The short-term effect of BMI, alcohol use, and related chronic conditions on labour market outcomes: A time-lag panel analysis utilizing European SHARE dataset

Abstract

Introduction: Non-communicable diseases (NCDs) like cancer, cardiovascular disease, and diabetes have spread at a remarkable pace in European countries over the past decades. Overweight/obesity and alcohol use are two leading risk factors contributing to both economic and epidemiological burden associated with NCDs. In OECD countries, the impact of indirect costs of obesity varies between 0.20% and 1.21% of GDP. Indirect costs of alcohol use range from 0.19% (Portugal) to 1.6% (Estonia) of GDP.

Aim: To assess the longitudinal impact of alcohol use and high body-mass index (BMI) on labour market outcomes in the European region by modeling the direct effect of high BMI and alcohol use, and the effect via associated diseases.

Methods: The impact of BMI, alcohol use, and associated diseases on employment likelihood, intent to retire early, days of absenteeism, and hours of work per week, were modelled via lagged Poisson and Zero-inflated Poisson regressions, adjusting for missingness via inverse probability weighting, as appropriate, using European SHARE data.

Results: Controlling for other chronic conditions, being overweight increases employment likelihood among men, but not among women. Obesity decreased female, but not male, employment chances. All chronic conditions linked with high BMI negatively affected employment likelihood, and increased the intention to retire early significantly. Alcohol use positively affects employment likelihood in women at all drinking levels relative to lifetime abstainers, but only in moderate (not heavy) male drinkers. There is super-additionality of impact of NCDs on absenteeism and hours worked, presenting a key economic argument to tackle NCD prevention and compression of morbidity.

Implications: NCD prevention is not just important for employment and hours worked, but also for employee morale, especially given increasing retirement age in Europe and globally.

Fig 1. Relative Risk of being employed by BMI category.

Note: The results are shown as relative risks (RRs), approximated from the Incidence Rate Ratios in the corresponding Poisson models. The model was adjusted for marital status, age, education, country level fixed effects, level of physical activity, smoking, drinking, and other chronic diseases. All relative risks can be combined on an additive scale, and refer to the likelihood of being employed when in the exposure category, compared to the reference category. A relative risk >1 means a greater likelihood of being employed, and a RR <1 means a lower likelihood of employment. p-value for effect modification by gender: p<0.0001 Source: OECD analysis of Harmonized SHARE + SHARE employment module, Release 6.0. The forest plot was created based on a template by [30].

Fig 2. Employment Likelihood due to past drinking status.

Note: Models adjusted for marital status, education, smoking, age, gender, country level fixed effects, and number of social events attended. p-value for gender effect modification: p<0.0001. The forest plot was created based on a template by [30].