Multimorbidity and the Transition Out of Full-Time Paid Employment: A Longitudinal Analysis of the Health and Retirement Study

Sander K R van Zon*, Sijmen A Reijneveld, Anne Galaurchi, Carlos F Mendes de Leon, Josué Almansa, Ute Bültmann

*Corresponding author for this work

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Objectives This study aims to examine whether older workers aged 50-64 years with multimorbidity are at increased risk to transition from full-time paid employment to part-time employment, partial retirement, unemployment, disability, economic inactivity, full retirement or die than workers without a chronic health condition and workers with one chronic health condition, and whether socioeconomic position (SEP) modifies these transitions.

Method Using data from the Health and Retirement Study (1992-2014; n = 10,719), sub-distribution hazard ratios with 95% confidence intervals were calculated with a time-varying Fine and Gray competing-risks survival regression model to examine exit from full-time paid employment. We investigated the modifying effect of SEP by examining its interaction with multimorbidity.

Results Workers with multimorbidity had a higher risk of transitioning to partial retirement (1.45; 1.22, 1.72), disability (1.84; 1.21, 2.78) and full retirement (1.63; 1.47, 1.81), and they had a higher mortality risk (2.58; 1.71, 3.88) than workers without chronic disorders. Compared to workers with one chronic health condition, workers with multimorbidity had an increased risk for partial (1.19; 1.02, 1.40) and full retirement (1.29; 1.17, 1.42), and mortality (1.49; 1.09, 2.04). Only SEP measured as educational level modified the relationship between multimorbidity and mortality.

Discussion Workers with multimorbidity seem more prone to leave full-time paid employment than workers without or with one a chronic health condition. Personalized work accommodations may be necessary to help workers with multimorbidity prolong their working life.

Original languageEnglish
Pages (from-to)705-715
Number of pages11
JournalThe Journals of Gerontology. Series B: Psychological Sciences and Social Sciences
Issue number3
Early online date2019
Publication statusPublished - Mar-2020


  • Chronic health condition
  • Labor market participation
  • Socioeconomic position
  • Transition
  • LIFE
  • EXIT

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