Do chronic diseases moderate the association between psychosocial working conditions and work ability and involuntary work exit? Results from 55,950 Dutch workers

Background: This study aims to examine whether the number of chronic diseases moderates the associations between psychosocial working conditions on the one hand and work ability and involuntary work exit through unemployment and disability on the other hand.
Methods: Lifelines data (n=55,950) were enriched with monthly information on employment status from Statistics Netherlands. Participants were classified as having no chronic disease, one chronic disease, or multi-morbidity. Working conditions were measured with the Copenhagen Psychosocial Questionnaire, work ability with the Work Ability Index, and work exit was defined as unemployment or work disability. Linear regression models and cause-specific Cox proportional hazard regression models were used to analyse associations between working conditions, work ability and work exit, respectively. Interaction terms were used to examine moderation by chronic disease status.
Results: Associations between working conditions and work ability were moderated by workers’ chronic disease status, but differences in magnitude of associations were modest. Associations between working conditions and work exit were generally not moderated by workers’ chronic disease status. Fewer possibilities for development and lower social support were associated with unemployment and work disability, and lower meaning of work with unemployment, regardless a workers’ chronic disease status. Only among workers with multi-morbidity was high work pace associated with unemployment (HR: 1.14; 95% CI: 1.00, 1.30) and lower meaning of work with work disability (HR: 1.22; 95% CI: 1.03, 1.45). 
Conclusion: Good psychosocial working conditions are important for all workers. Additional focus on work pace and meaning of work may benefit workers with multi-morbidity.

Keywords: Involuntary work exit, chronic disease, workers, working conditions, work ability