1. Chronic Conditions Among Middle-Aged Canadians in the Workforce – the Rule not the Exception Christina H. Chan 1, Monique A.M. Gignac 2,3, Elizabeth M. Badley 1,3 1.Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, University Health Network 2.Institute for Work and Health 3.Dalla Lana School of Public Health Canadian Public Health Association Conference 2014 May 28, 2014

2. Background ↑ prevalence of chronic conditions with age Onset often in middle-age years (45-55) – peak of working career for many Previous research focus on negative impact: early retirement, decreased productivity, sick days

3. Objective Fewer studies focus on those who continue to work: –How many stay in labour force? –How prevalent are chronic conditions in the labour force? Objective: To examine labour force participation among middle-aged Canadians with and without a variety of chronic health conditions using population-based data.

4. Method: Data source Secondary data analysis Canadian Community Health Survey – Healthy Aging (2008-2009) Nationally representative health survey Age: 45+ 30,865 individuals, 74.4% response rate Questions on long-term health conditions, labour force participation (age 45-74)  derived variable: in labour force, not in labour force

5. Method: Analysis By 10-year age groups: 45-54, 55-64, 65-74 Descriptive –Labour force participation (in labour force, not in labour force) –Prevalence of chronic conditions by labour force status Multivariate log-Poisson regression –Outcome: In labour force –Independent: Chronic conditions (individual, #) –Controlled for sex, education level, marital status (and other chronic conditions)

6. Results Overall, 67.8% were in the labour force 75.1% reported at least one chronic condition More highly educated, married, and men more likely to be in labour force

7. Results: by age groups

8. Prevalence of chronic conditions and labour force participation Age 45-54Age 55-64Age 65-74 At least one chronic condition In LF, without conditionIn LF, with conditionNot in LF, with conditionNot in LF, without condition

9. Prevalence of chronic conditions and labour force participation High blood pressure Back problems Arthritis Diabetes Thyroid condition Migraine Heart condition Osteoporosis Cataracts/glaucoma Mood disorder Asthma Anxiety disorder Age 45-54Age 55-64Age 65-74 In LF, without conditionIn LF, with conditionNot in LF, with conditionNot in LF, without condition

10. Relative likelihood (prevalence ratio) of labour force participation *Controlled for sex, education, marital status, other chronic conditions High blood pressure Back problems Arthritis Diabetes Thyroid condition Migraine Heart condition Osteoporosis Cataracts/glaucoma Mood disorder Asthma Anxiety disorder Age 45-54Age 55-64Age 65-74

11. Results: Multimorbidity 1 condition 2 conditions 3+ conditions 1 condition 2 conditions 3+ conditions 1 condition 2 conditions 3+ conditions 45-54 55-64 65-74 Age # condition

12. Results: Multimorbidity 1 condition 2 conditions 3+ conditions 1 condition 2 conditions 3+ conditions 1 condition 2 conditions 3+ conditions 45-54 55-64 65-74 Age # condition

13. Limitations Self-reported –Chronic conditions –Labour force Misclassification of labour force status –Temporary absence and recent unemployment included as being in LF No data on type of occupation –Important for some chronic conditions

14. Summary 1. Age 45+: Majority in labour force report chronic diseases 2. Under age 65: Most with chronic diseases in labour force 3. Multimorbidity important predictor of labour force participation: individual conditions not highly associated

15. Moving forward Recognize high prevalence of chronic disease among middle-aged working Canadians Improve accessibility of chronic disease management strategies to working population Better research on effective workplace measures to maintain labour force participation, with emphasis on broadly applicable interventions rather than focus on disease- specific solutions Address issue of multimorbidity

16. Questions? Contact information: christina.chan@uhnresearch.ca

17. Last week, did you work at a job or a business? Last week, did you have a job or business from which you were absent? In labour force Yes No Have you ever worked at a job or business? No Not in labour force Excluded In the past 4 weeks did you do anything to find work? What is the main reason you are currently not working at a job or business? No Retired Did you work at a job or a business at any time in the past 12 months? Other In labour force No Yes At this time, would you consider yourself to be completely retired, partly retired, or not retired? Completely Retired Yes No Not in labour force Permanently unable to work Partly or not retired Yes

18. Characteristics of Study Population Age 45-54 N a = 5085 Age 55-64 N a = 3865 Age 65-74 N a = 2195 ILFNILFTotalILFNILFTotalILFNILFTotal % 89.110.9 - 66.433.6 - 20.779.3 - Sex (%) Male 51.935.350.155.339.249.963.646.049.7 Female 48.164.750.044.760.850.136.454.050.4 Education (%) < Secondary graduate 9.720.910.912.620.215.223.534.232.0 Secondary graduate 21.526.122.019.922.620.815.416.115.9 Other post-secondary 4.66.64.85.75.45.6 4.74.9 Post-secondary graduate 62.943.160.760.550.757.254.144.146.2 Not stated 1.43.21.61.31.11.21.40.80.9 Marital status (%) Married/common law 79.871.178.879.776.778.781.171.373.3 Widowed 1.21.31.23.66.04.47.114.713.2 Divorced/separated 10.513.910.811.512.111.78.99.79.6 Single 8.513.79.15.15.2 2.84.34.0

19. Chronic condition Age 45-54Age 55-64Age 65-74 Population Prevalence Proportion Working Population Prevalence Proportion Working Population Prevalence Proportion Working No. of conditions 034.094.621.575.910.128.3 1 92.525.873.321.225.2 217.188.420.967.420.421.6 3+20.775.931.953.748.316.9 Any66.086.278.563.889.919.9