The contribution of work and health-related lifestyle to educational inequalities in physical health among older workers in Germany. A causal mediation analysis with data from the lidA cohort study

Max Rohrbacher; Hans Martin Hasselhorn

doi:10.1371/journal.pone.0285319

The contribution of work and health-related lifestyle to educational inequalities in physical health among older workers in Germany. A causal mediation analysis with data from the lidA cohort study

PLoS One. 2023 Aug 9;18(8):e0285319. doi: 10.1371/journal.pone.0285319. eCollection 2023.

Authors

Max Rohrbacher¹, Hans Martin Hasselhorn¹

Affiliation

¹ Department of Occupational Health Science, School of Mechanical Engineering and Safety Engineering, University of Wuppertal, Wuppertal, Germany.

Abstract

Objectives: The objective of the study was to investigate the contribution of work factors and health-related lifestyle to educational inequalities in physical health among older workers in Germany by applying causal mediation analysis with longitudinal data.

Methods: Data from the German lidA study was used. 2653 persons (53% female, 47% male) aged 46 (born 1965) and 52 (born 1959) at baseline were followed up for seven years with exposure and outcome assessments in 2011 (t0), 2014 (t1) and 2018 (t2). The total effect of education on physical health was decomposed into a natural direct effect (NDE) and a natural indirect effect (NIE) by using a sex-stratified causal mediation analysis with an inverse odds weighting approach. Baseline health, partner status and working hours were entered as a first set of mediators preceding the putative mediators of interest. All analyses were adjusted for age and migrant status.

Results: Independent of the first set of mediators, work factors explained 21% of educational inequalities in physical health between low and high educated women and 0% comparing moderate versus high educated women. The addition of health behaviors explained further 26% (low vs. high education) and 20% (moderate vs. high education), respectively. Among men, net of the first set of mediators, work factors explained 5% of educational inequalities in physical health between low and high educated and 6% comparing moderate versus high educated persons. Additional 24% (low vs. high education) and 27% (moderate vs. high education) were explained by adding health behaviors to the models.

Conclusions: To reduce educational inequalities in physical health among older workers in Germany, interventions to promote healthy behaviors are promising. Improving working conditions is likely an important prerequisite.

Copyright: © 2023 Rohrbacher, Hasselhorn. 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

Cohort Studies
Educational Status
Female
Germany
Humans
Life Style*
Male
Mediation Analysis*
Socioeconomic Factors

Grants and funding

Waves one and two (2011; 2014) of the lidA-study were funded by the Federal Ministry of Education and Research (grant numbers 01ER0806, 01ER0825, 01ER0826, 01|ER0827), wave three (2018) by the German Social Accident Insurance (DGUV) (grant number FP403). The first author received financial support by the graduate scholarship of the Friedrich-Ebert-Stiftung. We acknowledge support from the Open Access Publication Fund of the University of Wuppertal. The funders had no influence on the study design, data collection, data analyses or interpretation.