Spotlight on article published in Occupational and Environmental Medicine

IBI Spotlights call attention to important health and productivity findings from peer-reviewed work by external researchers. Unless otherwise stated, the authors are not affiliated with IBI, nor was the research executed on IBI’s behalf. IBI members are encouraged to obtain the original articles from the copyright holder.

What is the Issue?

Many advanced industrialized nations are seeking to extend participation in the labor force given aging population demographics and the social and economic benefits that accrue to both individuals and the economy from productive wage-earning work. However, little is known about the influence of poor health on employees’ exits from paid employment (including disability leaves, becoming unemployed and early retirement).

What are the findings/solutions?

Poor health, particularly self-assessed poor health, is highly predictive of an exit from paid employment into either long-term work disability or unemployment. To a lesser extent, poor health predicts early retirement.

Journal Citation

van Rijn, R.M., Robroek, S.J., Brouwer, S. and Burdorf, A. (2013) Influence of Poor Health on Exit from Paid Employment: a Systematic Review. _Occupational and Environmental Medicine_, doi:10.1136/oemed-2013-101591.


To conduct a systematic review of the research literature on the associations between poor health and exit from paid employment through disability pension, unemployment and early retirement, and to estimate the magnitude of these associations.


A systematic review of 44 peer-reviewed studies assessed what is known about the influence of poor health on exit from paid employment. Random effects models were used to estimate pooled effects across 29 studies with the required data.

The following criteria had to be met for a study to be included in the review: 1) a health measure was used, 2) exit from paid employment included extended work disability, unemployment or early retirement, 3) the association between health and the exit outcomes had to be expressed in a uniform way (e.g., odds ratio, relative risk, etc.) or sufficient data provided for computation, 4) longitudinal data were analyzed 5) non-patient population and 6) published in a peer-reviewed scientific journal written in English.

Self-assessed poor health, mental health and chronic conditions were determined by a variety of tools including four or five point Likert scales, SF-12 or SF-36, “less than [fair, good or moderate] health”.


Employees with self-assessed poor health (compared to better than poor health) were:

  • 4.5 times more likely to enter long-term work disability (95% CI 3.09 to 6.52)
  • 1.5 times more likely to become unemployed (95% CI 1.24 to 1.91)
  • 1.3 times more likely to retire early (95% CI 1.14 to 1.54)

Employees with mental illness (compared to no mental illness) were:

  • 1.8 times more likely to enter long-term work disability (95% CI 1.26 to 2.64)
  • 1.6 times more likely to become unemployed (CI 1.21 to 2.22 )

Employees with chronic disease (compared to no chronic disease) were:

  • 2.4 times more likely to enter long-term work disability (95% CI 2.14 to 2.75)
  • 1.3 times more likely to become unemployed (95% CI 1.13 to 1.50)


Primary preventive interventions focused on promoting good health may contribute to a sustained and productive workforce.