OP0259-HPR THE EFFECT OF OSTEOARTHRITIS ON HEALTHY WORKING LIFE EXPECTANCY AT AGE 50 IN ENGLAND
Authors: M. Lynch, M. Bucknall, C. Jagger, R. Wilkie
Journal: Annals of the Rheumatic Diseases (2021)

Background: Retirement ages are rising in many countries due to population ageing and increasing life expectancy. However, poor health, comorbidity and workplace factors are major reasons for work absence and it is unclear if people in later working-age life (age ≥50) are able to work for longer. Osteoarthritis (OA), the most common joint condition in adults, is the fastest increasing major health condition globally and is a leading cause of disability (especially in adults age ≥50). Objectives: We aimed to estimate healthy working life expectancy (HWLE; defined as the average number of years that adults from age 50 can expect to be healthy and in paid work) for adults with and without osteoarthritis and investigate the role of mental health problems as a comorbidity and the role of workplace factors through examining whether there is a sense of having any control over what happens at work. Methods: Longitudinal survey data of adults aged ≥50 years were used from six waves (2002-2013) of the English Longitudinal Study of Ageing with linked mortality data from the National Health Service Central Register. HWLE was defined using two self-report variables; health was defined as no long-standing illness or no activity limitation if long-standing illness was present, and work was defined being in employment or self-employment. OA status was identified by self-report of ever receiving a diagnosis from a doctor. Mental health and control of work were measured by self-report. Continuous-time multistate models with three states (healthy and working [state 1], other alive [2], dead [3]) were fitted in R (version 3.6.1) to investigate factors driving transitions out of the healthy and working state. Models included age and combinations of sex, OA, control at work, and mental health problems. Age-adjusted hazards of transitions between states were estimated using the ‘msm’ R package. HWLE for adults with different factors (OA, control of work, mental health) was estimated with the ‘elect’ R package using models fitted with ‘msm’. Missing data was handled using multiple imputation by predictive mean matching. Results: There were 11,540 adults with at least two observations (including survey and mortality data) for the study period (5251 males, 6289 females). Life expectancy at age 50 was 29.7 years for men and 33.4 years for women with HWLE being 9.9 years (men) and 8.3 years (women). HWLE at age 50 for adults with osteoarthritis was 7.3 years (men: 8.2, women: 6.8), and for adults without osteoarthritis was higher at 9.9 years (men: 10.6, women: 9.1). After adjusting for age, the instantaneous risk of ceasing to be both healthy and in work (not due to death) for people with OA was 1.5 times that of people without OA (hazard rate ratio 1.5 with 95% CI [1.3, 1.6]). For adults without OA, HWLE at age 50 was 13.2 years if they felt they had control at work and 4.1 years without control at work, whilst for adults with OA, HWLE was 10.4 years if they felt they had control at work and 3.1 years without. The effect of mental health problems as a comorbidity on HWLE was smaller; for adults without OA, HWLE at age 50 was 11.0 years for those without mental health problems and 8.3 years for those with, whilst for adults with OA, HWLE was 8.6 years for those without mental health problems and 6.2 years with. Conclusion: While the average HWLE for men and women in England is lower than State Pension age, HWLE at age 50 is even lower (by approximately 25%) in adults with OA compared to adults without OA. Poor mental health further reduces HWLE. However, good quality work environments significantly lessen the impact of osteoarthritis (there is a 7.3 year difference in HWLE for those with OA who do and do not experience control at work). These results suggest that interventions and policies that create appropriate job opportunities and supportive workplaces for older workers with health conditions are key to the feasibility and success of extended working life policies. Disclosure of Interests: None declared