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Labor force participation among persons with musculoskeletal conditions 1970-1987National estimates derived from a series of cross-sections.

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1361
LABOR FORCE PARTICIPATION AMONG PERSONS
WITH MUSCULOSKELETAL CONDITIONS, 1970-1987
National Estimates Derived from a Series of Cross-Sections
EDWARD H. YELIN and PATRICIA P. KATZ
In the present study, we estimated the labor force
participation rate among persons with musculoskeletal
conditions in 1987, compared this rate with that experienced by persons with other chronic conditions or with
none, and estimated the change in labor force participation rates among persons with musculoskeletal conditions for the period 1970-1987. Rates were estimated
from 18 years of National Health Interview Survey data,
and the sampling weights from this survey were used to
obtain population estimates. To ensure statistically stable estimates, we averaged the rates over 6 years of data.
In 1987,42.9% of all working-age persons with musculoskeletal conditions were out of the labor force, this
study’s definition of work disability. Overall labor force
participation rates among persons with musculoskeletal
conditions declined from 71% to 56% between 1 9 7 6
1981 and 19821987, 22% in relative terms. Much of
this decline was concentrated among men, especially
men 55-64 years of age. However, women 55-64 years
of age with musculoskeletal conditions also experienced
declining labor force participation rates. Labor force
participation patterns among persons with musculoskel=
etal conditions fit more general labor market trends,
From the Rosalind Russell Arthritis Center, the Department of Medicine, and the Institute for Health Policy Studies,
University of California, San Francisco.
Supported by NIAMS grant AR-20684. Dr. Yelin’s work
was supported by NIA Research Career Development Award K W
AG273.
Edward H. Yelin, PhD: Department of Medicine and Institute for Health Policy Studies; Patricia P. Katz, PhD: Department of
Medicine.
Address reprint requests to Edward H. Yelin, PhD, Department of Medicine, University of California, San Francisco, 350
Parnassus Avenue, Suite 600,San Francisco, CA 941 17.
Submitted for publication February 21, 1991; accepted in
revised form May 30, 1991.
Arthriiis and Rheumatism, Vol. 34, No. 11 (November 1991)
with gains among younger women more than offset by
declines among older men and women. However, these
trends appear to be more accentuated among persons
with musculoskeletal conditions, suggesting that enforcement of the employment provisions of the Americans with Disabilities Act of 1990 place special emphasis
on labor force participation among such persons.
The impact of musculoskeletal conditions on
labor force participation is profound. In studies of
persons with rheumatoid arthritis from clinical environments, the prevalence of work disability, defined as
not working due to the illness, varied from 50% to 60%
(1-3), with the work disability rate reaching close to
100% with the passage of time (3). In studies of
persons with musculoskeletal conditions sampled from
community environments, the prevalence of work
disability varied from a low of 10% (among all persons
with musculoskeletal conditions of any diagnosis or
severity) to 72% (among persons with rheumatoid
arthritis by diagnosis and symptoms) (4-6). Data on
the costs of musculoskeletal conditions reflect these
disability prevalence figures, demonstrating that the
work loss costs of these illnesses average between 40%
and 56% of total disease costs in national communitybased studies of all persons (7-91, between 60% and 67%
of total disease costs in national community-based studies of noninstitutionalized persons (5,6,10,1 l), and
between 75% and 87% of such costs in studies of
discrete conditions in clinical environments (12-16).
There is reason to believe that the prevalence of
work disability due to musculoskeletal conditions has
risen or will rise. First, several studies have noted that
the prevalence of musculoskeletal conditions and of
YELIN AND KATZ
I362
musculoskeletal condition-related activity limitation
have risen, both because the population is aging and
because age-adjusted rates of musculoskeletal conditions are rising (17-22). Second, work disability rates
among persons with all chronic conditions are rising
(23-26), and due to the high prevalence of musculoskeletal conditions and musculoskeletal conditionrelated work disability, musculoskeletal conditions
might account for part of this more general increase.
