Health disparities among workers and nonworkers with functional limitations: implications for improving employment in the United States

Abstract

Purpose: The aim of this study was to compare workers and nonworkers who reported mild, moderate, and severe/complete functional limitations to identify disparities in 19 health and social indicators. Method: Using the International Classification of Functioning, Disability and Health as our conceptual framework, we analyzed data from the combined 2000–2008 National Health Interview Survey, comparing workers and nonworkers by severity of functional limitations, as measured by the FL12 Scale of Functional Limitation Severity. Results: Only 9.5% of people reporting moderate/severe functional limitations worked. Although not without exception, not working and severity of functional limitation were associated with poorer health outcomes, with nonworkers reporting severe/complete limitations having least optimal health. Prevalence of chronic conditions was associated with level of functional limitation severity, with the strongest associations among nonworkers. Conclusions: By focusing exclusively on people with functional limitations, we were better able to examine factors contributing to health and participation of workers and nonworkers. People who worked and had moderate or severe/complete limitations often did so while reporting poor health. With improved access to health care, health promotion activities, and other support systems, the quality of life and likelihood of work participation of people with greater functional limitations might also be improved.

Implications for Rehabilitation

• Improving access to health care, health promotion activities, and other support systems may increase the quality of life and likelihood of work participation of people with moderate or severe/complete limitations.

• Specifically addressing health behaviors among workers and nonworkers with moderate and severe/complete functional limitations in the course of rehabilitation may improve both work participation and job retention.

• Workers and nonworkers with mild, moderate, and severe/complete activity limitations exhibit different patterns of health and participation requiring carefully crafted intervention strategies

• Consistent management of chronic health conditions and chronic pain may improve the likelihood of work participation and retention in the workforce among adults with moderate and severe/complete functional limitations.

Keywords::

• Health outcomes
• International Classification of Functioning
• Disability and Health

Disclaimer

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. This manuscript has not been published elsewhere and has not been submitted simultaneously for publication elsewhere.

Declaration of Interest: The authors report no conflicts of interest.