Chronic disease and labour force participation among older Australians.

Abstract

To examine the association between long-term health conditions and being out of the labour force among older Australians.
Retrospective analysis of cross-sectional data from the Australian Bureau of Statistics 2003 Survey of Disability, Ageing and Carers for people aged 45-64 years.
Rates of premature retirement associated with ill health; odds ratios of being out of the labour force associated with each long-term health condition and number of conditions; weighted population estimates; estimates of gross domestic product lost as a result.
9198 people surveyed were aged 45-64 years, 3010 of whom were not in the labour force. Of these, 1373 (45.6%) had retired because of a chronic health condition, most commonly a back problem (10.4%), or arthritis and related disorders (8.6%). When adjusted for age and sex, all conditions studied except diseases of the ear and mastoid process, other endocrine/nutritional and metabolic disorders, noise-induced deafness or hearing loss, and high cholesterol were significantly associated with being out of the labour force. Extrapolating from these results, an estimated 663 235 older Australians were not working because of ill health, reducing Australia's gross domestic product by around $14.7 billion per annum.
Prevention of long-term health conditions may help older Australians remain in the labour force longer, thereby increasing revenue to fund health care for the ageing population.

Full text

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MJA • Volume 189 Number 8 • 20 October 2008
447
MEDICINE AND THE COMMUNITY
The Medical Journal of Australia ISSN:
0025-729X 20 October 2008 189 8 447-
450
©The Medical Journal of Australia 2008
www.mja.com.au
Medicine and the Community
and 25% of women aged 60–64 years, are in
the labour force.6 Furthermore, 50% of men
and 20% of women in Australia retire from
full-time work early (ie, before the age of 55
years) because of ill health.7
Overseas studies have found lower employ-
ment rates among older people with musculo-
skeletal conditions,8 multiple sclerosis9 and
other chronic diseases.10-12 Australian and
New Zealand studies have found that arthri-
tis,13 multiple sclerosis,14 type 2 diabetes,15
cardiovascular disease16 and macular
degeneration17 are related to lower labour
force participation of older workers.
The current Labor Government’s health
platform suggests that chronic disease pre-
vention can increase labour force participa-
tion and ensure future government revenues
are sufficient to fund health care for an
ageing population.18
However, there have been no Australian
studies investigating the overall effect of
long-term disease on labour force participa-
tion. We undertook a retrospective cross-
sectional analysis to examine the association
between long-term health conditions and
being out of the labour force among Austra-
lians aged 45–64 years.
uccessive government reports have
highlighted population ageing and
labour shortages as pressures threaten-
ing the Australian Budget.1,2 As a result, the
previous federal government promoted
deferred or gradual retirement.3,4
However, current labour force participa-
tion among older Australians is low com-
pared with other Organisation for Economic
Co-operation and Development countries.5
In Australia, about 75% of men and 50% of
women aged 55–59 years, and 45% of men
METHODS
We analysed data on people aged 45–64
years from the Australian Bureau of Statistics
2003 Survey of Disability, Ageing and
Carers19 to identify conditions associated
with non-participation in the labour force.
The use of these data was approved by the
Australian Bureau of Statistics Microdata
Review Panel.
The labour force was defined as people
who are employed or seeking work. People
in hospitals and residential care were
included in the survey, but those in residen-
tial care were assumed to be out of the
labour force.
The survey collected demographic and
socioeconomic information, including
labour force participation and information
on participants’ long-term health condi-
tions, including the main disabling condi-
tion. We focused only on the main
condition for this analysis. Participants
were asked their reasons for being out of
the labour force, with ill health being one
response option. The survey data are
weighted by the Australian Bureau of Sta-
tistics to address the issue of unequal prob-
ability of selection in the survey, and to
make the survey data a true representation
of the whole Australian population. We
used these weightings in our analysis to
estimate the prevalence for the entire Aus-
tralian population.
