Health-related educational inequalities in paid employment across 26 European countries in 2005-2014: repeated cross-sectional study

BMJ Open. 2019 Jun 1;9(5):e024823. doi: 10.1136/bmjopen-2018-024823.


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.

Keywords: chronic illness; employment; social inequalities; trend analysis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chronic Disease / epidemiology*
  • Cross-Sectional Studies / methods
  • Cross-Sectional Studies / trends
  • Educational Status*
  • Employment* / statistics & numerical data
  • Employment* / trends
  • Europe / epidemiology
  • Female
  • Health Status
  • Humans
  • Male
  • Middle Aged
  • Prevalence
  • Sex Distribution
  • Social Conditions / statistics & numerical data*
  • Socioeconomic Factors*