76 Chapter 4 fulltime compared to lower and middle educational level. This seems to be in contrast with findings from other studies describing that higher educated workers are better able to adjust their work and are less work disabled than lower educated workers who are considered to be more vulnerable, have more health problems and worse working conditions [43–45]. In search for explanations for this difference, we explored if the higher educated workers in our study sample had more often diseases related with higher odds for inability to work fulltime, however this was not the case (data not shown). The difference might be due to a selection in our sample, as our sample was mostly already 2 years on sick leave, and had 2 years to find suitable working arrangements to continue working. Perhaps the selection of workers who were unable to find suitable work adjustments are those applying for a long term disability benefit. It might also be that higher educated people are better able to describe their experienced limitations, or that the effect of a chronic disease on cognitive functions has a more observable effect in daily functioning compared to lower educated people. Insurance physicians may be more inclined to go along with a consistent and credible story in the assessment of inability to work fulltime. Further research on this interesting finding on the association of educational level and inability to work fulltime is therefore recommended. Different associations were found for the specific disease groups and the inability to work fulltime. The highest odds were found for diseases of the blood, neoplasms, diseases of the respiratory system (all above OR 3.1) and lowest odds for diseases of the musculoskeletal system, pregnancy and diseases of the skin (OR 0.52 and lower). When looking at the two disease groups including the most applicants, results show that diseases of the musculoskeletal system (28.5% of the total cohort) had the lowest risk for inability to work fulltime (OR 0.29). Whereas being diagnosed with a mental disorder (29.5% of the total cohort), showed a significant increased risk for inability to work fulltime (OR 1.13). Mental disorders include a variety of diseases where some disorders do have an impact on energy levels (e.g. severe depression and schizophrenia), while other disorders more often cause emotional disturbance than a lack of energy and therefore do not have an impact on the inability to work fulltime. Musculoskeletal diseases (with by far the lowest risks for inability to work fulltime) are more likely responsible for physical work limitations (like limited walking and standing and lifting weights because of problems with joints and pain) than inability to work fulltime. The diseases in the groups with high odds of inability (like diseases of the blood, respiratory diseases and neoplasms), are often accountable for energy deficits, for example by reduced exercise tolerance or increased fatigue. This is in line with the guideline ‘Endurance capacity in work’ in the Netherlands [35], but also with earlier research findings in European countries, stating
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