneficial effects on self-rated health. Health inequalities may increase when every person, independent of educational level, must perform paid employment until the same age before being able to retire.

Objectives The aim of this study was to examine the association between co-occurring work stressors and risk of disability pension. Methods The work stressors job strain, effort--reward imbalance (ERI), and organizational injustice were measured by a survey in 2008 of 41 862 employees linked to national records of all-cause and cause-specific disability pensions until 2011. Co-occurring work stressors were examined as risk factors of work disability using Cox regression marginal models. Results Work stressors were clustered: 50.8% had no work stressors [observed-to-expected ratio (O/E)=1.2], 27.4% were exposed to one stressor (O/E=0.61-0.81), 17.7% to two stressors (O/E=0.91-1.73) and 6.4% to all three stressors (O/E=2.59). During a mean follow-up of 3.1 years, 976 disability pensions were granted. Compared to employees with no work stressors, those with (i) co-occurring strain and ERI or (ii) strain, ERI and injustice had a 1.9-2.1-fold [95% confidence interval (CI) 1.7-2.6] increased risk of disability retirement. The corresponding hazard ratios were 1.2 and 1.5 (95% CI 1.0-1.8) for strain and ERI alone. Risk of disability pension from depressive disorders was 4.4-4.7-fold (95% CI 2.4-8.0) for combinations of strain+ERI and strain+ERI+injustice, and 1.9-2.5-fold (95% CI 1.1-4.0) for strain and ERI alone. For musculoskeletal disorders, disability risk was 1.6-1.9-fold (95% CI 1.3-2.3) for strain+ERI and ERI+injustice combinations, and 1.3-fold (95% CI 1.0-1.7) for strain alone. Supplementary analyses with work stressors determined using work-unit aggregates supported these findings. Conclusions Work stressors tend to cluster in the same individuals. The highest risk of disability pension was observed among those with work stressor combinations strain+ERI or strain+ERI+injustice, rather than for those with single stressors. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Determinants in the domains health, job characteristics, skills, and social and financial factors may influence early retirement through three central explanatory variables, namely, the ability, motivation, and opportunity to work. Based on the literature, we created the Early Retirement Model. This study aims to investigate whether data support the model and how it could be improved. METHODS: Employees aged 58–62 years (N=1862), who participated in the first three waves of the Dutch Study on Transitions in Employment, Ability and Motivation (STREAM) were included. Determinants were assessed at baseline, central explanatory variables after one year, and early retirement after two years. Structural equation modeling was applied. RESULTS: Testing the Early Retirement Model resulted in a model with good fit. Health, job characteristics, skills, and social and financial factors were related to the ability, motivation and/or opportunity to work (significant β range: 0.05–0.31). Lower work ability (β=-0.13) and less opportunity to work (attitude colleagues and supervisor about working until age 65: β=-0.24) predicted early retirement, whereas the motivation to work (work engagement) did not. The model could be improved by adding direct effects of three determinants on early retirement, ie, support of colleagues and supervisor (β=0.14), positive attitude of the partner with respect to early retirement (β=0.15), and not having a partner (β=-0.13). CONCLUSIONS: The Early Retirement Model was largely supported by the data but could be improved. The prolongation of working life might be promoted by work-related interventions focusing on health, work ability, the social work climate, social norms on prolonged careers, and the learning environment.

OBJECTIVES: Job strain has previously been shown to predict disability pension, but it is unknown whether effort-reward imbalance (ERI), another major stress model, is also associated with disability pension. METHODS: We examined ERI as a risk factor for diagnosis-specific disability pension in a cohort of 51 874 public-sector employees in Finland. To control for reporting bias, work unit-level scores of ERI (based on the survey responses of 35 260 employees in 2000–2002) were constructed and linked to all eligible employees. A sub-cohort of the respondents was analyzed also with individual-level ERI. Disability pension data were derived from national pension registers with no loss to follow-up. The outcomes were all-cause disability pension and disability pension due to depression, musculoskeletal diseases, and ischemic heart diseases (IHD). Multivariate Cox proportional hazard models (adjusted for sociodemographic factors, baseline health, and work-related characteristics) were used for analyses. RESULTS: During a mean 8.9 years of follow-up, 4542 participants were granted disability pension. An increased risk for disability pension due to depression was detected for both high work unit- and individual-level ERI [hazard ratio (HR) 1.63, 95% confidence interval (95% CI) 1.31–2.04 and HR 1.90, 95% CI 1.51–2.40, respectively]. High individual-level ERI increased the risk of disability pension due to musculoskeletal diseases (HR 1.32, 95% CI 1.13–1.53), but no association was observed for work unit-level ERI (HR 1.02, 95% CI 0.88–1.19). ERI was not associated with disability pension due to IHD. CONCLUSION: The present study showed a consistent association between high ERI and an increased risk of disability pension due to depression.

