Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2019

Open Access 01-12-2019 | Research article

Educational inequalities in health after work exit: the role of work characteristics

Authors: Sascha de Breij, Jeevitha Yogachandiran Qvist, Daniel Holman, Jana Mäcken, Jorma Seitsamo, Martijn Huisman, Dorly J. H. Deeg

Published in: BMC Public Health | Issue 1/2019

Login to get access

Abstract

Background

Educational inequalities in health have been widely reported. A low educational level is associated with more adverse working conditions. Working conditions, in turn, are associated with health and there is evidence that this association remains after work exit. Because many countries are raising the statutory retirement age, lower educated workers have to spend more years working under adverse conditions. Therefore, educational health inequalities may increase in the future. This study examined (1) whether there were educational differences over time in health after work exit and (2) whether work characteristics mediate these educational inequalities in health.

Methods

Data from five prospective cohort studies were used: The Netherlands (Longitudinal Aging Study Amsterdam), Denmark (Danish Longitudinal Study of Aging), England (English Longitudinal Study of Ageing), Germany (German Aging Study), and Finland (Finnish Longitudinal Study on Municipal Employees). In each dataset we used Generalized Estimating Equations to examine the relationship between education and self-rated health after work exit with a maximum follow-up of 15 years and possible mediation of work characteristics, including physical demands, psychosocial demands, autonomy, and variation in activities.

Results

The low educated reported significantly poorer health after work exit than the higher educated. Lower educated workers had a higher risk of high physical demands and a lower risk of high psychosocial demands, high variation in tasks, and high autonomy at work, compared to higher educated workers. These work characteristics were found to be mediators of the relationship between education and health after work exit, consistent across countries.