Third, labor force participation rates have been falling
for close to 2 decades among older workers generally,
but especially among older male workers (27.28). This
suggests that the demand for the labor of persons with
medically limiting illnesses such as musculoskeletal
conditions may be falling.
The present study was designed to test the
hypothesis that work disability rates due to musculoskeletal conditions are rising. The specific goals
were: I ) to estimate the labor force participation rate
of US workingage adults by activity limitation status
for the period 1970 through 1987 in order to replicate
the finding that work disability rates are on the rise; 2)
to estimate the cross-sectional prevalence of musculoskeletal condition-related work disability among US
working-age adults in 1987, t o establish the dimension
of this problem with more contemporary data than
previous studies; and 3) t o estimate the change in work
disability rates among U S working-age adults with
musculoskeletal conditions from 1970 through 1987 to
demonstrate that the rates are, indeed, on the rise. The
study uses 18 years of the National Health Interview
Survey (HIS) public use data tapes to make these
estimates.
METHODS
Data source. The present study draws upon the
public use tapes of the HIS for the years 1970 through 1987.
The HIS is an annual survey administered to a clustered,
stratified sample (about I 10,000 persons) of the noninstitutionalized population living in the contiguous 48 states (29).
The HIS uses a different sample each year. Therefore, it is
not possible to follow respondents over time. Instead, the
HIS can only be used to establish trends in cross-sectional
estimates. The purpose of the HIS is to provide estimates of
the prevalence and impact of acute and chronic conditions
and to assess the US population's access to health care
services. Relying on face-to-face surveys, the HIS categorizes medical conditions on the basis of self-report of respondents (or their proxies). Using respondents' reports of
symptoms and diagnoses rendered to them by their physicians, the HIS employs a highly structured coding scheme
designed to provide cautious estimates of the prevalence of
conditions (30). In general, the HIS yields prevalence estimates lower than those from studies in which physicians
examine the patients, and misses subclinical cases of conditions (31.32). The systematic and large sampling frame,
cautious medical coding, and careful attention to measures
of the impact of illness yield a good, though not perfect,
estimate of disability associated with specific conditions.
Data definitions and data partitions. The present
study concerns only persons between the ages of 18 and 64,
the traditional working ages. We defined a respondent as
having a "musculoskeletal condition" if the "medical condition" file of the tape showed an ICD-A (International
Classification of Diseases. Adapted for use in the US) code
of 710 through 739. the inclusive codes for diseases of the
musculoskeletal system, including arthritis, rheumatism,
and disc disease; 358. 359. 376, or 648 (other diseases of the
musculoskeletal system or of bone); or 274 (gout) or an
ICD-9 (Ninth revision of ICD) code of 71 I through 733 or 274
(the same diseases as above, but using the newer coding
scheme). Some such persons also had other conditions; we
created a separate partition for those with an ICD code for a
musculoskeletal condition plus any other condition code.
The two other partitions included all persons who had no
code within the above musculoskeletal condition rubric, but
who had any other chronic condition code, and all persons
with no chronic conditions whatsoever. Thus, 4 disease
groups were defined: persons with no chronic conditions,
persons with musculoskeletal conditions alone, persons with
chronic conditions other than musculoskeletal conditions,
and persons with both musculoskeletal conditions and other
chronic conditions.
We further partitioned the data files by sex, age (age
groups 18-44, 45-54. and 55-64 years), and activity limitation status (those with and without limitations in activities).
The sex and age partitions yield groups with relatively
homogeneous labor force participation rates (27). The activity limitation screen is the principal way the HIS characterizes the health of the population. The HIS defines activity
limitation according to the responses to a series of questions
about one's ability to do one's major activity or outside
activities (29). Finally. we used the HIS question about labor
force participation to define the groups who were and were
not work disabled. The labor force participation item asks
respondents to report whether they are currently working or
looking for work. A negative response in the presence of
activity-limiting chronic disease implies work disability by
this definition. However, those without activity-limiting
chronic disease could also be out of the labor force, but this
would be for non-health reasons.
