63 Inability to work fulltime, prevalence and associated factors INTRODUCTION An important aspect of functioning at the level of the whole human being, is the ability of a person to be active in their working life [1, 2]. To determine whether someone is able to work, the concept “work ability” is seen as a standard and a marker for the current ability of a person to perform in a job [3–5]. Work ability reflects the extent to which people can do their job satisfactorily, taking their job demands and their (physical and mental) health into account [6]. Having a chronic disease, associated with activity limitations, can lead to decreased mental and physical functioning [7–9], and therefore threatening work ability and working hours [10–12]. In comparison to healthy workers, workers with a chronic disease work fewer hours and more often part-time due to differences in fatigue and emotional exhaustion [13–15]. In the Netherlands, long-term sick listed workers with a limited ability to work due to a chronic disease may apply for disability benefit to compensate for income loss. As part of the overall disability assessment, the (in)ability to work fulltime, i.e. the number of hours per day and per week the applicant is able to work, is assessed by insurance physicians from the Dutch Social Security Institute, The Institute for Employee Benefits Schemes (UWV). A limitation of working hours due to chronic disease usually results in partial disability in the Netherlands. Also in other countries the assessment of the (in)ability to work fulltime is an aspect of work disability assessment, although there are differences between countries in used definitions and measures to assess this construct [16]. Overall, more research on this topic is warranted, taking into account the huge impact the assessment outcome can have both from societal and individual perspective [17–19]. One knowledge gap is the limited knowledge about the prevalence of the (in)ability to work fulltime. A few studies across Europe reported on the prevalence of inability to work fulltime in their country, i.e. Belgium (2.6%) [20], Finland (2.9%) [21], Denmark (8.4%) [21], the Netherlands (ranging from 17 [22] to 48% [17]), Norway (18.0%) [21] and Sweden (36.3%) [21]. Differences in samples, e.g. type of sick leave (short- or long-term), included disease groups, assessment goals and social security systems, make the reported prevalence difficult to compare. For example the two Dutch studies are not comparable due to inclusion of different types of work disability benefit and timeframe. The first study [22] reported on all outcomes of (longterm) disability assessments for disability pension, for workers, and young handicapped persons in 1 year, while the other study [17] reported on workers with (not permanent) full disability benefit over a 7-year period. Another knowledge gap is that little is known about sociodemographic and disease-related factors that are associated with inability to work fulltime. Previous studies found that socio-demographic factors, such as age, gender and educational level are associated with having work (dis)ability. For 4
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