Some are Hit Hard, for Others It’s Business as Usual: The Effects of Chronic Illnesses on Employment and Income Trajectories

1 Introduction: Chronic Illness as a Risk to Employment and Income

In view of population ageing, the question of extending working lives will be of decisive importance in the coming decades in Germany. However, the debate is not only about whether employees will have to work until the ages of 67, 68, or even 70, but also whether they will be able to do so. Health is a crucial factor in this regard, as numerous studies show that it is among the most critical determinants for maintaining employment at older ages (Andersen et al. 2020; Blundell et al. 2023; Hasselhorn and Rauch 2013). Or in other words: poor health is one of the leading drivers of premature withdrawal from the labour market in Germany – predominantly, though not exclusively, among individuals with lower educational qualifications. Health-induced labour market exits are largely attributable to limited statutory pathways for early retirement. When individuals are ineligible for full or partial disability pensions, declining health often corresponds with periods of unemployment, economic inactivity, or marginal employment (Hagen and Himmelreicher 2020; Hofäcker et al. 2016; Rohrbacher and Hasselhorn 2022).

However, if health shocks, such as heart attacks, treatable cancers, or strokes are excluded, illness does not typically lead to an immediate and potentially permanent withdrawal from employment. On the contrary: non-communicable chronic diseases – such as arthritis, hypertension, or diabetes – are conditions with which individuals often live and work for many years (Dettmann and Hasselhorn 2020; OECD/EU 2016). To make matters worse, the incidence of chronic diseases among people of working-age is not a marginal phenomenon in Germany but affects a considerable proportion of workers. According to Dettmann and Hasselhorn (2020), approximately 49 % of employed men and 53 % of employed women report having at least one chronic illness, with prevalence increasing notably among older age groups (Schmidt et al. 2020). Unlike acute diseases, chronic conditions are rarely curable in a biomedical sense and are therefore characterised by long-term persistence and gradual progression.

Although chronic illness does not usually lead to an immediate withdrawal from employment, it often necessitates adjustments in working life, as the mere knowledge about its existence confronts those affected with the challenge of coping with both the chronic illness and working life, with its usually unchanged or even increasing work demands (Bartel 2018; OECD/EU 2016; Schaeffer and Haslbeck 2016). In this context, evidence from countries beyond Germany indicates that workers with chronic illnesses are more likely to reduce their working hours, change to another, possibly less stressful job or exit the labor market well before reaching statutory retirement age. In sum, chronically ill people not only show a lower employment rate, but also a lower average number of working hours than non-chronically ill (Oude-Hengel et al. 2019). However, the labour market problems of the chronically ill are not limited to people in employment. Rather, chronically ill people have considerable problems returning to work from unemployment or after a longer period of illness (OECD/EU 2016, 17–34; Van de Ven et al. 2023). Depending on the adjustment strategy, the occurrence of a chronic illness can have a negative impact on earned income and accompanying, on the individually acquired pension entitlements.^[1] However, adjustment strategies do not have to be limited to the affected individuals and their self-selection processes in working life. In fact, employers can also select their sick employees out of the company or into another, possibly lower-paid (part-time) job.

Because of the long-term character of chronic diseases and the subsequent phenomenon of working with illness, it makes sense to look at as long a part of the employment biography as possible to obtain a differentiated picture of the effects of a successively deteriorating state of health on income. Such long-term effects of a chronic disease on earned income have not yet been systematically analysed for Germany. Instead, the focus is strongly on the factors promoting an early exit from the labour market or prolonging working life because of or rather despite a chronic disease (Hagen et al. 2017; Söhn and Mika 2015). The non-consideration of employment biographies was long mainly due to a considerable lack of suitable longitudinal data allowing analysing most of or at least a large part of the employment histories of the chronically ill people. This shortage situation has changed with the introduction of the SHARE-RV dataset, a record linkage between the Survey of Health, Ageing and Retirement in Europe (SHARE) and administrative data from the German pension insurance (RV) making it possible to analyse the long-term effects of a chronic disease on employment and income trajectories taking into account the entire employment history. Given these new analytic possibilities, the paper adds to the research gap outlined above by firstly examining how onset and course of a chronic disease affect the employment and income history of the people affected in Germany (research question 1). Secondly, it is of interest whether the effects of a chronic disease on employment and income differ between qualification levels (research question 2). In general, there is no evidence – both internationally and nationally – regarding the question, if the kind of chronic disease makes a difference in terms of the labour market participation of chronically ill individuals.^[2] The following analysis aims to contribute to closing this research gap by thirdly examining whether the labour market effects differ depending on the type of chronic diseases (research question 3). However, due to the low number of cases, it is not possible to consider single chronic diseases. Rather, two different sets of chronic diseases are considered.

