Bartley M, Plewis I. Accumulated labour market disadvantage and limiting long term illness: data from the 1971-1991 ONS Longitudinal Study. International Journal of Epidemiology 2002; 31: 336-341.

BACKGROUND: Both social class and unemployment have been shown in many studies to be related to ill health. Recent work in social epidemiology has demonstrated the importance of examining the accumulation of disadvantage over the life course. This paper therefore uses a large longitudinal data set to examine the accumulation of both disadvantaged class and unemployment over a 20-year period in a representative sample of the male working population of England and Wales. METHODS: Logistic regression. RESULTS: Both membership of semi- or unskilled social class and unemployment in 1971 were related to limiting long-term illness (LLTI) in 1991 independently of each other, and of subsequent social class and unemployment. Any occurrence of disadvantaged social class or of unemployment added significantly to the risk of LLTI. A labour market disadvantage score comprising the number of occasions on which a study member had been either in a disadvantaged social class or unemployed showed a clear and graded relationship to illness, with odds of 4 to 1 in the worst-scoring group. CONCLUSION: The experiences of disadvantaged social class or unemployment at any time during this period contributed independently to an increased risk of chronic limiting illness up to 20 years later in the life course. Whereas improvements in social conditions at any one time will lessen the long-term combined impact of accumulated labour market disadvantage on health, it may not prove easy to obtain short term improvements in health inequality.