Employment and Multimorbidity Among Older Adults: Trends by Generation, Sex, and Educational Status in Canada, Denmark, England, and Sweden

Abstract

Introduction: Population ageing has led to policies that attempt to extend working lives. However, ageing is associated with increased multimorbidity and reducing employment rates, which particularly affects lower socioeconomic groups. This paper focuses on how multimorbidity has changed between generations, educational groups, and countries, and how these are related to employment consequences.

Methods: Using data from English Longitudinal Study of Aging, the Survey of Health and Aging in Europe, and the Canadian Community Health Survey, we assessed the differences in the prevalence of multi-morbidities by generation, age, sex, and education, for people with two or more conditions. We used a logistic regression model where the outcome is a binary variable indicating the number of conditions an individual has vs. not having a condition. Then we used a logistic regression model with employment status as the outcome and whether an individual has none, one, two, or more than two morbidities. Models were estimated for each of the 4 countries.

Results: In the UK we see that the Baby Boomers are increasingly likely to suffer from multimorbidity as they age relative to the Silent Generation. Swedish male Baby Boomers have a higher rate of multimorbidity at the older age categories than the Silent Generation particularly for the lower educated. There is no widening of the multimorbidity-generation gap for Danish people, and there are no notable generational differences in Canada. There are few obvious generational differences in the employment consequences of multimorbidity although there are notable country, sex and educational differences. We see that for all groups a lower proportion are employed as the number of chronic conditions increases relative to the higher educated with no chronic conditions. This is most clear for the UK and Canada. For 3+ conditions there is still a large difference between the UK and Canada for those with a high education and for men, although there is little difference for low educated women. In Sweden and Denmark there was no clear pattern suggesting more chronic conditions reduced employment, with any comorbidity reducing employment for high educated in Sweden only, and both countries for low educated.

Discussion: The findings have important policy implications. Policies to extend working lives should especially consider the needs of different groups (e.g. older women with chronic illness, co-morbidity and low education). Increasing multimorbidity means the importance of policies to support older adults with chronic health conditions to extend their working lives will increase in the future. Policies to maintain good health in older workers will also be important to extend working lives, as is reasonable adjustment of work places and work practices to make working feasible for older workers with chronic conditions or disabilities.

Note:
Funding Information: The study is part of a larger project entitled Tackling Health Inequalities and Extending Working Lives (THRIVE). The funders were The Innovation Fund Denmark (5194-00004B), the Swedish Research for Health, Working Life and Welfare (2015-01531), the UK Economic and Social Research Council (ES/N019261/1) and the Canadian Institutes of Health Research (EWL-14428). THRIVE is one of the projects of the Joint Programme Initiative More Years, Better Lives.

Declaration of Interests: None.

Ethics Approval Statement: Not required since the study used secondary data.

Keywords: Multimorbidity, employment, policy