The study contributes to the general literature on the correlation between health and labour market outcomes, and in this regard on the competing hypotheses of social causation and social selection (Kröger et al. 2015; Hoffmann et al. 2019). From a social policy perspective, evidence on the impact of chronic diseases on labour market trajectories is important for the discussion about suitable social protection as well as suitable support measures for chronically ill to remain in employment until reaching standard retirement age. Potential differences in the impact of ill health on income by qualification can partly explain the social gradient in health. Hence, the results will also provide evidence for the debate on health inequalities.

The structure of this paper is as follows: Section 2 reviews the relevant literature. Section 3 describes the data, the operationalisation of health and illness, and the methods employed. Sections 4 and 5 report the empirical findings, with Section 4 presenting descriptive results and Section 5 fixed-effects regression estimates. The paper concludes with Section 6.

2 Literature and Hypotheses

In the literature about the labour market effects of deteriorating health, the interplay between health and work-related factors plays a decisive role (García-Gómez et al. 2013; Jones et al. 2020; Lenhart 2019; Lundborg et al. 2015; Siegrist and Dragano 2020; Vaalavuo 2021). However, the interrelation can be conceptualised from two different theoretical perspectives, the social causation and the social selection hypotheses (Hoffmann et al. 2019; Warren 2009). Following social causation, risks of morbidity and mortality depend largely on the socio-economic group or, more precisely, on the working conditions associated with socio-economic status. In this regard, a first strand of research examines the influence of certain characteristics of the employment relationship as receiving a low wage, having physically demanding working conditions, occupying a low hierarchical position and, related to this, having low autonomy of agency and decision-making to organise its own work. From this perspective, a change or deterioration in health is the phenomenon to be explained (Hoffmann et al. 2019; Siegrist and Dragano 2020). The second theoretical perspective, which is more decisive for answering the research questions posed in the introductory section, takes the selection hypothesis as a starting point, postulating that the individual’s state of health forms the basis for (work-related) self-selection processes. From this perspective, health is understood as explanatory variable for employment outcomes like a reduction of working hours, a change to a less demanding job or a permanent labour market exit. The present analysis is based on this theoretical perspective.

3 Data Set, Operationalisation and Methods

4 Results: The Long-Term Impact of Chronic Illnesses on Income and Employment Histories

The following section shows the results on the long-term effects of chronic illnesses on income and employment trajectories. Figure 1 thereby compares the income development of chronically ill (all chronical diseases; chronic 1) with that of people not diagnosed as chronically ill up to the age of 50. In addition to the average number of earnings points, the cumulative difference in earnings points between the chronically ill and non-chronically ill is considered, serving as an indicator for the long-term economic consequences of the disease while the former indicates the consequences in each year of the observational period. Regarding the results, Figure 1 shows that after a largely similar development of earnings points during the first 10–12 years, differences between the chronically ill and non-chronically ill begin to widen from the mid-40s onward. In addition to the expected more severe effects of chronic diseases, this development can be explained by the fact that more and more people become chronically ill as they age.

Figure 1:

The development of individual earning points for chronically ill and not chronically ill individuals; diagnosis up to the age of 50; all chronic diseases (chronic 1). Source: Own calculations based on SHARE-RV Version 7.1; data from 2018; employed for at least 15 years; no health shock up to the age of 65; matched data is used; dotted lines: confidence bands.

Figure 2:

The development of individual earning points for men diagnosed as chronically ill and men not diagnosed as chronically ill up to the age of 50; selected chronic diseases (chronic 2). Source: Own calculations based on SHARE-RV Version 7.1; data from 2018; employed for at least 15 years; no health shock up to the age of 65; matched data is used; dotted lines: confidence bands.

The reason for this growing divergence is a stronger decline in earnings points for the chronically ill becoming more pronounced with age and resulting in a cumulative difference of 1.94 earnings points up to the age of 59. After age 60, both curves gradually align due to the rising entry into (early) retirement among both ill and healthy individuals. Given the average national income in Germany for 2024 (Overview 1), 1.94 earnings points correspond to an inflation-adjusted reduction in income of around 88,000 € since the onset of the chronic illness. With more severe chronic illness (chronic 2; Figure 2), earnings points drop more sharply, leading to a cumulative difference of 2.81 by age 59, which translates to an inflation-adjusted income loss of about 127,500 €.

