摘要：Objectives. The working poor sometimes delay retirement to survive. However, their higher risk of disease and disability threatens both their financial survival and their ability to work through the retirement years. We used the burden of disease attributable to arthritis by occupational class to illustrate the challenges faced by the older poor. Methods. We merged data from the National Health Interview Survey, Medical Expenditure Panel Survey, and the National Death Index into a single database. We then calculated and compared age- and occupational class–specific quality-adjusted life years (QALYs) between workers with and without arthritis by using unabridged life tables. Results. White-collar workers have a higher overall health-related quality of life than do other workers, and suffer fewer QALYs lost to arthritis at all ages. For instance, whereas 65-year-old white-collar workers without arthritis look forward to 17 QALYs of future life, blue-collar workers with arthritis experience only 11, and are much less likely to remain in the workforce than are those in service, farming, or white-collar jobs. Conclusions. To meet the needs of the aging workforce, more extensive health and disability insurance will be needed. In the United States, people aged 65 years and older are the fastest growing demographic group. The percentage of people aged 65 years and older is projected to almost double between the present day and 2050, rising from 6% to 11%, and about 1 in 5 of these elderly are poor. 1 , 2 Furthermore, the proportion of employed workers aged 65 years and older is increasing. 3 Over this same period, real earnings will continue to decline primarily because of high health insurance costs for households at or below the median income. 4 Increasing health costs are not only reducing retirement savings, they are also placing a financial burden on the elderly. 2 Therefore, although many elderly persons continue to work past retirement because they prefer to, a growing segment of this population will continue to work out of financial necessity. 5 – 7 Both blue-collar and elderly people are much more likely than are younger or more affluent people to suffer from disabling conditions and to live shorter lives. 8 – 13 We will therefore see an increasing burden of disease and disability among the American workforce, reducing both the quality of life and productivity of lower-income Americans. Arthritis provides a lens through which one can view the convergent social phenomena of aging, workforce globalization, skyrocketing health costs, and a falling quality of life among the middle and lower classes. Arthritis is a common disabling condition that would normally force many workers to leave the workforce. 8 , 14 From 2007 to 2009, approximately 49 million US adults had arthritis, and 21 million suffered activity limitations as a result. 14 The prevalence of arthritis reaches 50% for persons aged 65 years and older compared with 7.9% for persons aged 18 to 44 years. It is estimated that by the year 2030 approximately 67 million adults aged 18 years and older will have arthritis. 14 Although additional longitudinal studies are needed to examine causal pathways, arthritis has been shown to contribute to and arise from poverty 15 ; blue-collar and elderly workers are at increased risk of arthritis, and arthritis is a major risk factor for losing one's job. 7 , 16 In this study, we present a snapshot of the burden of disease attributable to arthritis among US workers by age and occupational class.