Conclusion

Educational inequalities in health are still present after work exit. If workers are to spend an extended part of their lives at work due to an increase in the statutory retirement age, these health inequalities may increase. Improving working conditions will likely reduce these inequalities in health.
Literature
1.
Walker A, Maltby T. Active ageing: a strategic policy solution to demographic ageing in the European Union. Int J Soc Welf. 2012;21(s1):S117–30.CrossRef
2.
3.
Everson SA, et al. Epidemiologic evidence for the relation between socioeconomic status and depression, obesity, and diabetes. J Psychosom Res. 2002;53:891–5.CrossRefPubMed
4.
Mackenbach JP, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358(23):2468–81.CrossRefPubMed
5.
Huisman, et al., Socioeconomic inequalities in mortality rates in old age in the World Health Organization Europe region. Epidemiologic reviews, 2013: p. mxs010-mxs010.
6.
Crimmins EM, Saito Y. Trends in healthy life expectancy in the United States, 1970–1990: gender, racial, and educational differences. Soc Sci Med. 2001;52(11):1629–41.CrossRefPubMed
7.
Schoeni RF, et al. Persistent and growing socioeconomic disparities in disability among the elderly: 1982-2002. Am J Public Health. 2005;95(11):2065–70.CrossRefPubMedPubMedCentral
8.
Hämmig O, Bauer GF. The social gradient in work and health: a cross-sectional study exploring the relationship between working conditions and health inequalities. BMC Public Health. 2013;13(1):1170.CrossRefPubMedPubMedCentral
9.
Borg V, Kristensen TS. Social class and self-rated health: can the gradient be explained by differences in life style or work environment? Soc Sci Med. 2000;51(7):1019–30.CrossRefPubMed
10.
11.
Marmot MG, Shipley MJ. Do socioeconomic differences in mortality persist after retirement? 25 year follow up of civil servants from the first Whitehall study. BMJ. 1996;313(7066):1170–80.CrossRef
12.
Nazroo J. Class and Health Inequality in Later Life: Patterns, Mechanisms and Implications for Policy. Int J Environ Res Public Health. 2017;14(12):1533.CrossRefPubMedCentral
13.
Hoebel J, et al. Socioeconomic Inequalities in Health and Perceived Unmet Needs for Healthcare among the Elderly in Germany. Int J Environ Res Public Health. 2017;14(10):1127.CrossRefPubMedCentral
14.
Majer IM, et al. Socioeconomic inequalities in life and health expectancies around official retirement age in 10 Western-European countries. J Epidemiol Community Health. 2011;65:972–9.CrossRefPubMed
15.
Hyde M, Jones IR. The long shadow of work - does time since labour market exit affect the association between socioeconomic position and health in a post-working population. J Epidemiol Community Health. 2007;61(6):533–9.CrossRefPubMedPubMedCentral
16.
Oxley, H., Policies for Healthy Ageing: An Overview, OECD Health Working Papers. 2009: Paris.
17.
Chau, N., M. Khlat, And G. Lorhandicap, Strong association of physical job demands with functional limitations among active people: a population-based study in North-eastern France. Int Arch Occup Environ Health, 2009. 82(7): p. 857–866.CrossRefPubMedPubMedCentral
18.
Leclerc A, et al. Level of education and back pain in France: the role of demographic, lifestyle and physical work factors. Int Arch Occup Environ Health. 2009;82(5):643–52.CrossRefPubMed
19.
Siegrist J, Marmot M. Health inequalities and the psychosocial environment-two scientific challenges. Soc Sci Med. 2004;58(8):1463–73.CrossRefPubMed
20.
Monden CW. Current and lifetime exposure to working conditions. Do they explain educational differences in subjective health? Soc Sci Med. 2005;60(11):2465–76.CrossRefPubMed
21.
Parker V, et al. The association between mid-life socioeconomic position and health after retirement--exploring the role of working conditions. J Aging Health. 2013;25(5):863–81.CrossRefPubMedPubMedCentral
22.
Kivimäki M, et al. Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals. Lancet. 2015;386(10005):1739–46.CrossRefPubMed
23.
Lund T, et al. Physical work environment risk factors for long term sickness absence: prospective findings among a cohort of 5357 employees in Denmark. BMJ. 2006;332(7539):449–52.CrossRefPubMedPubMedCentral
24.
Mänty M, et al. Changes in working conditions and physical health functioning among midlife and ageing employees. Scand J Work Environ Health. 2015;41(6):511–8.CrossRefPubMed
25.
Martikainen P, et al. Determinants of socioeconomic differences in change in physical and mental functioning. Soc Sci Med. 1999;49(4):499–507.CrossRefPubMed
26.
Descatha, A., et al., Long-term effects of biomechanical exposure on severe shoulder pain in the Gazel cohort. Scandinavian journal of work, environment & health, 2012: p. 568–576.
27.
Descatha A, et al. Long-term effects of biomechanical exposure on severe knee pain in the Gazel cohort. Scand J Work Environ Health. 2011;37(1):37–44.CrossRefPubMed
28.
Platts LG, et al. Physical occupational exposures during working life and quality of life after labour market exit: results from the GAZEL study. Aging Ment Health. 2013;17(6):697–706.CrossRefPubMedPubMedCentral
29.
Wahrendorf M, et al. Working conditions in mid-life and mental health in older ages. Adv Life Course Res. 2013;18(1):16–25.CrossRefPubMed
30.