We used logistic regression analysis,
adjusted for age and sex, to estimate the
odds ratios (ORs) of being out of the labour
force associated with each long-term health
condition and the risk of being out of the
labour force associated with the number of
long-term conditions, using “no condition”
as the reference group. ORs are presented
with 95% confidence intervals. Significance
was set at P<0.05.
The number of “missing workers” associ-
ated with each condition was estimated as
the excess proportion (EP) of people not in
the labour force associated with each long-
term health condition; that is, the propor-
tion of people out of the labour force among
those with the condition that is in excess of
people with no condition. The formula was
EP=(OR−1)/OR.
The impact of reduced labour force par-
ticipation on Australia’s gross domestic
product (GDP) was estimated with the
Commonwealth Treasury’s formula:
GDP=(GDP/H)? (H/EMP) ?
(EMP/LF)? (LF/Pop15+) ? Pop15+,
where GDP=gross domestic product; H=total
hours worked; EMP=total number of persons
employed; LF=total labour force; and
Pop15+=population aged 15 years and over.2
Chronic disease and labour force participation among
older Australians
Deborah J Schofield, Rupendra N Shrestha, Megan E Passey, Arul Earnest and Susan L Fletcher
ABSTRACT
Objective: To examine the association between long-term health conditions and being
out of the labour force among older Australians.
Design, setting and participants: Retrospective analysis of cross-sectional data from
the Australian Bureau of Statistics 2003 Survey of Disability, Ageing and Carers for
people aged 45–64 years.
Main outcome measures: Rates of premature retirement associated with ill health;
odds ratios of being out of the labour force associated with each long-term health
condition and number of conditions; weighted population estimates; estimates of gross
domestic product lost as a result.
Results: 9198 people surveyed were aged 45–64 years, 3010 of whom were not in the
labour force. Of these, 1373 (45.6%) had retired because of a chronic health condition,
most commonly a back problem (10.4%), or arthritis and related disorders (8.6%). When
adjusted for age and sex, all conditions studied except diseases of the ear and mastoid
process, other endocrine/nutritional and metabolic disorders, noise-induced deafness
or hearing loss, and high cholesterol were significantly associated with being out of the
labour force. Extrapolating from these results, an estimated 663235 older Australians
were not working because of ill health, reducing Australia’s gross domestic product by
around $14.7 billion per annum.
Conclusion: Prevention of long-term health conditions may help older Australians
remain in the labour force longer, thereby increasing revenue to fund health care for the
ageing population.
MJA 2008; 189: 447–450
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448MJA • Volume 189 Number 8 • 20 October 2008
MEDICINE AND THE COMMUNITY
All analyses were conducted using SAS,
version 9.1 (SAS Institute, Cary, NC, USA).
RESULTS
Of 41233 people surveyed, 9198 (22.3%)
were in the 45–64-years age group, 3010 of
whom were not in the labour force (Box 1).
Of these, 1373 (45.6%) cited a long-term
health condition as the reason for this, with
the remaining 1637 reporting other reasons.
The most common conditions among sur-
vey respondents were back problems, arthri-
tis and related disorders, and hypertension
(Box 2). Based on the proportion of people
out of the labour force, depression or mood
affective disorders, diseases of the respira-
tory system, diseases of the circulatory sys-
tem (other than hypertension), heart
diseases, and mental and behavioural disor-
ders were the most work-limiting conditions
(Box 2). Over 50% of Australians in the 45–
64-years age group who reported one of
these conditions as their main condition
were not in the labour force.
Crude ORs (not shown) revealed a signifi-
cant association with being out of the labour
force for all conditions studied except for
noise-induced deafness or hearing loss and
high cholesterol. After adjusting for age and
sex, all associations apart from diseases of the
ear and mastoid process, other endocrine,
nutritional and metabolic disorders, noise-
induced deafness or hearing loss, and high
cholesterol remained significant (Box 3).
