Health as predictor of unemployment. A population based study in Belgium

Abstract Background Health and employment are interrelated, but this can be both the result of social causation and health selection. Insights in the association between health and employment should be explored in different settings and countries because contextual factors may differ. In this study we investigate if at the Belgian population level, ill health leads to a higher risk of unemployment. Methods We used data from the Belgian health interview survey 2018 linked with administrative data from the compulsory health insurance including information on employment status in 2018 and 2019. The sample for this study consisted of people with a paid job, aged 18-64 year, with no record of having being unemployed in 2018 (n = 3769). Multivariate logistic regression was used to assess if the risk of becoming unemployed in 2019 varied in function of the health status assessed in the 2018 survey. Results After adjustment for age, sex, education and social support, the risk of becoming unemployed was significantly higher for people with moderate to very bad self-rated health compared to those in good health (OR 2.76; 95% CI 1.34-5.67). Similarly, unemployment in the year following participation in the survey was significantly higher among people with activity limitations because of health problems (OR 2.32; 95% CI 1.14-4.72). The higher the number of chronic diseases and conditions, the higher the risk of unemployment (OR 1.37; 95% CI 1.13-1.53). Specific predictors of unemployment were a history of serious depression in the past 12 months (OR 4.47; 95% CI 1.85-10.80) and hypertension (OR 2.54; 95% CI 1.08-6.00). Conclusions In Belgium, health problems are a risk factor of getting unemployed. Especially people with a history of serious depression in the past year have a higher risk to lose their job. The findings confirm the health selection of unemployment and the need for the labour market to invest in interventions to support people with health problems to keep or find a job. Key messages • As employment is a fundamental right, also for people with health problems, further efforts are needed to create an inclusive labour market, with also job opportunities for more vulnerable people. • To be able to understand better the link between health and unemployment at population level, longitudinal population data are needed including both dimensions.