64 Chapter 4 example, older age is associated with a higher risk of having one or more chronic diseases [23] and in particular individuals with a chronic disease are at an increased risk to exit paid employment due to unemployment, disability benefits, and early retirement. [24, 25]. Besides that, women more often suffer from common mental problems (e.g. depressive symptoms) compared to men [26]. Moreover, they work more often part-time [27, 28], and in jobs with low autonomy [29] and high mental work load [30]. These differences may lead to differences in impact of a chronic disease on the ability to work fulltime. In addition to age and gender differences, socio-economic differences may exist. It is known that workers with a low educational level are at a higher risk to exit paid employment compared to workers with a high educational level [24, 25]. These educational differences in disability benefits and unemployment can be explained for, respectively, 40% and 9% primarily due to a higher occurrence of chronic diseases among low educated workers [24]. Type of disease and multimorbidity might also be associated with the prevalence and degree of inability to work fulltime. Chronic diseases like cardiovascular diseases, neoplasms, musculoskeletal disorders, mental diseases and neurological diseases are highly prevalent and disabling diseases among individuals within the working age [10]. The prevalence of multimorbidity, i.e. having at least two chronic diseases, increases along with the ageing process [31, 32] and previous studies found that workers with multimorbidity are at an increased risk of involuntary exit from work, such as unemployment and disability benefits [24, 25]. Against this background, the present study aims to (1) gain insight in the prevalence and degree (number of hours per day able to work) of inability to work fulltime; (2) explore associations between socio-demographic and disease-related factors with inability to work fulltime; and (3) explore whether the prevalence and the associations differs across disease groups in a representative sample of applicants for a work disability benefit. METHODS Institutional Setting In the Netherlands, social insurance legislation (Work and Income Act; WIA [33]) allows employees to apply for a disability benefit after 2 years of sick leave [34]. Individuals may receive disability benefits for a disease or handicap due to either occupational or non-occupational causes. For the disability benefit assessment, insurance physicians gather information on the medical situation, work- and social situation and functioning of the applicant mainly in an assessment interview and from other sources such as treating- and occupational health physicians. Part of the assessment is a conclusion about an individuals’ (in)ability to work fulltime, reported as the number of hours
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