OBJECTIVES: This study aimed to investigate the relative contribution of health, job characteristics, skills and knowledge, and social and financial factors to the transition from work to (non-disability) early retirement. METHODS: Employees aged 59–63 years (N=2317) were selected from the Study on Transitions in Employment, Ability and Motivation in the Netherlands (STREAM). Individual characteristics, health, job characteristics, skills and knowledge, and social and financial factors were measured using a questionnaire at baseline. Information on early retirement was derived from the one-year follow-up questionnaire. Logistic regression analyses were used to identify predictors of early retirement. Population Attributable Fractions (PAF) were calculated. RESULTS: Older age [odds ratio (OR) 1.79], poor physical health (OR 1.78), a positive attitude of the partner with respect to early retirement (OR 3.85), and the financial possibility to stop working before the age of 65 (OR 10.2) predicted the transition to early retirement, whereas employees that reported high appreciation at work (OR 0.58) and higher focus on development of skills and knowledge (OR 0.54) were less likely to retire early. PAF were 0.75 for the financial possibility to stop working, 0.43 for a positive attitude of the partner with respect to early retirement, 0.27 for low appreciation at work, 0.23 for a low focus on development, and 0.21 for poor health. CONCLUSIONS: The financial possibility to stop working before the age of 65 importantly contributes to early retirement. In the context of rapidly diminishing financial opportunities to retire early in the Netherlands, the prolongation of working life might be promoted by workplace health promotion and disability management, and work-related interventions focusing on appreciation and the learning environment.

Objective This study examines the impact of organizational change and psychosocial work environment on non-disability early retirement among senior public service employees. Methods In January and February 2011, Danish senior public service employees aged 58-64 years (N=3254) from the Capital Region of Denmark responded to a survey assessing psychosocial work environment (ie, social capital, organizational justice, and quality of management). Work-unit organizational changes (ie, change of management, merging, demerging, and relocation) were recorded from January 2009 to March 2011. Weekly data on non-disability early retirement transfer were obtained from the DREAM register database, which holds weekly information about all public benefit payments in Denmark. Hazard ratios (HR) for early retirement following employees' 60th birthday were estimated with Cox regression adjusted for age, gender, and socioeconomic status. Results Exposure to change of management [HR 1.37, 95% confidence interval (95% CI) 1.13-1.66], mergers (HR 1.23, 95% CI 1.02-1.48), and relocation of work unit (HR 1.24, 95% CI 1.01-1.54) increased rate of non- disability early retirement, while demerging of work unit did not (HR 1.03, 95% CI 0.79-1.33). Work units with lower levels of social capital (HR 1.22, 95% CI 1.05-1.41), organizational justice, (HR 1.18, 95% CI 1.04-1.32), and quality of management (HR 1.14, 95% CI 1.02-1.25) increased rate of early retirement. Conclusion Organizational change and poor psychosocial work environment contribute to non-disability early retirement among senior public service employees, measured at work-unit level. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The objective of this review was to analyze systematically the association between overweight, obesity, and lack of physical activity (PA) and exit from paid employment through disability pension, unemployment, and early retirement. We also aimed to identify the influence of study population and study design on the magnitude of this association. METHODS: We searched PubMed and Embase for English language, longitudinal, quantitative studies that described the relationship between overweight, obesity, or lack of PA and exit from work. A short checklist was used to assess the internal and external validity of the studies. We first estimated the pooled effects using a random effects model and then analyzed the influence of study and population characteristics on associations by stratified meta-analyses. RESULTS: In total, 28 out of 1097 publications met the inclusion criteria. Obese [relative risk (RR)=1.53) and, to a lesser extent, overweight (RR=1.16) individuals had an increased likelihood of exit from paid employment through disability pension, but were not at statistically significant increased risk for unemployment or early retirement. Of 17 associations between a lack of PA and disability pension, 8 were statistically significant; this was also the case for 2 of 3 for unemployment. No associations were statistically significant for early retirement. CONCLUSIONS: Obesity is a risk factor for exit from paid employment through disability pension. There are also indications that a lack of PA is related to an increased risk of disability pension and unemployment. To protect workers against premature exit from paid employment, long-term interventions to prevent overweight and obesity and promote PA in the working population should be considered for implementation

