Chronic Conditions Among Middle-Aged Canadians in the Workforce – the Rule not the

ExceptionChristina H. Chan1, Monique A.M. Gignac2,3,

Elizabeth M. Badley1,3

1. Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, University Health Network

2. Institute for Work and Health3. Dalla Lana School of Public Health

Canadian Public Health Association Conference 2014May 28, 2014

Background

• ↑ prevalence of chronic conditions with age

• Onset often in middle-age years (45-55) – peak of working career for many

• Previous research focus on negative impact: early retirement, decreased productivity, sick days

Objective

• Fewer studies focus on those who continue to work: – How many stay in labour force? – How prevalent are chronic conditions in the labour

force?

• Objective: To examine labour force participation among middle-aged Canadians with and without a variety of chronic health conditions using population-based data.

Method: Data source

• Secondary data analysis• Canadian Community Health Survey – Healthy

Aging (2008-2009) • Nationally representative health survey • Age: 45+• 30,865 individuals, 74.4% response rate• Questions on long-term health conditions,

labour force participation (age 45-74) derived variable: in labour force, not in labour force

Method: Analysis

• By 10-year age groups: 45-54, 55-64, 65-74• Descriptive

– Labour force participation (in labour force, not in labour force)

– Prevalence of chronic conditions by labour force status

• Multivariate log-Poisson regression – Outcome: In labour force– Independent: Chronic conditions (individual, #)– Controlled for sex, education level, marital status (and

other chronic conditions)

Results

• Overall, 67.8% were in the labour force• 75.1% reported at least one chronic

condition• More highly educated, married, and men

more likely to be in labour force

Results: by age groups

45-54 55-64 65-74 Overall0

10

20

30

40

50

60

70

80

90

100

89.1

66.4

20.7

In Labour Force

Age group

Pe

rce

nta

ge

(%

)

45-54 55-64 65-74 Overall0

10

20

30

40

50

60

70

80

90

100

66.0

78.5

89.9

Chronic condition (1+)

Age group

Pe

rce

nta

ge

(%

)

Prevalence of chronic conditions and labour force participation

0% 10%

20%

30%

40%

50%

60%

70%

80%

90%

100% 0% 10

%20

%30

%40

%50

%60

%70

%80

%90

%10

0% 0% 10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Age 45-54 Age 55-64 Age 65-74

At least one chronic condition

In LF, without condition In LF, with condition Not in LF, with condition Not in LF, without condition

Prevalence of chronic conditions and labour force participation

0% 20% 40% 60% 80% 100%0% 20% 40% 60% 80% 100%0% 20% 40% 60% 80% 100%

High blood pressure

Back problems

Arthritis

Diabetes

Thyroid condition

Migraine

Heart condition

Osteoporosis

Cataracts/glaucoma

Mood disorder

Asthma

Anxiety disorder

Age 45-54 Age 55-64 Age 65-74

In LF, without condition In LF, with condition Not in LF, with condition Not in LF, without condition

Relative likelihood (prevalence ratio) of labour force participation

*Controlled for sex, education, marital status, other chronic conditions

0.0 0.5 1.0 1.5 0.0 0.5 1.0 1.5 0.0 0.5 1.0 1.5

High blood pressure

Back problems

Arthritis

Diabetes

Thyroid condition

Migraine

Heart condition

Osteoporosis

Cataracts/glaucoma

Mood disorder

Asthma

Anxiety disorder

Age 45-54 Age 55-64 Age 65-74

Results: Multimorbidity0.5 0.6 0.7 0.8 0.9 1 1.1 1.2Prevalence Ratio

1 condition

2 conditions

3+ conditions

1 condition

2 conditions

3+ conditions

1 condition

2 conditions

3+ conditions

45-54

55-64

65-74

Age # condition

Results: Multimorbidity0.5 0.6 0.7 0.8 0.9 1 1.1 1.2Prevalence Ratio

1 condition

2 conditions

3+ conditions

1 condition

2 conditions

3+ conditions

1 condition

2 conditions

3+ conditions

45-54

55-64

65-74

Age # condition

Limitations

• Self-reported – Chronic conditions– Labour force

• Misclassification of labour force status– Temporary absence and recent

unemployment included as being in LF

• No data on type of occupation – Important for some chronic conditions

Summary

1. Age 45+: Majority in labour force report chronic diseases

2. Under age 65: Most with chronic diseases in labour force

3. Multimorbidity important predictor of labour force participation: individual conditions not highly associated

Moving forward

• Recognize high prevalence of chronic disease among middle-aged working Canadians

• Improve accessibility of chronic disease management strategies to working population

• Better research on effective workplace measures to maintain labour force participation, with emphasis on broadly applicable interventions rather than focus on disease-specific solutions

• Address issue of multimorbidity

Questions?

Contact information:christina.chan@uhnresearch.ca

Last week, did you work at a job or a business?

Last week, did you have a job or business from

which you were absent?

In labour force

Yes

No

Have you ever worked at a job or business?

No

Not in labour force

ExcludedIn the past 4 weeks did you do anything to find

work?

What is the main reason you are

currently not working at a job or business?

No

Retired

Did you work at a job or a business at any time in

the past 12 months?

Other

In labour force

NoYes

At this time, would you consider yourself to be

completely retired, partly retired, or not retired?

Completely Retired

Yes

YesNo

Not in labour force

Permanently unable to work

Partly or not retired

Yes

Characteristics of Study Population

Age 45-54Na = 5085

Age 55-64Na = 3865

Age 65-74Na = 2195

ILF NILF Total ILF NILF Total ILF NILF Total% 89.1 10.9 - 66.4 33.6 - 20.7 79.3 -

Sex (%) Male 51.9 35.3 50.1 55.3 39.2 49.9 63.6 46.0 49.7 Female 48.1 64.7 50.0 44.7 60.8 50.1 36.4 54.0 50.4Education (%) < Secondary graduate 9.7 20.9 10.9 12.6 20.2 15.2 23.5 34.2 32.0 Secondary graduate 21.5 26.1 22.0 19.9 22.6 20.8 15.4 16.1 15.9 Other post-secondary 4.6 6.6 4.8 5.7 5.4 5.6 5.6 4.7 4.9 Post-secondary graduate 62.9 43.1 60.7 60.5 50.7 57.2 54.1 44.1 46.2 Not stated 1.4 3.2 1.6 1.3 1.1 1.2 1.4 0.8 0.9Marital status (%) Married/common law 79.8 71.1 78.8 79.7 76.7 78.7 81.1 71.3 73.3 Widowed 1.2 1.3 1.2 3.6 6.0 4.4 7.1 14.7 13.2 Divorced/separated 10.5 13.9 10.8 11.5 12.1 11.7 8.9 9.7 9.6 Single 8.5 13.7 9.1 5.1 5.2 5.2 2.8 4.3 4.0

Chronic condition

Age 45-54 Age 55-64 Age 65-74

Population Prevalence

Proportion Working

Population Prevalence

Proportion Working

Population Prevalence

Proportion Working

No. of conditions

0 34.0 94.6 21.5 75.9 10.1 28.3

1 28.3 92.5 25.8 73.3 21.2 25.2

2 17.1 88.4 20.9 67.4 20.4 21.6

3+ 20.7 75.9 31.9 53.7 48.3 16.9

Any 66.0 86.2 78.5 63.8 89.9 19.9