Adjusting for age and sex changed the
ORs for certain conditions. The major
reductions in ORs were observed for respi-
ratory diseases, arthritis, circulatory diseases
(other than hypertension), diseases of the
musculoskeletal system and connective tis-
sue (other than back problems), neoplasms
and heart diseases, as these conditions were
more common in older age groups than in
younger ones. Conversely, adjusting for age
and sex resulted in a rise in ORs for injury
and accident, and mental and behavioural
disorders because of their higher prevalence
among younger people.
The total number of people out of the
labour force because of a health condition
was estimated at 663235 for the population
aged 45–64 years, reducing Australia’s GDP
by approximately $14.7 billion per annum.
When people who had long-term health
conditions but reported that they were out
2 Prevalence of long-term health conditions and labour force participation
among 9198 Australians aged 45–64 years surveyed in 2003
*Some respondents had more than one condition. †People with each condition as a percentage of the
weighted population. ‡Proportion of people with each condition who were out of the labour force.
◆
Total Not in labour force
Long-term health condition*
No. in
survey
Weighted
no. (%)†
No. in
survey
Weighted
no. (%)‡
No long-term health condition
Back problems (dorsopathies)
Arthritis and related disorders
Hypertension (high blood pressure)
Diseases of the nervous system
Mental and behavioural disorders
Asthma
Diabetes
Injury/accident
All other conditions
Other diseases of the musculoskeletal
system and connective tissue
Diseases of the ear and mastoid process
Heart diseases
Depression/mood affective disorders
(excluding postnatal depression)
Deafness/hearing loss — noise-induced
Diseases of the digestive system
High cholesterol
Neoplasms (tumours/cancers)
Diseases of the respiratory system
Other endocrine/nutritional and
metabolic disorders
Other diseases of the circulatory system
Diseases of the genitourinary system
Diseases of the eye and adnexa
3781
929
773
596
335
393
247
224
233
219
192
2033476 (43.4%)
485085 (10.4%)
402898 (8.6%)
311465 (6.6%)
142123 (3.0%)
132186 (2.8%)
127766 (2.7%)
118147 (2.5%)
109181 (2.3%)
105126 (2.2%)
97403 (2.1%)
639
385
387
162
178
269
72
91
99
110
92
345180 (17.0%)
200673 (41.4%)
199418 (49.5%)
85925 (28.0%)
57759 (40.6%)
67598 (51.1%)
35737 (27.9%)
44793 (37.9%)
41511 (38.0%)
46875 (44.6%)
46016 (47.2%)
181
152
143
92376 (2.0%)
79676 (1.7%)
67161 (1.4%)
51
78
88
24669 (26.7%)
41142 (51.6%)
38457 (57.3%)
118
117
112
95
79
76
64172 (1.4%)
56684 (1.2%)
53641 (1.2%)
46011 (1.0%)
38857 (0.8%)
35091 (0.7%)
15
38
25
50
44
25
8651 (13.5%)
17168 (30.3%)
10860 (20.2%)
22744 (49.4%)
21986 (56.6%)
9483 (27.0%)
94
61
48
32392 (0.7%)
28262 (0.6%)
25508 (0.5%)
67
26
19
17178 (53.0%)
11125 (39.4%)
8451 (33.1%)
1 People not in the labour force by age group and sex, of 9198 Australians aged 45–64 years surveyed in 2003
*Proportion of each cohort not in the labour force. †Some weighted numbers and percentages do not add up exactly because of rounding.