OBJECTIVES: The aim of this study was to get insight into the role of poor health, unhealthy behaviors, and unfavorable work characteristics on exit from paid employment due to disability pension, unemployment, and early retirement among older workers. METHODS: Respondents of the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE) in 11 European countries were selected when (i) aged between 50 years and the country-specific retirement age, (ii) in paid employment at baseline, and (iii) having information on employment status during the 4-year follow-up period (N=4923). Self-perceived health, health behaviors, and physical and psychosocial work characteristics were measured by interview at baseline. Employment status was derived from follow-up interviews after two and four years. Cox proportional hazards regression analyses were used to identify determinants of unemployment, disability pension, and early retirement. RESULTS: Poor health was a risk factor for disability pension [hazard ratio (HR) 3.90, 95% confidence interval (95% CI) 2.51–6.05], and a lack of physical activity was a risk factor for disability pension (HR 3.05, 95% CI 1.68–5.55) and unemployment (HR 1.84, 95% CI 1.13–3.01). A lack of job control was a risk factor for disability pension, unemployment, and early retirement (HR 1.30–1.77). CONCLUSIONS: Poor health, a lack of physical activity, and a lack of job control played a role in exit from paid employment, but their relative importance differed by pathway of labor force exit. Primary preventive interventions focusing on promoting physical activity as well as increasing job control may contribute to reducing premature exit from paid employment.

OBJECTIVES: The aim of this study was to investigate the effect of ill health and socioeconomic status on labor force exit due to unemployment, early retirement, disability pension, or becoming economically inactive. A secondary objective was to investigate the effect of ill health and socioeconomic status on return to work. METHODS: A representative sample of the Dutch working population (N=15 152) was selected for a prospective study with ten years follow-up (93 917 person-years). Perceived health and individual and household characteristics were measured at baseline with the Permanent Quality of Life Survey (POLS) during 1999–2002. Statistics Netherlands ascertained employment status monthly from January 1999 to December 2008. Cox proportional hazards analyses were used to determine the factors that predicted labor force exit and return to work. RESULTS: Ill health increased the likelihood of labor force exit into unemployment [hazard ratio (HR) 1.89], disability pension (HR 6.39), and early retirement (HR 1.20), but was not a determinant of becoming economically inactive (HR 1.07). Workers with low socioeconomic status were, even after adjusting for ill health, more likely to leave the labor force due to unemployment, disability pension, and economic inactivity. Workers with ill health at baseline were less likely to return to work after unemployment (HR 0.75) or disability pension (HR 0.62). Socioeconomic status did not influence re-employment. CONCLUSIONS: Ill health is an important determinant for entering and maintaining paid employment. Workers with lower education were at increased risk for health-based selection out of paid employment. Policies to improve labor force participation, especially among low socioeconomic level workers, should protect workers with health problems against exclusion from the labor force.

OBJECTIVES: Long-term heavy work impairs employees, and they may retire prematurely by law. We investigated the value of energy expenditure (EE) during work shifts as a means to define heavy workload. METHODS: The study comprised 79 male [mean age 32.2 (standard deviation [SD] 7.5) years] and 33 female [33.5 (SD 11.2) years] employees in different occupations classified as "heavy work" (EE of 1400 and 2000 kcal for women and men, respectively). Cycle ergometry determined exercise performance. Gas exchange measures were performed during selected phases of work, and heart rate (HR) recordings were obtained for a complete work shift. EE was calculated from gas exchange measures. RESULTS: Male and female subjects differed significantly for maximal power output (P_max) [men=206.3 (SD 47.3) watts; women=149.6 (SD 36.1) watts] and maximal oxygen consumption (VO_2max) [men=2.965 (SD 0.63) l/min; women= 1.958 (SD 0.50) l/min] in the cycle ergometer test. Shift HR (HR_Sh) was found between 102 (SD 14) b/min [57.6 (SD 8.5) % HR_max] and 99 (SD 10) b/min [55.5 (SD 5.9) % HR_max] dependent on tasks and groups. Working EE was found between 1864 (SD 732) kcal and 1249 (SD 609) kcal for men and women, respectively, but approximately 60% of subjects were well below the legal limits. CONCLUSIONS: The legal definition of heavy workload by mean working EE per 8-hour work shift applies to all investigated occupations; however, a substantial proportion of workers may not fulfill the criterion if applied individually. Alternative definitions of heavy workload in terms of absolute oxygen consumption or EE relative to cardiorespiratory fitness lead to similar classification results of the investigated occupations.

