Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research · 2026
Paid and Unpaid Productivity Losses Associated With Musculoskeletal Conditions: Longitudinal Evidence From Australia.
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Alemu Nanati Legese, Niu Anthony, Watts Jennifer J, Robinson Suzanne, Chen Gang, Gao Lan
Аннотация
OBJECTIVES: To examine the impact of musculoskeletal conditions on paid and unpaid productivity using longitudinal Australian data.
METHODS: Data were drawn from 4 waves of the Household, Income, and Labor Dynamics in Australia Survey. Musculoskeletal conditions (MSCs) were identified from self-reported arthritis or osteoporosis, with prescription medication as an indicator of symptom severity. Functional limitation severity was classified using tertiles of the SF-36 Physical Functioning subscale. Correlated random-effects models estimated within- and between-person associations between MSCs and weekly paid, unpaid, and total productivity, adjusting for demographic, socioeconomic, and lifestyle covariates.
RESULTS: Overall, 36% of respondents reported an MSC in at least 1 wave. Individuals with MSCs worked 3.2 fewer paid hours per week (95% CI -3.9 to -2.4) but performed 3.1 more unpaid hours (95% CI 2.1 to 4.2), leaving total productivity largely unchanged. Respondents with MSCs but no medication worked 4.7 fewer paid hours (95% CI -5.8 to -3.5) and 4.7 more unpaid hours (95% CI 2.9 to 6.5), whereas those using medication worked 6.8 fewer paid hours (95% CI -7.8 to -5.9) and 3.0 more unpaid hours (95% CI 1.4 to 4.7). At lower physical functioning levels, paid (-12.8 hours) and total productivity (-13.2 hours) declined sharply. Paid-work losses were larger for men, consistent with significant sex differences in the correlated random-effects models.
CONCLUSIONS: MSCs substantially reduce paid work and partly redirect time into unpaid work. Policies that support labor-force retention-such as early management of functional decline-and recognition of the unpaid role are essential to address the broader productivity burden.
METHODS: Data were drawn from 4 waves of the Household, Income, and Labor Dynamics in Australia Survey. Musculoskeletal conditions (MSCs) were identified from self-reported arthritis or osteoporosis, with prescription medication as an indicator of symptom severity. Functional limitation severity was classified using tertiles of the SF-36 Physical Functioning subscale. Correlated random-effects models estimated within- and between-person associations between MSCs and weekly paid, unpaid, and total productivity, adjusting for demographic, socioeconomic, and lifestyle covariates.
RESULTS: Overall, 36% of respondents reported an MSC in at least 1 wave. Individuals with MSCs worked 3.2 fewer paid hours per week (95% CI -3.9 to -2.4) but performed 3.1 more unpaid hours (95% CI 2.1 to 4.2), leaving total productivity largely unchanged. Respondents with MSCs but no medication worked 4.7 fewer paid hours (95% CI -5.8 to -3.5) and 4.7 more unpaid hours (95% CI 2.9 to 6.5), whereas those using medication worked 6.8 fewer paid hours (95% CI -7.8 to -5.9) and 3.0 more unpaid hours (95% CI 1.4 to 4.7). At lower physical functioning levels, paid (-12.8 hours) and total productivity (-13.2 hours) declined sharply. Paid-work losses were larger for men, consistent with significant sex differences in the correlated random-effects models.
CONCLUSIONS: MSCs substantially reduce paid work and partly redirect time into unpaid work. Policies that support labor-force retention-such as early management of functional decline-and recognition of the unpaid role are essential to address the broader productivity burden.