Do regional labour market conditions affect transitions into employment from health-related inactivity? Multilevel analysis of longitudinal UK Labour Force Survey data

Abstract

BackgroundLong-term worklessness (unemployment or economic inactivity) is associated with adverse health outcomes and inequalities. Recent UK welfare reforms, alongside other return-to-work policies, have aimed to increase employment rates for people who have been out of the labour market because of sickness and disability. However, sickness benefit claimant counts vary substantially by geographical area and are highest in the post-industrial regions with the weakest economies. The aim of this study was to investigate whether local labour market conditions affect transitions from health-related inactivity into employment and compare them with transitions from unemployment to work. MethodsLongitudinal Labour Force Survey datasets were used to follow working age individuals resident in Great Britain over five consecutive quarters. Datasets from 1999–2013 were pooled (quarter 1 health-related inactivity group n=29 130, unemployed group n=14 873). Multilevel logistic regression models (region at level 3, year-within-region at level 2) were constructed with employment at quarter 5 (Q5) as the main outcome measure. Annual male regional employment rates were used as a proxy for local labour market conditions. FindingsTransitions into employment for the health-related inactivity group were rare (1057/29 130 [3·6%] at Q5) compared with the unemployed group (6255/14 873 [42·1%]). Regional variance was significant at baseline (p=0·03), and adding local employment rates as a fixed effect eliminated all observed area-level variability. A 1% increase in local employment rates was associated with an unadjusted odds ratio (OR) of transition to employment for the health-related inactivity group of 1·08 (95% CI 1·05–1·10) and for the unemployed group 1·08 (1·06–1·10). Adjustment for sex, age, education, and long-term health status had little effect (health-related inactivity group adjusted OR 1·07, 1·05–1·10). InterpretationLocal labour market conditions fully account for regional differences in transition rates from health-related inactivity into employment. Higher regional employment rates are associated with increased rates of return to employment, and this association is similar to that for unemployed groups; however, overall rates of transition were low compared with unemployed groups. One limitation of our study is loss to follow-up. Local labour market improvement could potentially increase return-to-work rates for the sick and disabled. Public health advocacy and collaborative action with policy makers in local and national government is needed to address this issue. FundingEC receives funding from the Chief Scientist Office of the Scottish Government Health Directorates (SPHSU1) as part of the Evaluating the Health Effects of Social Interventions programme at the Medical Research Council/Chief Scientist Office (MRC/CSO) Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK. AHL receives core funding from the UK Medical Research Council (MC_UU_12017/5) and the Chief Scientist Office of the Scottish Government Health Directorates (SPHSU2) as part of the Measuring Health programme at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow. FP receives core funding from the UK Medical Research Council (MC_UU_12017/7) as part of the Social Patterning of Health over the Lifecourse Programme at the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.