Data analysis. We used the sampling weights assigned to each case in the HIS public use data tapes to
estimate the prevalence of work disability in each conditionage-sex partition. The sampling weights are designed to
accomplish two goals. First, the weights compensate for the
fact that the HIS is not a true random sample of the
population, allowing one to make inferences as if it were.
Second, the weights allow estimates of the actual population
of persons experiencing work disability. not just the sample
of persons surveyed (around IIO.OO0 in this case) (33).
Because the HIS is not a true random sample,
estimates of the standard error for the prevalence of disabil-
1363
EMPLOYMENT AND MUSCULOSKELETAL CONDITIONS
ity from common statistical packages may be biased. There
are 3 methods researchers have devised to account for this.
The first uses either a balanced sample replication or jackknife sample technique to make these estimates more reliable (34). The second flags those situations in which the
standard error exceeds a set level of the actual parameter
estimate, usually 30% (21). The third smooths the data by
averaging estimates across years. We used the second
method in all analyses below, and the third in the analysis of
the change in work disability rates over time among persons
with musculoskeletal conditions. (Even the sample size of
the HIS did not prove sufficientto yield stable estimates of
work disability rates among such persons with 1 year's data;
we averaged work disability rates across 6 years of data and
combined the 2 musculoskeletal condition groups, those
with and without other chronic conditions.) All single analyses by sex met the Criterion that the standard error be <30%
of a parameter estimate. The estimates for condition groups
in which the data for both sexes were pooled did not meet
this criterion due to the inherent between-sex variations in
labor force participation rates. (The overall estimates of
labor force participation not stratifiedby condition group did
meet this criterion.)
RESULTS
Figure 1 charts the labor force participation rate
of men in the early and middle stages of their working
lives from 1970 through 1987. The rate among all men
ages 18-44, regardless of limitation status, proved
remarkably stable during this time, never varying by
more than 1 percentage point from a value of 90%. The
rate for all men ages 45-54 fell several percentage
points in the first part of the period under study,
although it recovered somewhat just prior to 1987.
This overall stasis masks declines in labor force participation rates among men with activity limitation,
however. In the early part of the period, about 78% of
0.9
18-44, All Statuses
t
i
; 0.8
!,
0.7
70 71 72 73 74 75 70 77 78 79 00 a1 02
83 84 05 a0 07
Year
Figure 1. Labor force participation rates among men ages 18-44
and ages 45-54, by limitation and year. See Methods for definitions
of groups.
P 0.95
All Ages, All Statuses
P 0.85
\+- +-+--+-%----*--
All Ages. Witb I i r n i t a t h
0.35
T
T
-
.
T
-
I
1
I
I
,
I
70 71 72 73 74 75 70 77 78 79 80 81 a2 a3 84 0s 00 8 7
Year
Figure 2. Labor force participation rates among men of all working
ages and ages 55-64, by limitation and year. See Methods for
definitions of groups.
men ages 18-44 with activity limitation were in the
labor force, but by 1987, the rate had fallen several
percentage points. The decline was more precipitous
among men 45-54, from 74% in 1970 to 62% in 1987, or
more than 16% in relative terms.
Among men ages 55-64, the reduction in labor
force participation rates was not limited to those with
activity limitation (Figure 2). Indeed, the proportion of
all such men in the labor force fell from about 80% at
the start of the period to about 67% at the end, or 16%
in relative terms, while the decline among those without limitation was 14% (results not shown). Among
men of all working ages, labor force participation rates
held steady, while those with activity limitation sustained a substantial decline, from 69% at the beginning
of the period under study to 59% at the end.
Among older male workers, those with activity
limitations sustained larger reductions in labor force
participation than such men without limitation. In
contrast, rates among younger women with activity
limitation increased in a manner consistent with that
among all such women, albeit starting at a lower level
(Figure 3). Thus, labor force participation rates among
all women ages 18-44 rose from 51% to 71% (40% in
relative terms), and among such women with activity
limitation the increase was from 39% to 56% (44%
relatively). The rates among women 45-54 with activity limitation also rose, but not quite as fast as among
all women in the age group, increasing by 14% among
the former, 26% among the latter.