Objectives The study aimed to (i) determine the influence of poor health on competing exit routes from paid employment among older workers in Europe, (ii) assess whether these risks are different among welfare state regimes in Europe, and (iii) evaluate differences in estimates between two different competing risk approaches. Methods The study population consisted of 5273 respondents (6-years follow-up) from the Survey of Health, Ageing, and Retirement in Europe (SHARE). The effect of poor health on exit routes from paid employment was assessed with a cause-specific Cox model and a Fine & Gray (F&G) model. These two competing risk analyses were used to calculate absolute risks of labor force exit among welfare state regimes in Europe. Results In both models, poor health was a risk factor for disability benefit [hazard ratio (HR) 3.36; subdistribution hazard ratio (SHR) 3.22], and unemployment (HR 1.43, SHR 1.32). Both models produced similar absolute risks. In countries with a Bismarckian welfare state regime, low-educated older workers living alone and in poor health had an 11% risk of disability benefit, 7% of unemployment, 46% of early retirement, and 7% of becoming economically inactive. In countries with a Scandinavian welfare state regime, the risks were 10%, 7%, 29%, and 3%, respectively, and in Southern European welfare state regimes 4%, 5%, 35%, and 7%. Conclusions Workers with poor health are more likely to leave the labor force than workers with good health. The absolute risks of early retirement and becoming economically inactive were lowest in countries with a Scandinavian welfare state regime. For disability benefit and unemployment, absolute risks were lowest in Southern European welfare state regimes. The direct estimation of absolute risks of leaving the labor force in the presence of competing exit routes is an appealing feature of the F&G model. [ABSTRACT FROM AUTHOR]

Objective Policy in many industrialized countries increasingly emphasizes extended working life. We examined associations between physical and cognitive capability in mid-adulthood and work in late adulthood. Methods Using self-reported physical limitations and performance-based physical and cognitive capability at age 53, assessed by trained nurses from the Medical Research Council (MRC) National Survey of Health and Development, we examined prospective associations with extended working (captured by age at and reason for retirement from main occupation, bridge employment in paid work after retirement from the main occupation, and voluntary work participation) up to age 68 among >2000 men and women. Results Number of reported physical limitations at age 53 was associated with higher likelihood of retiring for negative reasons and lower likelihood of participating in bridge employment, adjusted for occupational class, education, partner's employment, work disability at age 53, and gender. Better performance on physical and cognitive tests was associated with greater likelihood of participating in bridge or voluntary work. Cognitive capability in the top 10% compared with the middle 80% of the distribution was associated with an odds ratio of bridge employment of 1.71 [95% confidence interval (95% CI) 1.21-2.42]. Conclusions The possibility for an extending working life is less likely to be realized by those with poorer midlife physical or cognitive capability, independently of education, and social class. Interventions to promote capability, starting in mid-adulthood or earlier, could have long-term consequences for extending working. [ABSTRACT FROM AUTHOR]

Objectives We analyzed the work ability index (WAI) and its first item (work ability score, WAS) - and subsequent four-year changes thereof - as predictors of disability pension (DP). Methods We linked survey responses of 5251 Finnish municipal employees, aged 44-58 years, to pension and death register data until 2009. Job content (physical, mental, or mixed) was based on observation. Baseline (1981) WAI was divided into poor (<27), moderate (28-36), and good/excellent (>37) and WAS into poor (0-5), moderate (6-7), and good/excellent (8-10). Four-year changes in these scores were classified as strong decline (