4.1 Reasons for the Growing Divergence of Earnings Points

Figure 3 illustrates that a decline in employment among the group of the chronically ill is decisive for the growing divergence of earnings points. This is evident in both chronic 1 and chronic 2. However, the decline is more pronounced in more severely chronic illnesses. Starting from almost identical levels of employment at the age of 40/41, the employment rate of both groups of chronically ill decreases considerably stronger than it is the case in the group of the non-chronically ill.

Figure 3:

Proportion of individuals in insured employment by chronic illness status (in percent). Source: Own calculations based on SHARE-RV Version 7.10; data from 2018; employed for at least 15 years; no health shock up to the age of 65; age range 40/41 to 62/63 years; dotted lines: confidence bands.

Regarding alternatives to employment, Table 3 shows an increase in unemployment over time. At the age of 40/41, 5.8 % of the chronically ill (chronic 1) and 6.6 % of the more severely chronical ill are registered as unemployed. Up to the age of 50/51, the proportion increased by about 5 percentage points in both groups up to 10.2 % (chronic 1) and 11.2 % (more severely chronically ill; chronic 2). In contrast, the unemployment rate of the non-chronically ill only increased by 1.5 percentage points. The proportion of unemployment in both groups of the chronically ill, however, slightly declines in the 50s and is 9.3 % (chronic 1) and 10.8 % (chronic 2) at the age of 58/59. However, the reason for this decline is not a higher employment rate (this decreases continuously to 57.2 % (chronic 1) and 50.4 % (chronic 2) up to the age of 58/59). Rather, the decline in unemployment is accompanied by a rising number of chronically ill individuals receiving a disability pension. Between the ages of 50/51 and 58/59, the proportion of disability pensioners among the chronically ill increases from 2.1 % (chronic 1)/4.2 % (chronic 2) at the age of 50/51 to 13.2 % (chronic 1) and 15.3 % (chronic 2) among 58/59-year-olds.

Table 3:

Comparative employment status of chronically ill and non-chronically ill individuals by age; birth cohorts from 1948 onwards (percentages).

Employment status	Employment status of chronically ill (CI, chronic 1), severely chronically ill (SCI, chronic 2), and non-chronically ill (NCI) people at the age of …
	40/41 years			50/51 year			58/59 years
	CI	SCI	NCI	CI	SCI	NCI	CI	SCI	NCI
Employment	84.1	81.3	82.1	72.9	68.5	80.7	57.2	50.4	67.8
Marginal employment	/	/	/	3.5	4.2	2.0	4.2	5.5	2.9
Unemployment	5.8	6.6	5.4	10.2	11.2	6.9	9.3	10.8	8.9
Disability pension	/	/	/	2.8	4.2	1.4	13.2	15.3	8.8

1. Source: Own calculations based on SHARE-RV Version 7.10; data from 2018, employed for at least 15 years; no health shock up to the age of 65; age range 40/41 to 62/63 years. It should be noted that Table 2 presents only those statuses with a sufficiently large number of cases; as a result, the proportions do not sum to 100 %.

4.2 Significance of the Qualification

To better understand the role of educational qualifications in moderating the effects of chronic illness, the following analysis examines the development of earnings points among individuals with chronic conditions, stratified by qualification level. Respondents’ qualifications are classified according to the International Standard Classification of Education (ISCED).^[3] The sample includes only individuals employed and subject to social insurance contributions in the two years preceding illness onset. Figure 4 reveals that the onset and progression of a chronic condition (chronic 1) differentially affect qualification groups. For individuals with high qualifications, earnings points are stable at 1.26 prior to diagnosis but decrease gradually to 1.17 over the subsequent ten years – a total reduction of 0.09 earnings points. In contrast, those with low or medium qualifications experience a more substantial and steady decline, with earnings points falling from 0.92 to 0.75, thus widening the qualifications gap from 0.34 to 0.42 earnings points since illness diagnosis. Accordingly, among highly qualified individuals, the chronic 1 indicator is associated with only a modest diminution in average earnings points subsequent to illness onset. In contrast, the indicator capturing more severe chronic conditions (chronic 2) indicates that both onset and course of these illnesses are associated with a distinctly greater and more persistent reduction in earnings points.^[4] Starting from an average of 1.21 earnings points one year before diagnosis, mean earnings points decrease to 1.06 over the subsequent ten-year period, indicating a reduction of 0.15 points.

