Social and economic consequences of chronic illness : evidence from longitudinal studies in Britain and Sweden
In Study 1, data from the first eleven waves (1991-2001) of the British Household Panel Survey were used to explore the impact of poor self-rated health on subsequent employment status for men and women from different social classes. In Studies 3 and 4, two linked longitudinal registers, containing diagnostic and social data on the population of Stockholm County, were analysed to quantify gender and social class variations in the employment and financial consequences of ischaemic heart disease (IHD), musculoskeletal disorder, neurosis and psychosis. Results: In Britain, the risk of leaving employment increased with worsening health trajectories. In each health trajectory, women had a significantly higher risk of leaving work than men and the consequences of having poor health were more severe for individuals who were already socially disadvantaged. Case studies of women with limiting illness revealed a complex interplay between health and social factors and subsequent employment status and income. Limiting illness and reduced socio-economic circumstances led to poor mental health for some women. In Sweden, while employment rates rose in the general population of Stockholm in 1996-2001, they fell annually among men and women with IHD, musculoskeletal disorder, neurosis or psychosis. Women with musculoskeletal disorder had a significantly greater risk of leaving work than men but women with a diagnosis of IHD, neurosis or psychosis had a similar risk to their male counterparts. There was a social gradient in the risk of leaving work for most diagnosis. Having a mental illness led to greater employment disadvantage than having a physical diagnosis. Despite declining employment rates, the incomes of individuals with chronic illness increased, but not to the extent observed in the general population. Social differentials in income widened following admission. Conclusion: In both countries, women and manual workers with chronic illness were vulnerable to losing their employment. Sweden's welfare state appeared to protect the incomes of individuals with physical conditions, but people with psychiatric diagnoses fared less well.