◆
No. not in the labour force in survey group (%)* Weighted no. not in the labour force (%)* in population†
Age group (years) MenWomen AllMen Women All
45–49
50–54
55–59
60–64
Total
178 (13.5%)
196 (15.1%)
292 (27.3%)
406 (47.7%)
1072 (23.6%)
313 (22.9%)
421 (32.6%)
566 (50.2%)
638 (72.8%)
1938 (41.6%)
491 (18.3%)
617 (23.8%)
858 (39.0%)
1044 (60.4%)
3010 (32.7%)
73638 (10.5%)
80694 (12.5%)
138612 (23.9%)
185283 (43.3%)
478226 (20.3%)
148879 (21.3%)
200069 (31.2%)
278178 (49.4%)
298049 (70.4%)
925175 (39.7%)
222517 (15.9%)
280762 (21.8%)
416790 (36.4%)
483332 (56.8%)
1403402 (30.0%)

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MJA • Volume 189 Number 8 • 20 October 2008
449
MEDICINE AND THE COMMUNITY
of the labour force for reasons other than
their health were excluded from the analy-
sis, 541391 older Australians were esti-
mated to be not working because of ill
health, resulting in a loss of around $12
billion per annum.
The number of long-term health condi-
tions reported increased with age. The OR of
being out of the labour force rose with an
increase in the number of conditions
reported (Box 4).
DISCUSSION
Using data from the Australian Bureau of
Statistics, we estimated that 663235 older
Australian workers were missing from the
labour force because of ill health in 2003.
Back injuries, arthritis and mental health
disorders accounted for approximately half
the missing workers. This profile is similar
to the profile of disorders accounting for
most Disability Support Pension payments;
musculoskeletal disorders, psychological
problems and diseases of the circulatory
system are the top three long-term condi-
tions reported (Centrelink, Performance and
Information Branch, data request BI3268:
health conditions associated with sickness
benefits and Disability Support Pension, 13
Jan 2006).
Our study had limitations that must be
considered. Firstly, the impact on labour
force participation is based on respondents’
self-reported main conditions. Although
self-reported health is regarded as a valid
measure,20 a possible bias in the results
cannot be excluded. Secondly, as the data
are cross-sectional, it is possible to identify
associations, but not causal relationships.
Although it is unlikely that being out of the
labour force could cause most of the condi-
tions reported, it is possible that depression
and other affective disorders may be caused
or exacerbated by unemployment; therefore,
caution must be exercised in interpreting
the results. Finally, the study did not capture
mortality, and therefore could not estimate
the impact of mortality on the labour force.
In the past, government policy has
focused on increasing employment of older
people. An Age Discrimination Bill was
passed21 and the 15% tax on lump sums and
pensions from superannuation schemes
after the age of 60 years removed, effectively
making them tax-free.22 However, these eco-
nomic measures have not addressed the
health conditions associated with much of
the low labour force participation of older
workers, and are unlikely to have a major
impact on the labour force participation of
people who are ill.
Traditionally, health care has focused on
provision of services to improve health for
its own sake, and employment policies and
priorities have been determined independ-
ently from health priorities.
This study provides further support for
the Australian Government’s health platform
— to increase the opportunity for older
people to participate in the workforce.18 For
example, optimal treatment of depression
involving maintenance cognitive behaviour
therapy or drug treatment following an epi-
sode of major depression has been shown to
avert 50% of associated disability.23 The
increase in obesity, a risk factor for numer-
ous chronic conditions,24 needs to be
addressed. Internationally, lifestyle interven-
3 Long-term health conditions associated with being out of the labour force and
the lost workforce because of each condition
OR=odds ratio.
*Adjusted for age group and sex. The reference group was “no condition”.
†EP (excess proportion) based on adjusted OR.
‡Lost workforce is the number of people out of the labour force because of the long-term health condition
among people with that condition.
§The negative lost workforce was because of the estimated ORs of <1.0, implying that the rates of premature
retirement for those conditions are less than for “no condition” group. These estimates were not statistically
significant, so caution must be exercised in interpreting these results.
