25 The effects of exit from work on health across different socioeconomic groups Introduction A rising life expectancy and decreasing birth rates causes a demographic transition in which Western society is confronted with an ageing population (1, 2). This means, relatively fewer workers to compensate for the elderly not being active in the workforce. The percentage of retired elderly compared to the active working population is expected to increase further in Europe, i.e. from 28% in 2014 to 50% in 2060 (3). This poses great challenges for the welfare state, such as providing pensions and long-term healthcare. To keep the welfare state affordable, many Western countries raised their statutory retirement age (4). Exit from work can be viewed as a major life transition, as it is accompanied by social, psychological, and environmental changes in one’s life (5). Social changes may involve the increase of social contact, because more time can be spent with family and friends; psychological changes could be role loss, as people’s identity might be determined by their job; and environmental changes could be loss of adverse or favorable work characteristics, such as high mental demands or receiving appreciation at work. Two recent systematic literature reviews on the effects of exit from work on health concluded that exit from work has both positive and negative effects on health (6, 7). For example, people with work related low back pain, will likely benefit from the work exit, because it can take away the source of their pain (i.e. physical health) or physical activity may increase, because exit from work provides more time for leisure-time physical activity (i.e. health behaviour). Otherwise, exit from work can also have adverse health effects, such as the increase of stress caused by the loss of income and work responsibilities (i.e. general health and mental health). Hence, exit from work holds different effects on health, depending on the circumstances in which a transition takes place (6-10). Moreover, effects may be different for various health outcomes, such as general, physical, or mental health and health behaviour (6, 7). The effects of exit from work on health may also be different across people from low or high socioeconomic groups (10-12), which is determined by occupation, education, and income (13, 14). Until now, studies have shown contradictory results regarding the effects of exit from work on health for different socioeconomic groups. Previous research demonstrated that people with a higher SES experience a larger decline in general health compared to people with a lower SES (15). Conversely, other studies demonstrated that people with a higher SES experience an increase in mental and physical health compared to people with a lower SES (16, 17). Thus, evidence with regard to the relationship between health and exit from work among different socioeconomic groups remains inconclusive. Therefore, the aim of this review is to systematically review the available evidence regarding the effects of exit from work on health in high and low socioeconomic groups. 2
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