BACKGROUND/AIMS: In England, the proportion of adults not in work due to long-term illness or disability has risen sharply in recent years. This study examined differences in trends in health-related economic inactivity between 2014 and 2025 by level of alcohol consumption.

DESIGN: Repeated cross-sectional analysis of data from a nationally representative, monthly survey conducted between March 2014 and May 2025.

SETTING: England.

PARTICIPANTS: 162 935 adults aged 18-64.

MEASUREMENTS: Health-related economic inactivity was defined as self-reporting being out of work due to long-term illness or disability. Alcohol consumption was classified using the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) into five risk levels: non-drinker (score of 0), low risk (1-4), increasing risk (5-7), higher risk (8-10) and possible dependence (11-12). Logistic regression was used to model time trends adjusted for age and gender. Modelled estimates were then extrapolated to the adult population of England using national population and drinking prevalence estimates. Secondary analyses were conducted using the full AUDIT and a measure of heavy episodic drinking.

RESULTS: Between 2014 and 2025, the prevalence of health-related economic inactivity more than doubled among non-drinkers (from 4.9% to 10.0%; a 104% increase) and low-risk drinkers (from 2.3% to 4.7%; a 104% increase), and increased by 50% among those drinking at increasing-risk levels (from 1.8% to 2.7%). In contrast, it remained relatively stable among those drinking at high-risk levels (from 3.2% to 2.9%; a 9% decrease) and declined among those drinking at levels indicating possible dependence (from 5.4% to 3.4%; a 37% decrease). This pattern of results was consistent across different measures of alcohol use (AUDIT-C classifications, full AUDIT, heavy episodic drinking). However, when accounting for population growth and increases in the overall prevalence of riskier drinking, the absolute numbers of increasing- and high-risk drinkers and those with possible dependence who reported health-related economic inactivity increased from 229 000 to 318 000.

SUMMARY:The prevalence of economic inactivity due to long-term illness and disability among working-age adults in England between 2014 and 2025 more than doubled among non-drinkers and low-risk drinkers while remaining stable or declining among those drinking at higher-risk levels, likely reflecting reverse causality and broader shifts in the population composition of drinkers in recent years.