Labor force participation rates among all
women ages 55-64 remained fairly stable throughout
the period under study, never rising above 44% nor
YELIN AND KATZ
1364
I
Table 1. Labor force participation among men in 1987, by condition, age, and activity limitation status groups*
i 1
Labor force
participation rate
among all
persons (%)
Labor force
participation rate
among persons
with activity
limitation (%)
90.8
88.4
65.4
83.0
86.2
77.2
52.4
74.4
78.2
69. I
44.0
62.2
68.7
56.7
33.0
50.0
83.9
76.5
50.5
70.2
74.8
62.1
37. I
57. I
87. I
85.3
60.8
82.0
68.6
63.4
39.6
59.2
0.7
Condition, age group
Musculoskeletal conditions
only
0.3
18-44
45-54
55-64
All ages
I-r- -r-7
T
- r T- -T- r . I . r - - T - - T
-7
I
70 71 72 73 74 75 76 77 70 T9 00 01 02 83 64 05 06 87
Year
Figure 3. Labor force participation rates among women ages 18-44
and ages 45-54, by limitation and year. See Methods for definitions
of groups.
falling below 40% (Figure 4). Among women of this
age group with activity limitation, the proportion in the
labor force declined very slightly, averaging 25% at the
beginning of the period and 22% at the end of it. The
entrance of women into the labor force has been one of
the most pronounced social trends over the last 2
decades. The overall labor force participation rate
among women increased 32% in relative terms between 1970 and 1987, from half of all women to
two-thirds. Among women of all ages with activity
limitation, labor force participation rates increased
17% in relative terms during this time (since reaching
their low point in 1972, the rates have increased 28%).
Thus, the surge of women into the labor market has
been so strong that some women with activity limitation have been pulled into the labor market.
Tables 1 through 3 provide a comprehensive,
p
r
0
0.65 -
All Ages. All SlatiJsesr.*+-+-+--+
dC
+
-7
Musculoskeletal conditions
plus other chronic
conditions
18-44
45-54
55-64
All ages
Both musculoskeletal
condition groups
18-44
45-54
55-64
All ages
Chronic conditions other
than musculoskeletal
1844
45-54
55-64
All ages
No chronic conditions
90.5
95.6
78.3
90.0
18-44
45-54
55-64
All ages
Total
All ages
~~
70.0
62.9
38.8
58.6
89.3
90.4
67.3
8S.6
18-44
45-54
55-64
~
~-
~~
* See Methods for definitions of groups.
albeit cross-sectional, picture of labor force participation among men and women with musculoskeletal
conditions, respectively.* The last 2 columns indicate
the labor force participation rates for all working-age
persons and those with activity limitation. Among men
of working ages (Table I), 83.0% of all men with
musculoskeletal conditions only were in the labor
force, while 74.4% of all men with activity limitations
were. The addition of other conditions dramatically
reduced the probability of work. The labor force
70 71 72 73 7 4 75 70 77 70 79 00 01 0 2 0 3 04 85 68 07
Year
Figure 4. Labor force participation rates among women of all
working ages and ages 5544, by limitation and year. See Methods
for definitions of groups.
* Tables I through 3 include only the labor force participation rates (total number of persons working divided by total number
of persons) for the different condition, sex. and age stratifications.
More complete tables including the raw counts that went into the
calculation of these rates are available upon request to the authors.
1365
EMPLOYMENT AND MUSCULOSKELETAL CONDITIONS
participation rate among men with musculoskeletal
and other conditions was 62.2%; the analogous rate
among such men with activity limitation was 50.0%.
Among the combined musculoskeletal condition
group, 70.2% were in the labor force; among those
with activity limitation, 57.1% were, but only 37.1% of
those ages 55-64 reported labor force participation.
