People with little education and low socioeconomic status are more likely to leave the workforce in midlife for health reasons than better-educated, higher-status workers, according to a review of research across four developed countries. In the context of national policies to extend working life by raising retirement ages, the most vulnerable workers may not be capable of working extra years, the authors write in Occupational & Environmental Medicine. Lead author Ewan Carr of King's College London said that population ageing and rising old-age dependency ratios have led many governments to increase statutory retirement age, but remaining in work until or beyond pensionable age may be challenging for those with low socioeconomic positions. Service industry workers, custodial or sanitation workers, and construction workers are examples of low socioeconomic-status jobs that require less education. Study coauthor Jenny Head of University College London said the researchers wanted to find out to what extent people in these disadvantaged positions were more likely to stop working at an earlier age than people in more advantaged socioeconomic positions. The researchers analyzed data from seven studies covering a total of 99,164 workers in Finland, France, the UK, and the U.S. Participants were, on average, 48 years old at the start of the observation period and were followed until they left paid work or reached age 64. The studies covered 1989–2015. Health-related labor market exit was defined as stopping paid work because of poor health or disability, based on self-reports and administrative records. Researchers also examined self-rated health, education level, and occupational grade. Overall, about 9% of people with less than a high school education or in low-grade occupations reported poor health, compared with about 4.7% of those with postsecondary education or high-grade occupations. During the study, 50,003 workers left the labor force, and 14% of these departures were for health-related reasons; roughly one in six of those who left for health reasons had less than a high school education. Across studies, low versus high education was associated with a 32% to 3.5-fold higher risk of health-related early exit, and low versus high occupational grade with a 61% to 4.6-fold higher risk. Carr noted that older workers are at greater risk of leaving work due to poor health if they have low education or work in low-grade occupations. The team wasn’t surprised by the findings, since many previous studies have shown associations between socioeconomic position and poor health and between education level and poor health. Work-related factors are likely associated with early work exit and health-related exit and would be relevant to the population studied, he said. Public policy could help mitigate this trend by reducing health disparities between high- and low–socioeconomic-status workers, said Dr. Peter Muennig, a health policy and management researcher at Columbia University’s Mailman School of Public Health, who was not involved in the study. “The ideal is to create a situation in which the health gradients are smaller than they are,” he said in an email. “It may be that we can do this with better schools, cheaper education and better welfare benefits, but no one is 100 percent sure yet because experimental data have not been collected. What is clear is that older people in the U.S. are much worse off than anywhere else, and that is doubly true for older people with less educational attainment.” Source: Occupational & Environmental Medicine, online March 12, 2018 (bit.ly/2J2r8JN).