Increasing illness among people out of labor market – A Danish register-based study

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Highlights

  • During three decades, 25% of the labor force has been out of labor in Denmark.

  • Inefficiency in labor market policies may be due to weak focus on health among non-employed.

  • Prevalence of mental disorders is increasing among those with non-health related benefits.

  • Incidence of mental disorder increases among those out-of-work compared to employed.

  • The inflow to non-health related benefits of people with mental disorders is strong.

Abstract

In spite of decades of very active labor market policies, 25% of Denmark's population in the working ages are still out-of-work. The aim of this study was to investigate whether that is due to consistent or even increasing prevalence of ill health. For the period of 2002–2011, we investigated if i) the prevalence of four chronic diseases (cardiovascular disease, diabetes, cancer and mental disorders) among those out-of-work had changed, ii) the occurrence of new cases of those diseases were higher among those who were already out-of-work, or iii) if non-health-related benefits were disproportionately given to individuals recently diagnosed with a disease compared to those without disease. The study was register-based and comprised all Danish residents aged 20–60. During the study period, the prevalence of cardiovascular diseases and mental disorders increased among both employed and non-employed people. The increased prevalence for mental disorder was particularly high among people receiving means-tested benefits. Disease incidence was higher among people outside rather than inside the labor market, especially for mental disorders. Employed people with incident diseases had an unsurprisingly increased risk of leaving the labor market. However, a high proportion of people with incident mental disorders received low level means-tested benefits in the three years following this diagnosis, which is concerning. Men treated for mental disorders in 2006 had high excess probability of receiving a cash-benefit, OR = 4.83 (4.53–5.14) for the period 2007–2010. The estimates were similar for women.

Section snippets

Background

The sustainability of the Nordic welfare state model depends on a high employment rate (Dølvik et al., 2015). For many decades, social investment policies (Morel et al., 2012) placed a strong focus on education, health care and active labor market policies. As a result, the Danish employment rate among 20–60-year-olds has existed at 75–80% for more than three decades. An expansion of welfare services for children and the elderly, a focus on vocational rehabilitation, lifelong possibilities for

Study population

We used register data covering information on all Danish residents ages 20 to 60 and followed them from 31st December 2002 to 31st December 2011. This period was chosen because register variables on labor market status were consistent throughout the period. We included four disease-groups in the study (Table 1). The prevalence sub-study (research question i) was comprised of the total population (N = 2,778,044 individuals in 2002); whereas, the sub-studies of new registered cases only included

Results

  • i)

    Cross-sectional study of prevalent cases of treatment

Fig. 2a–d shows the proportion (not age standardized) of people with the four chronic diseases (“prevalence”) by sub-populations as defined by type of income in the years 2003, 2007 and 2011. The total prevalence of registered cases of cardiovascular diseases (CVD) among men and women ages 20–60 increased from 10% in 2003 to 14% in 2011. The yearly prevalence of CVD was slightly higher among the unemployed and people on sick-leave compared to

Discussion

Our results show that overall, the prevalence of registered cases of the four chronic disorders has increased from 2003 to 2011, particularly for mental disorders among those on means-tested benefits. Compared to employees, people outside of the labor market have a higher occurrence of disease, and employees with incident cases have an increased risk of leaving the labor market even with non-health related benefits.

  • i)

    The increasing prevalence of chronic diseases

Based on the data, we cannot

Strengths and limitations

A major strength of the study is the use of nationwide register data from NPR, MDR and Statistics Denmark, which means that almost the entire population is included. The number of individuals who were not included in the analyses due to missing information on covariates was low. However, missing information on education was more frequent among immigrants and descendants of immigrants than among people of Danish origin. The use of longitudinal registers makes it possible to clarify whether

Conclusions

The results show a rising prevalence of health problems among those outside of the labor market in particular among those on means-tested cash-benefits. The higher prevalence is generated by a higher disease incidence after they have left the labor market compared to those who continue to work. Further, individuals who become ill have a higher risk of receiving non-health related benefits compared to those with better health. The high proportion of people out-of-work in Denmark has been

Ethical approval

Ethical approvement is not required for this study, since it is based on registerdata. All data at Statistics Denmark are totally anonymous to the researchers.

Funding

Funding The Work was funded by the Health Foundation, grant no. 2013B077.

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