As low as these rates appear to be, they are
very comparable with those among persons with other
chronic conditions. For example, the labor force participation rates among men ages 1844, 45-54, and
55-64 with activity limitation in the combined musculoskeletal condition group were 74.8%, 62.1%, and
37. I%, respectively; among men these ages with other
Table 3. Labor force participation among adults with musculoskeletal conditions in 1987. by age and activity limitation status
mOUDS*
Condition, age group
Both musculosk~etal
condition groups
18-44
45-54
55-64
All ages
Total
1
W
45-54
55-64
AU ages
Table 2. Labor force Participation among women in 1987, by
Labor force
participation rate
among all
persons (%)
Labor force
participation rate
among persons
with activity
limitation (%)
73.4
62.7
38.3
57.1
64.4
50.0
26.2
44.2
79.9
78.8
54.0
75.4
62.8
50.9
29.4
49.3
* See Methods for definitions of groups.
condition, age, and activity limitation status groups’
Labor force
participation rate
participation rate among persons
among all
with activity
persons (%)
limitation (%)
Labor force
Condition, age group
Musculoskeletal conditions
only
1 W
45-54
55-64
All ages
Musculoskeletal conditions
plus other chronic
conditions
18-44
45-54
55-64
All ages
Both musculoskeletal
condition groups
1844
45-54
55-64
All ages
Chronic conditions other
than musculoskeletal
1844
45-54
5564
All ages
No chronic conditions
18-44
45-54
5564
All ages
Total
18-44
45-54
55-64
All ages
68.5
66.6
43.1
58.4
62.0
54.2
31.8
47.5
62.9
48.4
25.8
43.5
52.9
39.8
16.9
32.3
65.0
54.2
31.2
48.5
55.5
42.6
20.2
35.8
69.7
64.8
41.0
64.4
55.7
40.4
22.5
43.6
72.0
73.2
49.0
69.6
-
71.O
55.7
41 .O
21.3
40.9
67.8
42.2
65.7
* See Methods for definitions of groups.
chronic conditions and activity limitation, the rates
were 68.6%, 63.4%, and 39.6%, respectively. Thus,
the prominence of musculoskeletal condition-related
work disability is more a function of the prevalence of
these conditions than of their severity. (This is not true
of rheumatoid arthritis; however, work disability associated with rheumatoid arthritis among men represents only a small fraction of all musculoskeletal
condition-related disability.)
Musculoskeletal conditions would appear to
suppress labor force participation among men, even in
the absence of self-reported activity limitation (Table
1). Eighty-three percent and 62.2% of all men with
musculoskeletal conditions only and of all men with
musculoskeletal conditions and other conditions, respectively, reported being in the labor force, compared with 90% of all men with no chronic conditions.
Interestingly, about the same proportion of men ages
1844 reporting musculoskeletal conditions only and
no chronic conditions, respectively, were in the labor
force. In the absence of activity limitation, the impact
of musculoskeletal conditions on labor force participation seems to become manifest only after age 45.
Table 2 describes the labor force ‘participation
of women in 1987, highlighting the impact of ~ U S C U loskeletql conditions. Slightly more than a third of all
working-age women with musculoskeletal conditions
and actjvity limitation were in the labor force. In
contrast, 69.6% of women with no chronic conditions
(and, thus, no activity limitation) reported being in the
labor force, as were 65.7% of all working-age women
regardless of limitation status. As with men, muscu-
YELIN AND KATZ
1366
Table 4. Labor force participation among men in 1970-1975. 19761981. and 1982-1987. by condition, age, and activity limitation status
PUPS*
All ages
Ages 55-64
Condition, years
% limited and
% not limited
% limited and
% not limited
% working
working
and working
% working
working
and working
73
75
51
54
46
38
82
85
78
87
86
70
69
67
57
95
89
90
80
71
61
55
40
41
92
88
79
89
84
81
69
55
60
93
90
91
67
61
60
91
91
90
Both musculoskeletal
condition groups
1970-1 975
19761981
1982-1987
Chronic conditions
other than
musculoskeletal
1970-1975
1976-1981
1982-1987
No chronic conditions
1970-1975
I976198I
1982-1987
79
72
88
87
80
90
Total
1970-1975
1976-1981
1982-1987
79
72
68
53
43
40
90
88
86
80
86
86
* See Methods for definitions of groups.
loskeletal conditions and musculoskeletal conditionrelated activity limitation disproportionately affected
the labor force participation of older women. Thus, the
rate among all women ages 18-44 with musculoskeletal
and other conditions was 62.9%, just slightly lower
than the rate among women these ages with no conditions (72%) and among all women these ages (71%).
