Educational differences in the influence of health on early work exit among older workers

Sascha De Breij, Jana Mäcken, Jeevitha Yogachandiran Qvist, Daniel Holman, Moritz Hess, Martijn Huisman, Dorly J H Deeg

Research output: Contribution to JournalArticleAcademicpeer-review


OBJECTIVES: Previous research has shown that poor physical and mental health are important risk factors for early work exit. We examined potential differences in this association in older workers (50+) across educational levels.

METHODS: Coordinated analyses were carried out in longitudinal data sets from four European countries: the Netherlands (Longitudinal Aging Study Amsterdam), Denmark (Danish Longitudinal Study of Ageing), England (English Longitudinal Study of Ageing) and Germany (German Ageing Survey). The effect of poor self-rated health (SRH), functional limitations and depression on different types of early work exit (early retirement, economic inactivity, disability and unemployment) was examined using Cox regression analysis. We examined educational differences in these effects by testing interaction terms.

RESULTS: Poor physical and mental health were more common among the lower educated. Poor SRH, functional limitations, and depression were all associated with a higher risk of early work exit. These health effects were strongest for the disability exit routes (poor SRH: HRs 5.77 to 8.14; functional limitations: HRs 6.65 to 10.42; depression: HRs 3.30 to 5.56). In the Netherlands (functional limitations) and England (functional limitations and SRH), effects were stronger in the lower educated.

CONCLUSIONS: The prevalence of health problems, that is, poor SRH, functional limitations and depression, was higher in the lower educated workers. All three health indicators increase the risk of early work exit. In some countries, health effects on early exit were stronger in the lower educated. Thus, lower educated older workers are an important target group for health policy and intervention.

Original languageEnglish
Pages (from-to)568-575
Number of pages8
JournalOccupational and Environmental Medicine
Issue number8
Publication statusPublished - Aug 2020

Bibliographical note

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.


Funding The research was conducted within the project ’eXTenD: social inequalities in extending working lives of an ageing workforce’ in the framework of the Joint Programming initiative (JPi) ’More Years, Better lives – The Potential and challenges of Demographic change’. sDB was supported by The netherlands Organisation for health research and Development (ZonMW) (grant number 208 060 002). Dh was supported by the economic and social research council (grant number es/P000177/1).

FundersFunder number
Economic and Social Research Counciles/P000177/1
ZonMw208 060 002


    • Depression
    • Disabled Persons/statistics & numerical data
    • Educational Status
    • Employment/statistics & numerical data
    • Europe/epidemiology
    • Female
    • Health Status
    • Humans
    • Longitudinal Studies
    • Male
    • Middle Aged
    • Retirement/statistics & numerical data
    • Risk Factors


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