Healthy working life expectancy at age 50 for people with and without osteoarthritis in local and national English populations

Abstract

Retirement ages are rising in many countries to offset the challenges of population ageing, but osteoarthritis is an age-associated disease that is becoming more prevalent and may limit capacity to work until older ages. We aimed to assess the impact of osteoarthritis on healthy working life expectancy (HWLE) by comparing HWLE for people with and without osteoarthritis from ages 50 and 65 nationally and in a local area in England. Mortality-linked data for adults aged ≥ 50 years were used from six waves (2002–13) of the English Longitudinal Study of Ageing and from three time points of the North Staffordshire Osteoarthritis Project. HWLE was defined as the average number of years expected to be spent healthy (no limiting long-standing illness) and in paid work (employment or self-employment), and was estimated for people with and without osteoarthritis and by sex and occupation type using interpolated Markov chain multi-state modelling. HWLE from age 50 years was a third lower for people with osteoarthritis compared to people without osteoarthritis both nationally (5.68 95% CI [5.29, 6.07] years compared to 10.00 [9.74, 10.26]) and in North Staffordshire (4.31 [3.68, 4.94] years compared to 6.90 [6.57, 7.24]). HWLE from age 65 years for self-employed people with osteoarthritis exceeded HWLE for people without osteoarthritis in manual or non-manual occupations. Osteoarthritis was associated with a significantly shorter HWLE. People with osteoarthritis are likely to have significantly impaired working ability and capacity to work until older ages, especially in regions with poorer health and work outcomes.

Demographic, health, physical activity, and workplace factors are associated with lower healthy working life expectancy and life expectancy at age 50

“…This work makes a methodological contribution on the number and nature of covariates that may feasibly be analysed together using this approach. Smaller differences between subpopulations were observed in this study than were identified previously using the IMaCh approach 11 , 25 , which is considered to be methodologically sound but has restrictively high data requirements 73 , 74 .…”

“…Sensitivity analyses indicated that aHRR results were robust to the use of a simplified 3-state HWLE model compared to the full 5-state model previously published 11 , 25 . The higher HWLE estimates resulting from alternative ADL-based health operationalisation despite higher age HRR for transition the from healthy and working to unhealthy and/or not working (transition 1–2) and similar age HRRs for other transitions is likely to reflect different proportions of the population classed as a healthy at age 50.…”

“…Research to meet methodological development needs is ongoing and it has not yet been feasible to develop an overall model of key biopsychosocial drivers of reduced HWLE either in the general population or among specific subgroups of interest to policymakers such as people with musculoskeletal conditions. In this study, we aimed to expand on previously published evidence of differences in HWLE and in life expectancy associated with individual health and sociodemographic factors 11 , 25 by quantifying the associations with individual and small combinations factors selected from the wider biopsychosocial model for which data were available and targeted policy initiatives may have leverage.…”

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“…15 This is supported by numerous loading studies ranging from those examining the impacts of joint immobilization to those examining the outcomes of excessive joint loading 16 and others that imply that both too little movement as well as excessive repetitive movements can foster cartilage damage or render the bone beneath this tissue noncompliant 17 with dire functional and pain consequences, even if the individual is initially in good health, and especially if the older adult already suffers from osteoarthritis of one or more joints, 18 and is a woman. 19 In addition, while often overlooked, a host of prior economic factors, 20 as well as age, trauma, and obesity 21,22 may have a collective negative impact on the complex manifestations of osteoarthritis, including possible emergent problems of joint instability, muscle and bone attrition, excess functional disability, and impairments of those sensory perception mechanisms that serve joints and are designed to foster protection against undue loads and the high risk of moderate to severe joint injury, common in vulnerable adults.…”

Psychometric testing of the British English Workplace Activity Limitations Scale in four rheumatic and musculoskeletal conditions

“…paid work) is important for the health and well-being of people with rheumatic and musculoskeletal disorders (RMDs). Yet they have a shorter healthy working life expectancy [ 1 ] and are less likely to be employed compared with those without long-term health conditions [ 2 ]. Working people with RMDs can struggle to manage work, leading to presenteeism (i.e.…”