Keele Research Repository

Introduction
Retirement ages are rising in many countries due to population ageing and increasing life expectancy. It is unclear whether people in later working life (age ≥50) are able to work for longer due to health conditions and a lack of job opportunities. The work described in this thesis aimed to determine the average number of years that adults in England are expected to be healthy and in work from age 50, and investigate inequalities, projections until the year 2035, and association with health, lifestyle and workplace factors including osteoarthritis (OA) as an exemplar of a common long-term health condition.

Methods
Healthy Working Life Expectancy (HWLE) was identified through a systematic review as a potential indicator of population ableness to work for longer and operationalised as years spent healthy (no limiting long-standing illness) and in paid work ((self-)employment) from age 50. HWLE was estimated with discrete-time and continuous-time multistate models using IMaCh/R software, and longitudinal data from the English Longitudinal Study of Ageing and the North Staffordshire Osteoarthritis Project. HWLE projections were estimated using Health Survey for England data and official mortality rate statistics.

Results
HWLE at age 50 was 9.42 years (men: 10.94 years, women: 8.25 years). Subgroup analyses highlighted inequalities by socioeconomic status, and to an extent by occupation type and region. Having OA was associated with reduced HWLE, as was obesity, physical inactivity, pain interference, mental health problems, unsupportive work environments, and having no control at work. Projected from 2020 to 2035, life expectancy gains (men: 3.37 years; women: 2.46 years) exceeded HWLE gains (men: 0.38 years; women: 1.08 years).

Conclusion
HWLE in England is less than the years to the State Pension age. HWLE has potential to be used as a population indicator for work and support a joined-up approach between policymakers, employers and healthcare providers to extend working lives.