Health-related Educational Inequalities in Paid Employment Across 26 European Countries in 2005-2014: Repeated Cross-sectional Study

Objective: The study investigates the trends in health-related inequalities in paid employment among men and women in different educational groups in 26 countries in 5 European regions.

Design: Individual-level analysis of repeated cross-sectional annual data (2005-2014) from the EU Statistics on Income and Living Conditions.

Setting: 26 European countries in 5 European regions.

Participants: 1 844 915 individuals aged 30-59 years were selected with information on work status, chronic illness, educational background, age and gender.

Outcome Measures: Absolute differences were expressed by absolute differences in proportion in paid employment between participants with and without a chronic illness, using linear regression. Relative differences were expressed by prevalence ratios in paid employment, using a Cox proportional hazard model. Linear regression was used to examine the trends of inequalities.

Results: Participants with a chronic illness had consistently lower labour force participation than those without illnesses. Educational inequalities were substantial with absolute differences larger within lower educated (men 21%-35%, women 10%-31%) than within higher educated (men 5%-13%, women 6%-16%). Relative differences showed that low-educated men with a chronic illness were 1.4-1.9 times (women 1.3-1.8 times) more likely to be out of paid employment than low-educated persons without a chronic illness, whereas this was 1.1-1.2 among high-educated men and women. In the Nordic, Anglo-Saxon and Eastern regions, these health-related educational inequalities in paid employment were more pronounced than in the Continental and Southern region. For most regions, absolute health-related educational inequalities in paid employment were generally constant, whereas relative inequalities increased, especially among low-educated persons.

Conclusions: Men and women with a chronic illness have considerable less access to the labour market than their healthy colleagues, especially among lower educated persons. This exclusion from paid employment will increase health inequalities.