In which ways do unhealthy people older than 50 exit the labour market in France?

Our plain-English summary of In which ways do unhealthy people older than 50 exit the labour market in France?, by T. Barnay (The European Journal of Health Economics, 2010).

The study

• Author: T. Barnay
• Journal: The European Journal of Health Economics
• Published: 2010;11(2):127-40
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Among 55-64 year olds, poor health is a reason for leaving the labour market early within the framework of schemes such as not only Early Retirement for Certain Employees (or Early Retirement for Asbestos Workers), but also by absence from the workforce (sick pay and disability pensions, respectively). It is interesting to single out the controlling factors for participation in or absence from the labour market after 50 and the link between poor health and employment status. The prevalence of functional limitations in everyday activities leads to a more pronounced exclusion of those over 50 years old from the labour market. Some of those aged between 55 and 59 on disability benefits become unemployed and do not look for work; in other words, they are potentially exempted from job-seeking. This would confirm the hypothesis that some of those exempted from job-seeking are in poor health.

In plain English

This was a statistical analysis of a 2002–2003 French national household health survey of people aged 50 to 59 in metropolitan France (2,513 men and 2,629 women). It did not study asbestos exposure or asbestos disease. Asbestos appears only as the name of a scheme that let asbestos workers stop working at 57. Using logistic regression, the author related self-reported health to employment status. After accounting for other health measures, reporting an activity limitation was linked to 68% lower odds of working for men (odds ratio 0.32) and 51% lower odds for women (odds ratio 0.49). Among non-working people aged 55 to 59 who had worked, unemployed people not seeking work reported activity limitations about twice as often as those seeking work (32.4% versus 16.7%). Unemployed people in that group who reported an activity limitation had lower odds of seeking work (odds ratio 0.44, or 0.37 with further health adjustment). The author concluded that the results appear to support the hypothesis that some people with job-seeking exemptions are unhealthy, but noted that a causal link could not be proved.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Cross-sectional statistical analysis of national survey data, using binomial and multinomial logistic regression
• Who was studied: People aged 50 to 59 in metropolitan France, from the INSEE decennial health survey (EDS) 2002–2003: 2,513 men and 2,629 women (5,142 in total). Some analyses were limited to non-working people aged 55 to 59 who had worked in the past (882 observations).
• Exposure: No asbestos or fiber exposure was studied. The factors examined were self-reported health indicators (activity limitation, perceived health, chronic illness, abnormal body mass index and feelings of depression) in relation to employment status. Asbestos is mentioned only as an early retirement scheme (CAATA) that allows asbestos workers to stop working at 57.
• Main results:
  • Among people aged 50–59, in the model that also controlled for perceived health, chronic illness and BMI (model A), reporting an activity limitation was associated with lower odds of working. The odds ratio was 0.32 for men (68% lower odds) and 0.49 for women (51% lower odds).
  • When activity limitation was the only health measure (model B), the odds ratio for working was 0.26 for men (74% lower odds) and 0.41 for women (59% lower odds). These were compared with people of the same sex reporting no activity limitation.
  • In model C, a career interruption for health reasons was associated with lower odds of working at ages 50–59 among men (odds ratio 0.59, i.e. 41% lower odds). The figure for women (0.87) was not marked significant.
  • Men who reported changing jobs for health reasons had higher odds of being employed at the end of working life (odds ratio 1.63). The author noted that the level of significance was not high.
  • Among non-working men aged 50–59, reporting an activity limitation was associated with almost threefold higher odds of being non-working without a recognised handicap (odds ratio 2.73, model B).
  • In further analyses of non-working men, the author reported that perceived health, rather than activity limitation, explained the link. A non-working man reporting poor health was described as four times more likely to be non-working without a recognised handicap; the table gives 4.00, without a significance mark.
  • Among non-working people aged 55–59 who had worked, activity limitations were reported by 32.4% of unemployed people not seeking work and 16.7% of unemployed people seeking work. The figures were 70.9% for non-workers with a recognised handicap and 13.2% for the retired and early retired.
  • In the adjusted multinomial model of non-working people aged 55–59 who had worked (882 observations, 141 unemployed not seeking work), unemployed people reporting an activity limitation had lower odds of seeking work than of not seeking work. The odds ratio was 0.44, or 0.37 in a second estimate with further health adjustment. The article's text gives this as 66% less likely, a figure that does not match the table.
  • In the same model, reporting an activity limitation was associated with lower odds of being retired or early retired rather than unemployed and not seeking work, the stand-in for job-seeking exemption (odds ratio 0.30, or 0.37 with further health adjustment). The author describes this as an associated risk of 70%.
• The authors' conclusion: The author concluded that a proportion of 55–59 year olds with disabilities appear to be unemployed and not seeking work, and so may have job-seeking exemptions. In the author's view, this appears to support the hypothesis that some people with job-seeking exemptions are unhealthy.
• Limitations the authors state:
  • The results suggest a relationship between poor health and leaving the labour market, but cannot prove a causal link.
  • The survey data are subject to reporting bias and are incomplete, because only households were surveyed; people in hospitals and institutions were not included.
  • Holding a job-seeking exemption does not necessarily mean a person is not seeking work, so the survey category only approximates the administrative category.
  • Survey self-reports differed from official statistics: 256,000 people over 50 reported being unemployed and not seeking work, while official statistics count over 377,900 with job-seeking exemptions.
  • The male model of non-working without a recognised handicap lacked statistical power.
  • Men and women had to be grouped together in the multinomial analysis, which hides large differences between the sexes.

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