Figure 4:

Effects of diagnosed chronic illnesses on earning points depending on qualification; average EP before and after diagnosis of chronic disease; 2 years of insured employment before diagnosis mandatory; no health shock up to the age of 65; birth cohorts from 1948 upwards; indicator is chronic 1. Source: Own calculations based on SHARE-RV Version 7.10; data from 2018; dotted lines: confidence bands.

In contrast, the corresponding decline among individuals with any chronic condition (chronic 1) is only 0.09 earnings points. However, the decline is even steeper among low- and medium-qualified individuals (from 0.88 to 0.65 earnings points). Although earnings points also exhibit a more persistent decline among highly qualified individuals under chronic 2 relative to chronic 1, the qualification gap widens over time, increasing from 0.31 earnings points prior to diagnosis to 0.41 after 10 years.

Overall, the results suggest that the ability to compensate illness-related limitations diminishes markedly in the case of more severe chronic diseases for both highly qualified and low- and medium-qualified individuals. However, the decline is notably more pronounced among individuals with low and medium qualifications. This leads not only to a widening wage gap between the two comparison groups but also indicates that the most pronounced employment effects of severe chronic illness (chronic 2) occur among low- and medium-qualified individuals. This pattern likely reflects reduced opportunities within these qualification groups to adjust occupational tasks or workloads to the constraints imposed by illness. Consequently, maintaining employment while managing a severe chronic condition appears comparatively less feasible for these individuals than for those with higher qualifications. However, this indicator does not allow for definitive conclusions regarding a potential increase in income inequality, as it remains uncertain how earnings disparities between qualification groups would have developed in the absence of a diagnosis. It is, for example, conceivable that the faster wage progression typically observed among highly qualified individuals could have produced an even larger gap in earnings points. Therefore, whether chronic illness actually amplifies social inequality requires verification through a fixed-effects regression model. Nonetheless, the findings offer at least partial descriptive support for the hypothesis that chronic illness functions as a driver of social inequality. Furthermore, it should be noted that the confidence intervals for the earnings trajectories of highly qualified individuals shown in Figure 5 are comparatively wide due to the limited sample size, implying that these results should be interpreted with caution.

Figure 5:

Effects of diagnosed chronic illnesses on earning points depending on qualification; average EP before and after diagnosis of chronic disease; 2 years of insured employment before diagnosis mandatory; no health shock; birth cohorts from 1945 upwards; indicator is chronic 2. Source: Own calculations based on SHARE-RV Version 7.10; data from 2018; dotted lines: confidence bands.

5 The Long-Term Effects of Diagnosed Chronic Diseases on Income Trajectories

The following section assesses whether the patterns identified in the descriptive analysis remain evident within a multivariate framework. Annual earned income, operationalised as earnings points, serves as the dependent variable. The principal research objective is to determine whether a chronic disease negatively affects earnings points. Control variables are introduced sequentially across Models 1 to 3, as detailed in Table 5.^[5]

Table 6 presents estimation results for chronic 1, while Table 7 contains the corresponding findings for chronic 2. The analysis is conducted separately for women and men in order to account for potential gender differences. Three distinct models are estimated throughout this analysis. Model 1 includes only individual-level control variables, as detailed in Table 4. Model 2 extends the specification by incorporating household-related factors. In the final model, employment-related variables are introduced to evaluate whether the observed effect of chronic illness attenuates when periods of unemployment or receipt of disability pension are accounted for. A reduction in the effect would suggest that alternative employment pathways, such as diminished working hours, may substantially contribute to explaining the observed income losses. The coefficients of control variables are not reported here but can be found in Appendix Tables A1 and A2. The regressions use a composite indicator of chronic diseases (Table 1).

In a first step, the effect of deteriorating health on earnings points is estimated, including interactions with qualification and with age, as the health-related gap in earnings points widens over the life course. Men are included with at least 15 years of employment, women with at least 10 years, reflecting gender differences in labour market participation in Germany. All models employ robust standard errors.

The estimation results indicate a significant negative association between both the onset and progression of chronic illness and subsequent earnings points trajectories among women and men, consistently evident across all model specifications and measures of chronic illness. Accordingly, the regression findings substantiate the patterns observed in the descriptive analysis. The most notable finding is the markedly stronger negative effect among women when comparing results for all chronic illnesses (chronic 1) with those for more severe chronic illness, with the latter showing a substantially greater adverse impact on earnings points in all three models. In contrast, among men, the magnitude of the effect shows little variation by illness severity.