Among all women ages 55-64 with musculoskeletal
conditions (“Both groups” in the table), only 3 1.2%
were in the labor force, and those who also have activity
limitation had a rate of only 20.2%, much lower than the
rates among women these ages with no chronic conditions (49.0%) and among all women these ages (42.2%).
Summing across groups (sex and musculoskeletal condition groups) (Table 3). the overall labor force
participation rate among all persons with musculoskeletal conditions was only three-quarters of that among
all working-age persons (57.1% versus 75.4%). Moreover, the rate among those with musculoskeletal conditions and activity limitation (44.2%) was only 90% of
that among all persons with activity limitation (49.3%),
principally because a high proportion of those with
musculoskeletal conditions and activity limitation
were in the immediate pre-retirement years, when
labor force participation rates begin to flag.
Table 4 shows the labor force participation
rates among men for 3 successive dyear periods,
197&1975, 197fL1981,and 1982-1987. Among men of
all working ages regardless of medical condition, labor
force participation rates held reasonably steady, falling only 2 percentage points over the 18 years of
observation, from 88% to 86%. However, men with
activity limitations have experienced a substantial
decline in labor force participation rates, from 67% to
60% between the first and the third dyear periods.
Among all men ages 55-64, even those without activity
limitation have sustained declining labor force participation rates (from 90% to 80%, 11% in relative terms).
Men these ages with activity limitation, however,
experienced a larger absolute (from 53% to 40%) and
relative (25%) decline in labor force participation
rates.
The trend in labor force participation among
men with musculoskeletal conditions fits this general
pattern, albeit with steeper rates of decline. In the first
&year period under study (last 3 columns, first 3 lines,
Table 4), 87% of all men with musculoskeletal conditions were in the labor force. By the last byear period,
only 70% were, a decline of 20% in relative terms.
Again, the declines were more pronounced among
men ages 55-64. After a slight increase between the
first and second 6-year periods among all men these
ages with musculoskeletal conditions, labor force participation rates declined from 75% to 51%. or by more
than 30% in relative terms. Men 55-64 with musculoskeletal conditions and activity limitation experi-
1367
EMPLOYMENT AND MUSCULOSKELETAL CONDITIONS
Table 5. Labor force participation among women in 197W975. 1976-1981. and 1982-1987. by condition, age. and activity limitation status
groups*
All ages
Ages 1844
Condition, years
% limited and
96 not limited
?
' 6 limited and
% not limited
% working
working
and working
% working
working
and working
50
61
64
41
53
55
52
62
72
47
59
46
33
41
35
54
62
64
51
66
68
40
52
50
62
52
66
72
60
34
39
41
53
64
69
55
63
70
-
-
53
58
67
-
-
-
54
63
69
42
50
53
55
64
70
51
34
37
39
54
61
67
Both musculoskeletal
condition groups
1970- I975
1976198 1
1982-1987
Chronic conditions other than
musculoskeletal
1970-1975
19761981
1982-1987
No chronic conditions
1970- I975
I9761 98 1
I 982- I 987
Total
I 970- I975
19761981
1982- I987
-
-
62
58
63
-
* See Methods for definitions of groups.
enced steady declines in labor force participation,
from 54% to 46% between the first and second 6-year
periods, and then to 38% in the third.
The relative decline in labor force participation
rates among all men ages 55-64 with musculoskeletal
conditions exceeded that experienced by all men with
other chronic conditions, and the relative decline
among men 55-64 with musculoskeletal conditions and
activity limitation exceeded that experienced by men
with other chronic conditions and activity limitation.
If the general trend among men has been declining labor force participation rates, especially among
men ages 55-44, the general trend among women has
been increasing labor force participation rates, especially among women 1 8 4 4 (Table 5 , last 3 rows).