Objectives Using Swedish population-based register data, we examined the extent to which comorbid conditions contribute to the risk of disability pension among people with diabetes. Methods We carried out Cox proportional hazard analyses with comorbid conditions as time-dependent covariates among 14 198 people with newly diagnosed diabetes in 2006, and 39 204 people free from diabetes during the follow-up from 2007–2010. The average follow-up times were 46 and 48 months for those with and without diabetes, respectively. Results For those with diabetes only, the incidence of all-cause disability pension was 9.5 per 1000 personyears. The highest incidence of disability pension were for those with: diabetes and depression (23.6); diabetes and musculoskeletal disorder (30.6), and those with diabetes and more than one comorbid condition (36.5). The incidence rate was 5.8 for those without diabetes. Diabetes was associated with a 2.30 times [95% confidence interval (95% CI) 2.09–2.54] higher risk of disability pension (adjusted for sociodemographic factors). This association attenuated by 41% after further adjustment for comorbid chronic conditions. While diabetes was a risk factor for disability pension due to musculoskeletal disorders and diseases of the circulatory system, even after accounting for the above-mentioned conditions, the association between disability pension due to mental disorders and diabetes was diluted after adjustment for mental disorders. Conclusions Although diabetes is an independent risk factor for disability pension, comorbid conditions contribute to this risk to a large degree. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to investigate (i) the influence of entering or leaving paid employment on self-rated health trajectories before, during, and after this transition and (ii) educational differences in these health trajectories. Methods In this prospective study, we used yearly measurements of self-rated health from the European Community Household Panel (ECHP) to establish how health is affected by employment transitions in or out of the workforce due to early retirement, unemployment or economic inactivity. Trajectories of self-rated health were analyzed among 136 556 persons with low, intermediate, or high educational level by repeated-measures logistic regression with generalized estimating equations. Results Among low-educated workers, ill-health partly prompted their voluntary labor force exit through early retirement and becoming economically inactive, but thereafter these exit routes seemed to prevent further deterioration of their health. In contrast, among higher educated workers, early retirement had an adverse effect on their self-rated health. Becoming unemployed had adverse effects on self-rated health among all educational levels. Entering paid employment was predetermined by self-rated health improvement in the preceding years among intermediate and high educated workers, whereas, among low-educated workers, self-rated health improved in the year of entering paid employed and continued to improve in the following years. Conclusions Prolonging working life may have both adverse and beneficial effects on self-rated health. Health inequalities may increase when every person, independent of educational level, must perform paid employment until the same age before being able to retire. [ABSTRACT FROM AUTHOR]

Objectives: Determinants in the domains health, job characteristics, skills, and social and financial factors may influence early retirement through three central explanatory variables, namely, the ability, motivation, and opportunity to work. Based on the literature, we created the Early Retirement Model. This study aims to investigate whether data support the model and how it could be improved. Methods: Employees aged 58-62 years (N=1862), who participated in the first three waves of the Dutch Study on Transitions in Employment, Ability and Motivation (STREAM) were included. Determinants were assessed at baseline, central explanatory variables after one year, and early retirement after two years. Structural equation modeling was applied. Results: Testing the Early Retirement Model resulted in a model with good fit. Health, job characteristics, skills, and social and financial factors were related to the ability, motivation and/or opportunity to work (significant ß range: 0.05-0.31). Lower work ability (ß= -0.13) and less opportunity to work (attitude colleagues and supervisor about working until age 65: ß= -0.24) predicted early retirement, whereas the motivation to work (work engagement) did not. The model could be improved by adding direct effects of three determinants on early retirement, ie, support of colleagues and supervisor (ß=0.14), positive attitude of the partner with respect to early retirement (ß=0.15), and not having a partner (ß= -0.13). Conclusions: The Early Retirement Model was largely supported by the data but could be improved. The prolongation of working life might be promoted by work-related interventions focusing on health, work ability, the social work climate, social norms on prolonged careers, and the learning environment. [ABSTRACT FROM AUTHOR]

Objectives Job strain has previously been shown to predict disability pension, but it is unknown whether effort-reward imbalance (ERI), another major stress model, is also associated with disability pension. Methods We examined ERI as a risk factor for diagnosis-specific disability pension in a cohort of 51 874 public-sector employees in Finland. To control for reporting bias, work unit-level scores of ERI (based on the survey responses of 35 260 employees in 2000-2002) were constructed and linked to all eligible employees. A subcohort of the respondents was analyzed also with individual-level ERI. Disability pension data were derived from national pension registers with no loss to follow-up. The outcomes were all-cause disability pension and disability pension due to depression, musculoskeletal diseases, and ischemic heart diseases (IHD). Multivari-ate Cox proportional hazard models (adjusted for sociodemographic factors, baseline health, and work-related characteristics) were used for analyses. Results During a mean 8.9 years of follow-up, 4542 participants were granted disability pension. An increased risk for disability pension due to depression was detected for both high work unit- and individual-level ERI [haz-ard ratio (HR) 1.63,95% confidence interval (95% CI) 1.31-2.04 and HR 1.90,95% CI 1.51-2.40, respectively]. High individual-level ERI increased the risk of disability pension due to musculoskeletal diseases (HR 1.32,95% CI 1.13-1.53), but no association was observed for work unit-level ERI (HR 1.02, 95% CI 0.88-1.19). ERI was not associated with disability pension due to IHD. Conclusion The present study showed a consistent association between high ERI and an increased risk of dis-ability pension due to depression. [ABSTRACT FROM AUTHOR]