For individuals experiencing a health shock (control), a significant association is observed for both women and men in Models 1 and 2, but this effect dissipates in the final model. Since Model 3 accounts for the receipt of a disability pension, marginal employment, and unemployment, it appears that most of the income variation following a health shock is attributable to transitions from employment to alternative social statuses rather than continued employment. Consistent with prior literature, chronic diseases differ in that they typically do not compel affected individuals to leave employment outright; if employment is relinquished, it tends to occur later in the individual’s work history. Notably, severe chronic illness among men represents an exception and, in this regard, constitutes a relatively new contribution to the existing body of research.

The significantly positive coefficient for the interaction between qualification and chronic illness among both women and men clearly underscores the hypothesized selective effect of chronic illness on income. Specifically, this positive interaction indicates that the otherwise negative impact of chronic illness on income is offset for individuals with high qualifications. Explanation: by implementing the interaction effects between high qualification and chronic illness as well as between age and chronic illness, the indicator “chronic illness” only shows the effect for average-aged women and men with low or medium qualification. The effect for highly skilled people is obtained by summing the effects “chronic disease” and “chronic disease*high qualification” turning the coefficient for the highly skilled people in each of the models positive. For example: The moderating effect of a high qualification in Model 3 for women is calculated as follows: −0.057 + 0.132 = 0.075. Thus, a chronic disease can clearly be seen as an amplifier of social inequality on the labour market since no negative income effects due to the onset of a chronic illness can be identified for highly qualified people. On the contrary: the corresponding coefficients remain positive. Hence, chronic illness cannot be characterised as a “career killer” among the highly qualified, although it does partly slow income progression. For this group, chronic illness appears to function more as a career brake – or, in some cases, as business as usual – rather than a career-ending event. This is different for people with low or medium qualifications showing a clearly negative income effect after the onset of a chronic disease. However, the compensatory effect associated with a high level of qualifications is observed to be significantly diminished in cases involving severe chronic illnesses compared to analyses including all chronic conditions. Consequently, negative income effects are more likely to manifest when the chronic illness is classified as severe, since variation according to disease progression remains relevant.

This suggests that, for men, labour market exit plays a more pivotal role in explaining income losses following a severe chronic illness, whereas continued employment with reduced hours or workload appears to be less influential than it is the case when all chronic illnesses are taken into account. In contrast, the third model also identifies a significant negative effect of severe chronic illness among women. The ability to remain in employment, and thus to adapt to and cope with more serious chronic conditions, appears to constitute a potentially viable strategy for women in managing the challenges associated with such illnesses.

It should be noted that annual earnings points are calculated only up to the contribution assessment ceiling for social insurance in Germany, which in 2025 is set at €96,600 per year. Variations in income above this threshold are not captured with this indicator. This means that income losses occurring exclusively above the ceiling for highly qualified individuals may not be reflected in the results. Consequently, the observed positive interaction effect between qualification and chronic illness should be interpreted with some caution. Nevertheless, the significant positive interaction effect between qualification and chronic illness remains robust for those individuals whose incomes vary within the contributory range. For this group, the observed association – that highly qualified individuals are less affected by negative income effects following the onset of chronic disease – can be considered a reliable finding. It should simply be kept in mind that the results pertain to the portion of income that is subject to social security contributions.

6 Conclusions: Chronic Illness is a Serious Employment and Income Risk

In summary, the analysis yields robust evidence in favour of the first hypothesis, indicating that both the onset and progression of chronic illness are negatively associated with employment and, consequently, earned income. These results corroborate recent findings reported by Islam et al. (2024) for Norway, thereby extending their applicability to the German context. The corresponding income losses range from minor reductions in annual earnings points to a complete loss of earned income due to unemployment, withdrawal from the labour force, or receipt of a disability pension. As is typical for chronic diseases, these adverse income effects generally do not manifest immediately, but only in the longer course of illness, confirming the second hypothesis as well. In this respect, chronic disease acts first as a brake on career development. Evidence for such mechanisms is documented in the literature for contexts such as Finland and the United Kingdom, showing that individuals suffering a health shock are less frequently considered for promotion than their healthy counterparts and are more likely to reduce weekly working hours (Islam et al. 2024; Lenhart 2019; Vaalavuo 2021).