Wahrendorf M, et al. Long-term effects of psychosocial work stress in midlife on health functioning after labor market exit--results from the GAZEL study. J Gerontol B Psychol Sci Soc Sci. 2012;67(4):471–80.CrossRefPubMedPubMedCentral
31.
Dieker AC, et al. The contribution of work and lifestyle factors to socioeconomic inequalities in self-rated health a systematic review. Scand J Work Environ Health. 2018.
32.
Brand JE, et al. Do job characteristics mediate the relationship between SES and health? Evidence from sibling models. Soc Sci Res. 2007;36(1):222–53.CrossRef
33.
Warren JR, et al. Job characteristics as mediators in SES-health relationships. Soc Sci Med. 2004;59(7):1367–78.CrossRefPubMed
34.
Aldabe B, et al. Contribution of material, occupational, and psychosocial factors in the explanation of social inequalities in health in 28 countries in Europe. J Epidemiol Community Health. 2011;65(12):1123–31.CrossRefPubMed
35.
Hofer SM, Piccinin AM. Integrative data analysis through coordination of measurement and analysis protocol across independent longitudinal studies. Psychol Methods. 2009;14(2):150–64.CrossRefPubMedPubMedCentral
36.
37.
Lauritzen, H.H., Ældres ressourcer og behov i perioden 1997-2012. SFI - Det Nationale Forskningscenter for Velfærd 2014.
38.
Steptoe A, et al. Cohort profile: the English longitudinal study of ageing. Int J Epidemiol. 2013;42(6):1640–8.CrossRefPubMed
39.
Engstler H, Schmiade N. The German Ageing Survey (DEAS) - a longitudinal and time-series study of people in the second half of life. Schmollers Jahr. 2013;133(1):97–108.CrossRef
40.
Ilmarinen J, et al. Background and objectives of the Finnish research project on aging workers in municipal occupations. Scandinavian Journal of Work, Environment & Health. 1991;(1):7–11.
41.
Rijs KJ, et al. Development and validation of a physical and psychosocial job-exposure matrix in older and retired workers. Ann Occup Hyg. 2014;58(2):152–70.PubMed
42.
White IR, Royston P, Wood AM. Multiple imputation using chained equations: issues and guidance for practice. Stat Med. 2011;30(4):377–99.CrossRefPubMed
43.
Twisk JWR. Applied longitudinal data analysis for epidemiology: a practical guide. 2nd ed. Cambridge: Cambridge University Press; 2013.CrossRef
44.
MacKinnon DP. Introduction to statistical mediation analysis. New York: Routledge; 2008.
45.
Rijnhart JJM, et al. Comparison of logistic-regression based methods for simple mediation analysis with a dichotomous outcome variable. BMC Med Res Methodol. 2019;19(1):19.CrossRefPubMedPubMedCentral
46.
Aiken, L.S. and S.G. West, Multiple regression: Testing and interpreting interactions. 1991: Newbury Park: Sage.
47.
Preacher KJ, Selig JP. Advantages of Monte Carlo confidence intervals for indirect effects. Commun Methods Meas. 2012;6(2):77–98.CrossRef
48.
Selig JP, Preacher KJ. Monte Carlo method for assessing mediation: an interactive tool for creating confidence intervals for indirect effects [computer software]; 2008, June.
49.
MacKinnon DP, Krull JL, Lockwood CM. Equivalence of the mediation. Confounding and Suppression Effect Prevention Science. 2000;1(4):173–81.CrossRefPubMed
50.
Burgess-Limerick R. Participatory ergonomics: evidence and implementation lessons. Appl Ergon. 2018;68:289–93.CrossRefPubMed
51.
52.
53.
Moore DE, Hayward MD. Occupational careers and mortality of elderly men. Demography. 1990;27(1):31–53.CrossRefPubMed
54.
55.
56.
57.
Idler EL, Russell LB, Davis D. Survival, functional limitations, and self-rated health in the NHANES I Epidemiologic Follow-up Study, 1992. First National Health and nutrition examination survey. Am J Epidemiol, 2000. 152(9):874–83.
58.
59.
Dowd JB. Whiners, deniers, and self-rated health: what are the implications for measuring health inequalities? A commentary on Layes, et al. Soc Sci Med. 2012;75(1):10–3.CrossRefPubMed
60.
Huisman M, Deeg DJ. A commentary on Marja Jylha's "what is self-rated health and why does it predict mortality? Towards a unified conceptual model"(69:3, 2009, 307-316). Soc Sci Med. 2010;70(5):652–4 discussion 655-7.CrossRefPubMed
61.
Metadata
Title
Educational inequalities in health after work exit: the role of work characteristics
Authors
Sascha de Breij
Jeevitha Yogachandiran Qvist
Daniel Holman
Jana Mäcken
Jorma Seitsamo
Martijn Huisman
Dorly J. H. Deeg
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2019
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-019-7872-0

Other articles of this Issue 1/2019

BMC Public Health 1/2019 Go to the issue

Research article

The association between urbanization and child height: a multilevel study in China

Research article

Announcing the availability of oral HIV self-test kits via text message to increase HIV testing among hard-to-reach truckers in Kenya: a randomized controlled trial

Research article

How organisations promoting vaccination respond to misinformation on social media: a qualitative investigation

Research article

Associations between occupational factors and self-rated health in the national Brazilian working population

Research article

“Development in well-being and social function among Danish hemophilia patients with HIV: a three-wave panel study spanning 24 years”

Research article

Utilization of skilled birth attendant at birth and associated factors among women who gave birth in the last 24 months preceding the survey in Gura Dhamole Woreda, Bale zone, southeast Ethiopia