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

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

doi:10.1186/s12889-019-7872-0

Abstract

BackgroundEducational 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.MethodsData 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.ResultsThe 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.ConclusionEducational 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.

Highlights

Educational inequalities in health have been widely reported
The aim of our study was to examine whether educational level is associated with health after work exit in five Northern and Western European countries, and whether work characteristics mediate the association between educational level and health after work exit
Consistent with the empirical literature [8, 9], we found that 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

Summary

Introduction

A low educational level is associated with more adverse working conditions. Because many countries are raising the statutory retirement age, lower educated workers have to spend more years working under adverse conditions. The literature suggests that a low educational level is associated with adverse working conditions such as high physical job demands [17, 18] and low control and reward at work [19]. Many studies suggest that poor working conditions are associated with poor health [17, 18, 22,23,24,25], and there is evidence that this effect remains after work exit [26,27,28,29,30]

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