Women with activity limitation have shared in these
gains, but not to the same extent as women without
activity limitation. Thus, among women of all ages and
limitation statuses, the proportion in the labor force
increased from 51% to 63%. or by 24% in relative
terms. The analogous increase among women of all
working ages with activity limitation was IS%, from
34% to 39%. Among women ages 1844, regardless of
limitation status, labor force participation surged 28%,
to 69% of all such women.
Labor force participation rates among women
ages 18-44 with musculoskeletal conditions (first 3
columns, first 3 rows, Table 5 ) fit this general pattern:
the proportion of all such women in the labor force
increased from 50% to 64% during the Itbyear period
under study; the proportion of such women with
activity limitation in the labor force increased at about
the same rate during this time, from 41% to 55%.
Among women of all ages with musculoskeletal conditions, however, there was a reversal of the increase
in labor force participation during the third dyear
period, and since the rates among women of working
ages with musculoskeletal conditions but without activity limitation rose throughout this period, the reversal was concentrated among those women reporting
activity limitations. Moreover, since we have noted
that women ages 1 8 4 4 with musculoskeletal conditions
sustained steady increases in labor force participation
rates, we can conclude that the reversal was limited to
older women with musculoskeletal conditions.
The situation among women with musculoskeletal conditions differs from that among women with
other chronic conditions. Whereas younger women
with musculoskeletal conditions sustained steady increases in labor force participation and older women
with musculoskeletal conditions sustained a reversal,
younger women with other chronic conditions and
activity limitations experienced a decline in labor force
participation between the second and third periods
under study, while women of all working ages and with
other chronic conditions sustained steady, albeit mod-
YELIN AND KATZ
1368
Table 6. Labor force participation rates among adults in 1970-1975. 197&1981, and 1982-1987. by condition. age, and activity limitation
status groups*
% not limited and working. age
% limited and working. age group
% working, age group
Condition, years
Both musculoskeletal
condition groups
1970-1975
19764981
1982-1987
Total
1970-1975
I976198I
1982-1987
All
1844
45-54
55-64
All
1844
45-54
55-64
All
55
67
57
37
71
63
64
66
54
56
49
38
34
27
50
54
44
14
75
82
81
81
80
13
66
60
75
75
74
60
63
52
72
74
62
50
38
33
30
51
49
49
12
77
80
76
78
82
67
65
64
72
75
78
18-44
45-54
55-64
72
74
73
70
76
61
71
72
73
17
59
56
54
69
77
79
group
56
50
* See Methods for definitions of groups.
erating, increases in their labor force participation
rates, regardless of limitation status.
Among men and women of all working ages
(Table 6), we note that overall labor force participation
rates among those with musculoskeletal conditions
rose slightly between the first and second 6-year
periods under study, but have fallen substantially in
the interim, from 71% to 56% (21% in relative terms).
As stratified by age groups, labor force participation
held fairly steady among persons 18-44 with musculoskeletal conditions throughout the three 6-year periods. However, after slight increases between the first
and second period among persons 45-54 and 55-64
with musculoskeletal conditions, labor force participation rates declined rapidly, by 20% among the former
group and 35% among the latter. Thus, at a time of
rapid expansion in the proportion of working-age
adults in the labor force, persons with musculoskeletal
conditions have experienced more difficulty in sustaining employment. This is especially so for those persons with musculoskeletal conditions and activity limitation 45-54 and 55-64 years of age, but it is also true
for persons 55-64 with musculoskeletal conditions and
no activity limitation.
DISCUSSION
In 1990, the Americans with Disabilities Act
(ADA) became law (35). This legislation bars discrimination in employment, accommodation, and transportation against persons with disability, defined in terms
of ability to perform age-appropriate activities. Although an individual can be barred from a job if an
employer can prove that the person lacks the physical
or mental capacity required, testimony on behalf of the
passage of the ADA indicates that few persons who
are out of the labor force because of chronic disease
meet this criterion (36). Jobs in the service sector,
which has replaced manufacturing as the primary
component of the US economy, require less physical
exertion on average than jobs in manufacturing. The
manufacturing industry itself has changed; increasingly, manufacturing workers monitor computercontrolled processes, rather than perform the assembly themselves or even operate the machines that do.
