The burden of arthritis in the aging workforce is disproportionately felt among blue-collar and low-income populations, according to a study published online in the American Journal of Public Health. This is particularly problematic, note the authors, because it is often the lower-income individuals who, for financial reasons, need to remain in the workforce longer, despite greater health problems than white-collar workers.  

“The message here is that blue-collar workers are in trouble,” says Alberto Cabán-Martinez, DO, lead author and at the time of the study a professor in the department of epidemiology and public health at the University of Miami Miller School of Medicine in Florida. Dr. Caban-Martinez’ findings show they need to stay in the workforce longer because of financial insecurity, but are retiring earlier due to a “disproportional amount of arthritis.”

Dr. Cabán-Martinez’s team looked at data from almost 18,000 people aged 18 and older derived from the National Health Interview Survey, or NHIS, and the Medical Expenditure Panel Survey, or MEPS, as well as the National Death Index. Subjects were sorted in four occupational categories: white collar, blue collar, service and farming.

They found that, in workers aged 65 and older, approximately 67 percent of farmers, 58 percent of those in service, 51 percent in white-collar occupations and 47 percent of those in blue-collar jobs had arthritis. Blue-collar workers may have lower numbers because they were much more likely to leave the workforce if they had arthritis than the other groups.

The results showed that white-collar workers have a higher health-related quality of life at all ages than others in the workforce, and blue-collar workers have the lowest. The study found that 25-year-old white-collar workers with arthritis will live healthily for 39 more years, while blue-collar workers with arthritis will have 33 more quality years. Of the four groups, blue-collar workers retire earlier, and have poorer health as they age.

Dr. Cabán-Martinez says experts speculate that blue-collar, service and farm workers tend to have higher rates of arthritis than white-collar workers because they are more physically active.

“A construction worker outside with a jackhammer is doing something very different every day than someone sitting in an office writing a report,” he says. “Blue-collar workers on the whole tend to be more physically active and put more of a burden on their joints.”

Leigh Callahan, PhD, professor of medicine and social medicine at the Thurston Arthritis Research Center at the University of North Carolina Chapel Hill, says a large base of research supports this theory. She says osteoarthritis, or OA, often caused by wear and tear of the joints, is more prevalent among physical laborers. Data show more prevalence of disease and mortality from most chronic illnesses in lower socioeconomic groups, although it is difficult to pinpoint why. She says risk factors like obesity are seen in greater numbers in lower-income populations, which also tend to be less educated and more likely to spend money on daily needs than expenses like preventive care.

Blue-collar workers with arthritis retire sooner possibly because they are less likely to have good health care options, says Eric Gall, MD, professor of clinical medicine at the University of Arizona and director of the Arizona Arthritis Center. With arthritis in particular, early diagnosis and intervention lead to better outcomes.

“White collar-workers can arrange their schedules to exercise and get physical therapy,” he says. “Blue-collar workers may only have evenings and weekends [available], and those services might not be available then.”

Regardless of the kind of work one does, people are living and remaining in the workforce longer, and the mere process of aging increases the likelihood of getting arthritis. Dr. Cabán-Martinez says it is important to use studies like this to reinforce the need for workforce change. The authors suggest improving disability and unemployment insurance and arthritis health promotion interventions.

He suggests using ergonomic interventions, or changing the workflow or duties to allow people to remain productive longer. For instance, a nurse or police officer could be reassigned from patient handling or street patrol to perform administrative duties. “Wal-Mart might have an elderly greeter at the door instead of at a labor-intensive job so it is not so burdensome on the joints and body,” he says.

“We should be sensitive to people with functional limitations. A lot of people are very able to remain engaged and simple tweaks in the workload can make a huge difference for them.”