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Work, permanent sickness and mortality risk: a prospective cohort study of England and Wales, 1971–2006
  1. Bola Akinwale1,
  2. Kevin Lynch2,
  3. Richard Wiggins3,
  4. Seeromanie Harding4,
  5. Mel Bartley5,
  6. David Blane1
  1. 1Department of Primary Care and Social Medicine, Imperial College London, London, UK
  2. 2Office for National Statistics, Titchfield, Fareham, UK
  3. 3Department of Quantitative Social Science, Institute of Education, University of London, London, UK
  4. 4MRC Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
  5. 5Department of Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to Bola Akinwale, Department of Primary Care and Social Medicine, Imperial College London, St Dunstan's Road, London W6 8RP, UK; b.akinwale{at}


Background In recent decades, labour market participation has fallen in men, with large amounts of this decline accounted for by increases in permanent sickness. There is speculation that the rising numbers of permanently sick incorporate more people with less severe conditions than was previously the case. This paper examines the relationship between labour market position and subsequent mortality around State Pension Age.

Methods Using linked census and death records in the ONS Longitudinal Study, samples of men aged 55–69 and women aged 50–64 were selected from each decennial census, 1971–2001 and their health followed up. Differences between the employed, unemployed and economically inactive in age-specific death rates, Standardised Mortality Ratios and odds of reporting limiting long-term illness were examined.

Results Labour market activity in late middle age has changed since 1971. For example, the proportion of men employed at ages 60–64 years has fallen by 39%, and the proportion permanently sick has more than doubled. Despite this change, there has been stability in the RR of mortality between labour market positions. Working people have the lowest risk of premature death, while, relative to working people, the permanently sick continue to have mortalities around three times higher among men and four to five times higher among women.

Conclusion The evidence does not support the notion that the permanently sick are becoming less seriously ill. The persistence of the group's raised mortality suggests that measures aimed at encouraging later life employment should ensure provision of work environments suitable for people with chronic illnesses.

  • Labour market position
  • mortality
  • early old age
  • ONS longitudinal study, mortality SI

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  • Funding The work is funded by UK Research Council's Programme New Dynamics of Ageing (Award Number RES-352-25-0015) and ESRC International Centre for Life Course Studies in Society and Health (Award Number RES-596-28-0001).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.