Trends in cancer-free working life expectancy based on health insurance data from Germany-Is the increase as strong as in working life expectancy?

Fabian Tetzlaff; Enno Nowossadeck; Jelena Epping; Vanessa di Lego; Magdalena Muszynska-Spielauer; Johannes Beller; Stefanie Sperlich; Juliane Tetzlaff

doi:10.1371/journal.pone.0288210

Trends in cancer-free working life expectancy based on health insurance data from Germany-Is the increase as strong as in working life expectancy?

PLoS One. 2023 Jul 26;18(7):e0288210. doi: 10.1371/journal.pone.0288210. eCollection 2023.

Authors

Fabian Tetzlaff^{1

2}, Enno Nowossadeck², Jelena Epping^{1

3}, Vanessa di Lego^{4

5}, Magdalena Muszynska-Spielauer^{4

5}, Johannes Beller^{1

3}, Stefanie Sperlich¹, Juliane Tetzlaff¹

Affiliations

¹ Medical Sociology Unit, Hannover Medical School, Hanover, Germany.
² Division of Social Determinants of Health, Robert Koch-Institute, Berlin, Germany.
³ Comprehensive Cancer Center Hannover, Hannover Medical School, Hanover, Germany.
⁴ Wittgenstein Centre for Demography and Global Human Capital (IIASA, OeAW, Univ. Vienna), Vienna, Austria.
⁵ Vienna Institute of Demography, Austrian Academy of Sciences, Vienna, Austria.

Abstract

Background: Against the backdrop of population ageing, governments are facing the need to raise the statutory retirement age. In this context, the question arises whether these extra years added to working life would be spent in good health. As cancer represents a main contributor to premature retirement this study focuses on time trends and educational inequalities in cancer-free working life expectancy (WLE).

Methods: The analyses are based on the data of a large German health insurer covering annually about 2 million individuals. Cancer-free WLE is calculated based on multistate life tables and reported for three periods: 2006-2008, 2011-2013, and 2016-2018. Educational inequalities in 2011-2013 were assessed by two educational levels (8 to 11 years and 12 to 13 years of schooling).

Results: While labour force participation increased, cancer incidence rates decreased over time. Cancer-free WLE at age 18 increased by 2.5 years in men and 6.3 years in women (age 50: 1.3 years in men, 2.4 years in women) between the first and third period while increases in WLE after a cancer diagnosis remained limited. Furthermore, educational inequalities are substantial, with lower groups having lower cancer-free WLE. The proportion of cancer-free WLE in total WLE remained constant in women and younger men, while it decreased in men at higher working age.

Conclusion: The increase in WLE is accompanied by an increase in cancer-free WLE. However, the subgroups considered have not benefitted equally from this positive development. Among men at higher working age, WLE increased at a faster pace than cancer-free WLE. Particular attention should be paid to individuals with lower education and older men, as the general level and time trends in cancer-free WLE are less favourable.

Copyright: © 2023 Tetzlaff et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Child, Preschool
Employment
Female
Germany / epidemiology
Humans
Infant
Insurance, Health
Life Expectancy*
Male
Retirement*

Grants and funding

JE’s and JT’s work is supported by the AOK Niedersachsen (Statutory Local Health Insurance of Lower Saxony) [grant number: not applicable] as part of an ongoing project on morbidity compression. FT’s work is supported by the German Research Foundation (DFG) [grant number: TE 1395/1-1]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.