The type and severity of chronic illness prove decisive for the magnitude of effects: both women and men experience considerably stronger negative effects on income when an indicator for severe chronic illnesses is used in the analysis rather than one encompassing all chronic conditions. The results therefore also confirm the fourth hypothesis. One explanation for the negative impact of the onset and progression of a chronic disease on average earnings points is that chronically ill people have a higher risk of becoming unemployed, working in marginal employment or drawing a partial or full disability pension in the aftermath of the diagnosis. This was confirmed in the descriptive analysis. In this reading, the chronic disease is thus to be seen as a “career killer”. Beyond these changes in employment status, the results, however, also point to adjustments in existing employment relationships. Compensation strategies commonly adopted include reducing weekly working hours or transitioning to a less demanding, albeit typically lower-paid, position (Flüter-Hoffmann et al. 2017; Jones et al. 2020; Vaalavuo 2021). While the income losses resulting from such adaptations tend to be less severe than those associated with complete withdrawal from employment, they nevertheless exert a significant impact on the total earnings points accumulated by an individual and on the level of their eventual old-age pension.

On the other hand, a large proportion of those affected had no income losses, at least in the first 10 years after diagnosis. Instead, the number of average earnings points remains at the pre-diagnosis level or even continues to rise. For these groups the consequences of the chronic disease are limited and vary between “career brake” and “business as usual”.

Last, the income and employment history of highly qualified persons is significantly less affected by the occurrence of a chronic disease than is the case with persons with low and medium qualifications. On the contrary: The fixed-effects regression clearly showed that the earnings points of the highly qualified develop positively even after the onset of the chronic disease. This positive income trend among highly skilled workers is also evident in the study by Islam et al. (2024), which shows that a high level of education seems to “shield” against negative labour market consequences:

To sum up, our results point in the direction that the highly educated chronically ill are more ‘shielded’ both in relative and absolute terms against unfortunate consequences of their illness compared to the other two groups. (Islam et al. 2024, 10)

An exception, however, is observed for men with severe chronic illnesses when alternative social statuses such as unemployment or disability pension are considered. In these cases, the compensatory effect associated with higher qualifications is substantially reduced and does not reach statistical significance. This finding suggests that withdrawal from the labour market – potentially at an early stage – and the resulting change in social status may constitute a relevant coping strategy even for highly qualified men affected by severe chronic illness. No analogous effect has been identified among women. As a side note: The adverse effects of a health shock on the progression of earnings points are substantially reduced and lose statistical significance for both women and men when alternative social status is controlled for. Accordingly, health shocks may be considered critical turning points for the career trajectories of both genders.

It should be noted that, as a consequence of the contribution assessment ceiling for social insurance in Germany, income losses occurring exclusively above this threshold for highly qualified individuals may not be captured in the results. This constitutes a methodological shortcoming, and it is important to be aware of the potential for slightly biased estimations as a result. On the other hand, the strong and significant effects observed among highly qualified individuals with chronic illness indicate meaningful variation in earnings points below the contribution assessment ceiling. Consequently, estimates for individuals with incomes up to this threshold can be regarded as robust. In sum, the analysis provides clear evidence for the validity of hypothesis 3 assuming that a chronic disease does not weaken existing income inequalities between socio-economic groups, but tends to increase them. In this sense, a chronic disease can be characterised as an amplifier of social inequality on the labour market.

Overall, the analysis indicates that chronic illness constitutes a significant risk to both employment and income, particularly among individuals with low to medium levels of educational qualification. In addition to the adverse effects on current employment and future pension entitlements, the associated income losses reduce contributions to the statutory pension system while simultaneously increasing expenditures for social security programs, such as higher rates of disability pension or unemployment benefit claims. Moreover, the objective of extending working life is undermined by the early labor market exit of individuals with chronic illnesses.

Mitigating these risks requires a targeted focus on the working conditions of affected individuals. Relevant workplace adaptations may include height-adjustable desks for those with musculoskeletal disorders or technical aids such as speech recognition software for employees with impaired vision. Additional measures – such as enhancing spatial and temporal flexibility, adjusting daily working hours, modifying weekly/monthly schedules, or enabling remote work – may further support sustained participation, predominately among office workers and those in larger firms.

By contrast, preventive strategies and the promotion of health literacy are especially important for chronically ill semi-skilled and unskilled workers as well as for workers in small companies, for whom workplace adaptations are less feasible. However, the responsibility for fostering health-promoting behaviours cannot rest with employers alone; active engagement of affected individuals is essential. Policy should therefore prioritise raising awareness and educational efforts regarding healthy behaviours, for example, through targeted workplace information sessions or statutory health insurance initiatives, and when possible, incorporating these themes into early education at schools.