The concurrence of chronic diseases among unemployed and employed persons: a register-based study

Abstract

Abstract Background The first aim of this study was to describe the prevalence of chronic diseases and multimorbidity among employed and unemployed persons. The second aim was to investigate associations of sociodemographic characteristics with the prevalence of chronic diseases and multimorbidity. Methods Data linkage of large-scale registries on employment status, medication use and sociodemographic characteristics for all Dutch residents in 2016 was applied. In total, 5,074,227 subjects aged 18-65 years were included in the study. The prevalence of six common chronic diseases and multimorbidity was investigated among unemployed and employed persons. Multivariate logistic regression analyses were performed to examine associations of sociodemographic characteristics with the prevalence of chronic diseases and multimorbidity. Results Unemployed persons had a higher prevalence of psychological disorders (18.3% vs 5.4%), cardiovascular disease (20.1% vs 8.9%), inflammatory diseases (24.5% vs 15.8%), and respiratory illness (11.7% vs 6.5%) compared to employed persons. Unemployed persons were more likely to have one (OR 1.30, 95% CI 1.29-1.31), two (OR 1.74, 95% CI 1.73-1.76) and at least three chronic diseases (OR 2.59, 95% CI 2.56-2.61) than employed persons. Older persons, women, lower educated persons and migrants were more likely to have one, two, and at least three chronic diseases. Especially at younger ages, psychological disorders and inflammatory conditions were more prevalent but declined from middle age onwards among unemployed persons, whereas as slight increase from middle age onwards was observed among employed persons. Conclusions Using objective data, this study provided evidence for inequalities in the prevalence of chronic diseases and multimorbidity, indicating employment status to be an important determinant of health. Policy measures and health interventions should target chronic diseases and multimorbidity, especially among unemployed persons. Key messages Using objective data, this study showed that unemployed persons had a higher prevalence of chronic diseases and multimorbidity compared to employed persons. In particular older persons, women, lower educated persons and migrants were more likely to have chronic diseases and multimorbidity.