One might therefore expect labor force participation
rates to increase with such changes in physical requirements for work.
The labor force participation rates among all
women, and especially among younger women, are
broadly consistent with this expectation. Thus, there
are more women of all working ages with activity
limitation and more women 1 8 4 4 with such limitation
in the labor force than ever before, reflecting the more
general rise in women’s labor force participation rate.
Only women ages 55-64 have not shared in these
gains. The labor force participation rates among men,
however, show a steady erosion in the employment of
those with activity limitations. The declines are more
severe among men 45-54 than among those 1 8 4 4 , and
are most severe among those 5 5 6 4 . Although labor
force participation rates have been falling among all
older male workers for some time, the decline among
those with activity limitations is much more pronounced. As recently as 2 decades ago, well over half
of men ages 55-64 with activity limitation were in the
labor force; now, just slightly more than a third are.
In general, trends in labor force participation by
persons with musculoskeletal conditions fit these more
general trends in employment. Thus. the entrance of
EMPLOYMENT AND MUSCULOSKELETAL CONDITIONS
young women into the labor force aided those with
musculoskeletal conditions, even those with musculoskeletal conditions and activity limitation, while
older men with musculoskeletal conditions, especially
those with activity limitation, were part of the overall
trend for older men to withdraw from employment.
However, there are several disturbing counter-trends
to this more general picture. Men with musculoskeletal conditions sustained larger declines in labor force
participation rates than did men with other chronic
conditions. Indeed, they seem to have become the
wrong kind of leading edge. Moreover, older women
with musculoskeletal conditions and activity limitation
saw the gains they experienced in labor force participation between the first and second &year periods
erode by the third. Among males and females, labor
force participation rates among persons ages 55-64
with musculoskeletal conditions and activity limitation
fell 30% in relative terms, suggesting that older workers with musculoskeletal conditions face daunting
problems in the contemporary labor market despite
the lessened physical requirements of work and, for
women, generally rising employment levels.
Even if the labor force participation rate of
persons with musculoskeletal conditions had not worsened with the passage of time, the absolute levels of
employment would be a cause for concern. We found
that in 1987, only 57.1% of working-age persons with
musculoskeletal conditions reported being in the labor
force, as were only 44.2% of such persons with activity limitations. In that year, only 26.2% of persons
55-64 with musculoskeletal conditions and activity
limitation were in the labor force, which is less than
half the rate among all persons-regardless of activity
limitation status-these ages.
With the passage of the ADA, persons with
disabilities were vested, by law, with equal opportunity for employment. The labor force participation
rates among persons with musculoskeletal conditions
suggest that much work will be necessary to actually
achieve this: men of all working ages with musculoskeletal conditions and women of older working ages
with musculoskeletal conditions have experienced a
greater decline in these rates than those with other
chronic conditions.
Elsewhere we have shown that the work disability rate among persons with chronic disease ebbs
and flows with the demand for labor within the expanding and contracting sectors of the economy (28).
Thus, the erosion of employment in manufacturing has
hurt older men with disabilities disproportionately. In
1369
contrast, younger women with disabilities have seen
their labor force participation rates rise in tandem with
the service sector expansion of the 1970s and 1980s. In
a separate series of papers, it has been shown that
flexible working conditions reduce the probability of
work loss among persons with musculoskeletal conditions (1-3) and that such persons do not differ from the
rest of the population in their commitment to work
(37). Together these studies suggest the hypothesis
that persons with musculoskeletal conditions have
been disproportionately represented in the manufacturing sector of the economy, which may account, in
part, for their rising work disability rates. However,
the findings of this and other studies also suggest that
persons with musculoskeletal conditions and their
physicians should jointly pursue a strategy of seeking
jobs with flexible working conditions, particularly in
the expanding sectors of the economy. Fortuitously,
service work-the fastest growing component of ernployment-tends to be less physically demanding than
work in the goods-producing sectors, and this feature
should also help persons with musculoskeletal conditions stay in the labor force.
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