◆
Condition
Adjusted OR*
(95% CI)P EP†
Lost
workforce‡
Back problems (dorsopathies)
Arthritis and related disorders
Mental and behavioural disorders
Diseases of the nervous system
All other conditions
Depression/mood affective disorders
(excluding postnatal depression)
Other diseases of the musculoskeletal
system and connective tissue
Heart diseases
Injury/accident
Diabetes
Hypertension (high blood pressure)
Neoplasms (tumours/cancers)
Diseases of the respiratory system
Other diseases of the circulatory system
Asthma
Diseases of the ear and mastoid process
Diseases of the digestive system
Diseases of the genitourinary system
Diseases of the eye and adnexa
Other endocrine/nutritional and
metabolic disorders
Deafness/hearing loss — noise-induced
High cholesterol
3.59 (2.98–4.33)
3.06 (2.52–3.73)
5.71 (4.16–7.84)
3.25 (2.42–4.35)
3.42 (2.43–4.82)
6.71 (4.44–10.14)
<0.001
<0.001
<0.001
<0.001
<0.001
<0.001
0.721
0.674
0.825
0.692
0.708
0.851
144764
134318
55757
39976
33169
32724
3.16 (2.25–4.44) <0.001 0.68331452
4.21 (2.77–6.40)
3.71 (2.63–5.23)
2.52 (1.85–3.43)
1.29 (1.03–1.62)
3.66 (2.19–6.11)
3.68 (2.07–6.54)
4.13 (2.30–7.43)
1.44 (1.04–1.98)
1.43 (0.97–2.11)
1.67 (1.06–2.62)
2.21 (1.17–4.17)
2.77 (1.41–5.47)
1.07 (0.64–1.78)
<0.001
<0.001
<0.001
0.03
<0.001
<0.001
<0.001
0.03
0.07
0.03
0.01
0.003
0.80
0.762
0.730
0.603
0.227
0.727
0.728
0.758
0.304
0.302
0.401
0.548
0.640
0.063
31363
30311
27004
19546
16525
16014
13019
10858
7459
6880
6092
5405
599
0.97 (0.55–1.70)
0.93 (0.56–1.55)
0.91
0.78
−0.032
− 273§
− 796§
−0.073
4 Association of number of long-
term health conditions with being
out of the labour force
*Adjusted for age group and sex. The reference
group was “no condition”.
◆
No. of
conditions
Adjusted odds
ratio* (95% CI)P
1
2
3
4–5
6+
1.63 (1.41–1.89)
2.31 (1.96–2.73)
3.90 (3.20–4.75)
5.44 (4.42–6.70)
16.10 (11.45–22.5)
<0.001
<0.001
<0.001
<0.001
<0.001

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450MJA • Volume 189 Number 8 • 20 October 2008
MEDICINE AND THE COMMUNITY
tions, involving weight loss through
improved diet and physical activity, have
been shown to reduce the incidence of
diabetes among people identified as high
risk.25,26
With emerging skills shortages and an
ageing workforce, Australia needs a more
holistic approach to increase labour force
participation among older people that con-
siders the interaction of health, illness pre-
vention and labour force priorities.
ACKNOWLEDGEMENTS
This study is part of ongoing research funded by an
Australian Research Council Grant (Grant No.
LP0774919) and by Pfizer Australia. We thank Mr
Phil Gallagher, Manager, Retirement and Income
Modelling Unit at the Commonwealth Treasury for
his advice on estimating the GDP data.
COMPETING INTERESTS
None identified.
AUTHOR DETAILS
Deborah J Schofield, BSpPath, GradDipComp,
PhD, Associate Professor and Director of
Research
Rupendra N Shrestha, BSc, MSc(Statistics),
Research Officer
Megan E Passey, BMed(Hons), MPH, MSc,
Senior Lecturer
Arul Earnest, DLSHTM, MSc, Biostatistician
Susan L Fletcher, BAppSc(Psych), PGDipPsych,
Research Officer
Northern Rivers University Department of Rural
Health, Lismore, NSW.
Correspondence:
dschofield@med.usyd.edu.au
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