Paid and Unpaid Productivity Losses Associated with Musculoskeletal Conditions: Longitudinal Evidence from Australia

OBJECTIVE: To examine the impact of musculoskeletal conditions on paid and unpaid productivity using longitudinal Australian data. METHODS: Data were drawn from four waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey. MSCs were identified from self-reported arthritis or osteoporosis, with prescription medication as an indicator of symptom severity. Functional limitation severity was classified using tertiles of the SF-36 Physical Functioning subscale. Correlated random-effects models estimated within- and between-person associations between MSCs and weekly paid, unpaid, and total productivity, adjusting for demographic, socioeconomic, and lifestyle covariates. RESULTS: Overall, 36% of respondents reported an MSC in at least one wave. Individuals with MSCs worked 3.2 fewer paid hours per week (95% CI -3.9 to -2.4) but performed 3.1 more unpaid hours (95% CI 2.1 to 4.2), leaving total productivity largely unchanged. Respondents with MSCs but no medication worked 4.7 fewer paid hours (95% CI -5.8 to -3.5) and 4.7 more unpaid hours (95% CI 2.9 to 6.5), whereas those using medication worked 6.8 fewer paid hours (95% CI -7.8 to -5.9) and 3.0 more unpaid hours (95% CI 1.4 to 4.7). At lower physical functioning levels, paid (-12.8 hours) and total productivity (-13.2 hours) declined sharply. Paid-work losses were larger for men, consistent with significant sex differences in the CRE models. CONCLUSIONS: MSCs substantially reduce paid work and partly redirect time into unpaid work. Policies that support labour-force retention-such as early management of functional decline-and recognition of the unpaid role are essential to address the broader productivity burden.