Health-related educational inequalities in paid employment across 26 European countries in 2005–2014: repeated cross-sectional study

OBJECTIVE: The study investigates the trends in health-related inequalities in paid employment among men and women in different educational groups in 26 countries in 5 European regions. DESIGN: Individual-level analysis of repeated cross-sectional annual data (2005–2014) from the EU Statistics on Income and Living Conditions. SETTING: 26 European countries in 5 European regions. PARTICIPANTS: 1 844 915 individuals aged 30–59 years were selected with information on work status, chronic illness, educational background, age and gender. OUTCOME MEASURES: Absolute differences were expressed by absolute differences in proportion in paid employment between participants with and without a chronic illness, using linear regression. Relative differences were expressed by prevalence ratios in paid employment, using a Cox proportional hazard model. Linear regression was used to examine the trends of inequalities. RESULTS: Participants with a chronic illness had consistently lower labour force participation than those without illnesses. Educational inequalities were substantial with absolute differences larger within lower educated (men 21%–35%, women 10%–31%) than within higher educated (men 5%–13%, women 6%–16%). Relative differences showed that low-educated men with a chronic illness were 1.4–1.9 times (women 1.3–1.8 times) more likely to be out of paid employment than low-educated persons without a chronic illness, whereas this was 1.1–1.2 among high-educated men and women. In the Nordic, Anglo-Saxon and Eastern regions, these health-related educational inequalities in paid employment were more pronounced than in the Continental and Southern region. For most regions, absolute health-related educational inequalities in paid employment were generally constant, whereas relative inequalities increased, especially among low-educated persons. CONCLUSIONS: Men and women with a chronic illness have considerable less access to the labour market than their healthy colleagues, especially among lower educated persons. This exclusion from paid employment will increase health inequalities.