Ill-health related job loss among cleaners in France: A 4-year follow-up study.

Chronic ill-health is a major driver of premature exit from employment. While the annual incidence of ill-health-related job loss in the French workforce is estimated at 7.8 per 1,000 workers, the specific burden among cleaners remains unknown. This study aimed to quantify the incidence of medical unfitness among cleaners in France and to identify the principal diseases and demographic factors associated with job loss. A 4-year follow-up study (2016-2019) was conducted within the occupational health service of Montpellier, France. All employees deemed medically fit at baseline were included. Demographic and occupational data were extracted from electronic medical records. All decisions of medical unfitness for work issued by occupational physicians according to legal procedures were collected along with their ICD-10 diagnostic causes. Incidence rates and disease profiles were compared between cleaners and other workers. Among 118,033 workers, 13,089 were cleaners. The annual incidence of ill-health-related job loss was 2.3 times higher among cleaners (16.7 ‰ or permille); 95% Confidence Interval (CI) [15.6;17.8]) than in the overall population (7.3‰; 95% CI [7.1;7.6]. Musculoskeletal disorders and mental disorders were the most frequently reported causes of unfitness among cleaners (both 57.7%). Less frequent conditions, including schizophrenia (RR = 8.11) and cardiovascular diseases (RR = 6.55), were markedly over-represented in this group. Cleaners experience a substantially elevated risk of ill-health-related job loss compared with other workers, largely driven by musculoskeletal and mental disorders. Over-representation of severe psychiatric and cardiovascular diseases highlights the need for targeted preventive strategies in this socio-economically vulnerable group.