Objectives The objective of this review was to analyze systematically the association between overweight, obesity, and lack of physical activity (PA) and exit from paid employment through disability pension, unemploy-ment, and early retirement. We also aimed to identify the influence of study population and study design on the magnitude of this association. Methods We searched PubMed and Embase for English language, longitudinal, quantitative studies that described the relationship between overweight, obesity, or lack of PA and exit from work. A short checklist was used to assess the internal and external validity of the studies. We first estimated the pooled effects using a random effects model and then analyzed the influence of study and population characteristics on associations by stratified meta-analyses. Results In total, 28 out of 1097 publications met the inclusion criteria. Obese [relative risk (RR)=1.53] and, to a lesser extent, overweight (RR=1.16) individuals had an increased likelihood of exit from paid employment through disability pension, but were not at statistically significant increased risk for unemployment or early retirement. Of 17 associations between a lack of PA and disability pension, 8 were statistically significant; this was also the case for 2 of 3 for unemployment. No associations were statistically significant for early retirement. Conclusions Obesity is a risk factor for exit from paid employment through disability pension. There are also indications that a lack of PA is related to an increased risk of disability pension and unemployment. To protect workers against premature exit from paid employment, long-term interventions to prevent overweight and obesity and promote PA in the working population should be considered for implementation. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to investigate the effect of ill health and socioeconomic status on labor force exit due to unemployment, early retirement, disability pension, or becoming economically inactive. A secondary objective was to investigate the effect of ill health and socioeconomic status on return to work. Methods A representative sample of the Dutch working population (N=l 5 152) was selected for a prospective study with ten years follow-up (93 917 person-years). Perceived health and individual and household character-istics were measured at baseline with the Permanent Quality of Life Survey (POLS) during 1999-2002. Statistics Netherlands ascertained employment status monthly from January 1999 to December 2008. Cox proportional hazards analyses were used to determine the factors that predicted labor force exit and return to work. Results 111 health increased the likelihood of labor force exit into unemployment [hazard ratio (HR) 1.89], disability pension (HR 6.39), and early retirement (HR 1.20), but was not a determinant of becoming economi-cally inactive (HR 1.07). Workers with low socioeconomic status were, even after adjusting for ill health, more likely to leave the labor force due to unemployment, disability pension, and economic inactivity. Workers with ill health at baseline were less likely to return to work after unemployment (HR 0.75) or disability pension (HR 0.62). Socioeconomic status did not influence re-employment. Conclusions 111 health is an important determinant for entering and maintaining paid employment. Workers with lower education were at increased risk for health-based selection out of paid employment. Policies to improve labor force participation, especially among low socioeconomic level workers, should protect workers with health problems against exclusion from the labor force. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to get insight into the role of poor health, unhealthy behaviors, and unfavorable work characteristics on exit from paid employment due to disability pension, unemployment, and early retirement among older workers. Methods Respondents of the longitudinal Survey of Health, Ageing, and Retirement in Europe (SHARE) in 11 European countries were selected when (i) aged between 50 years and the country-specific retirement age, (ii) in paid employment at baseline, and (iii) having information on employment status during the 4-year follow-up period (N=4923). Self-perceived health, health behaviors, and physical and psychosocial work characteristics were measured by interview at baseline. Employment status was derived from follow-up interviews after two and four years. Cox proportional hazards regression analyses were used to identify determinants of unemployment, disability pension, and early retirement. Results Poor health was a risk factor for disability pension [hazard ratio (HR) 3.90, 95% confidence interval (95% CI) 2.51-6.05], and a lack of physical activity was a risk factor for disability pension (HR 3.05, 95% CI 1.68-5.55) and unemployment (HR 1.84,95% CI 1.13-3.01). A lack of job control was a risk factor for disability pension, unemployment, and early retirement (HR 1.30-1.77). Conclusions Poor health, a lack of physical activity, and a lack of job control played a role in exit from paid employment, but their relative importance differed by pathway of labor force exit. Primary preventive inter-ventions focusing on promoting physical activity as well as increasing job control may contribute to reducing premature exit from paid employment. [ABSTRACT FROM AUTHOR]

In this article, the authors discuss the association of socioeconomic status (SES) with the health of employees. They discusses the results of a study published in the periodical which was based on a rich data set that permitted the separation of different pathways out of work including unemployment, early retirement, and disability pension.