Smoking and early retirement due to chronic disability

The effect of heavy smoking on retirement risk: A mendelian randomisation analysis

BACKGROUND AND AIMS

The extent to which heavy smoking and retirement risk are causally related remains to be determined. To overcome the endogeneity of heavy smoking behaviour, we employed a novel approach by exploiting the genetic predisposition to heavy smoking, as measured with a polygenic risk score (PGS), in a Mendelian Randomisation approach.

METHODS

8164 participants (mean age 68.86 years) from the English Longitudinal Study of Ageing had complete data on smoking behaviour, employment and a heavy smoking PGS. Heavy smoking was indexed as smoking at least 20 cigarettes a day. A time-to-event Mendelian Randomization (MR) analysis, using a complementary log-log (cloglog) link function, was employed to model the retirement risk.

RESULTS

Our results show that being a heavy smoker significantly increases the risk of retirement (β = 1.324, standard error = 0.622, p < 0.05). Results were robust to a battery of checks and a placebo analysis considering the never-smokers.

CONCLUSIONS

Overall, our findings support a causal pathway from heavy smoking to earlier retirement.

Individuals with long-term illness, disability or infirmity are more likely to smoke than healthy controls: An instrumental variable analysis

Despite the prevalence of smoking cessation programs and public health campaigns, individuals with long-term illness, disability, or infirmity have been found to smoke more often than those without such conditions, leading to worsening health. However, the available literature has mainly focused on the association between long-term illness and smoking, which might suffer from the possible bidirectional influence, while few studies have examined the potential causal effect of long-term illness on smoking. This gap in knowledge can be addressed using an instrumental variable analysis that uses a third variable as an instrument between the endogenous independent and dependent variables and allows the identification of the direction of causality under the discussed assumptions. Our study analyzes the UK General Household Survey in 2006, covering a nationally representative 13,585 households. We exploited the number of vehicles as the instrumental variable for long-term illness, disability, or infirmity as vehicle numbers may be related to illness based on the notion that these individuals are less likely to drive, but that vehicle number may have no relationship to the likelihood of smoking. Our results suggested that chronic illness status causes a significantly 28% higher probability of smoking. The findings have wide implications for public health policymakers to design a more accessible campaign around smoking and for psychologists and doctors to take targeted care for the welfare of individuals with long-term illnesses.

Health-related factors leading to disabilities in Korea: Survival analysis

The purpose of this study is to analyze (a) population and socioeconomic factors affecting disability, excluding the occurrence of disability due to accidents and congenital diseases, and (b) health-related behavioral factors and factors that can prevent and reduce the cause of disability due to disease in Korea. This study was a longitudinal research. Data were obtained from The 2018 Korean Health Panel (KHP) is a survey jointly conducted by the Korea Institute of Health and Social Affairs and the National Health Insurance Service. A total of 7, 372 (Mage = 52.14, SD = 21.39; Male = 47.52%) were analyzed in this study. People with Higher education attainments and more income levels were associated with lower hazard of developing new disabilities (all p < 0.05). In this study, the health factors that could be related to the occurrence of new disabilities were smoking, alcohol consumption, physical activity, and stress (all p < 0.0001). However, physical activity was negatively associated with the risk of developing a disability at all follow-ups (p < 0.05). Higher scores on the number of chronic diseases (valid scores = 0, 1, 2, 3, or more) represented a greater level of newly developing disability present at all follow-ups (all p < 0.0001). This longitudinal study confirmed the relationship between health-related factors and specific chronic diseases. Its findings can be used as a crucial foundation for establishing healthcare policies and services that can lower and prevent disability by preventing and reducing specific negative health behaviors and unhealthy behavioral factors, and alleviating chronic diseases in Korea.

As if it weren't hard enough already: Breaking down hiring discrimination following burnout

Hiring discrimination towards (former) burnout patients has been extensively documented in the literature. To tackle this problem, it is important to understand the underlying mechanisms of such unequal hiring opportunities. Therefore, we conducted a vignette experiment with 425 genuine recruiters and jointly tested the potential stigma against job candidates with a history of burnout that were mentioned earlier in the literature. We found candidates revealing a history of burnout elicit perceptions of requiring work adaptations, likely having more unpleasant collaborations with others as well as diminished health, autonomy, ability to work under pressure, leadership capacity, manageability, and learning ability, when compared to candidates with a comparable gap in working history due to physical injury. Led by perceptions of a reduced ability to work under pressure, the tested perceptions jointly explained over 90 % of the effect of revealing burnout on the probability of being invited to a job interview. In addition, the negative effect on interview probability of revealing burnout was stronger when the job vacancy required higher stress tolerance. In contrast, the negative impact of revealing burnout on interview probability appeared weaker when recruiters were women and when recruiters had previously had personal encounters with burnout.

Body weight and premature retirement: population-based evidence from Finland

BACKGROUND

Health status is a principal determinant of labour market participation. In this study, we examined whether excess weight is associated with withdrawal from the labour market owing to premature retirement.

METHODS

The analyses were based on nationally representative data from Finland over the period 2001-15 (N ∼ 2500). The longitudinal data included objective measures of body weight (i.e. body mass index and waist circumference) linked to register-based information on actual retirement age. The association between the body weight measures and premature retirement was modelled using cubic b-splines via logistic regression. The models accounted for other possible risk factors and potential confounders, such as smoking and education.

RESULTS

Excess weight was associated with an increased risk of premature retirement for both men and women. A closer examination revealed that the probability of retirement varied across the weight distribution and the results differed between sexes and weight measures.

CONCLUSION

Body weight outside a recommended range elevates the risk of premature retirement.

Associations of sustained smoking and smoking cessation with work-related outcomes: a longitudinal analysis

Purpose

The aim of this study was to assess the association between sustained smoking and quitting with work-related outcomes among older workers.

Methods

We categorized a sample of older employees into non-smokers, sustained smokers and quitters. Multivariable regression models were used to test longitudinal associations of sustained smoking and smoking cessation with sickness absence, productivity loss and work ability.

Results

We included 3612 non-smokers, 673 sustained smokers and 246 quitters. Comparing sustained smokers to non-smokers, we found higher (but not statistically significant) sickness absence for sustained smokers [1.01, 95% confidence interval (CI) − 0.16–2.17]. We did not find differences in productivity loss (OR 0.82, 95% CI 0.60–1.13) and work ability (0.05, 95% CI −0.05–0.15). For employees with a relatively high physical health at baseline, comparing quitters to sustained smokers, we found higher (but not statistically significant) productivity loss for quitters (OR 2.23, 95% CI 0.94–5.31), and no difference in sickness absence (0.10, 95% CI − 2.67–2.87), and work ability (− 0.10, 95% CI −  0.36–0.16). For employees with a relatively low physical health at baseline, comparing quitters to sustained smokers, we found a statistically significant lower work ability (− 0.31, 95% CI − 0.57–0.05), and no difference in sickness absence (2.53, 95% CI − 1.29–6.34) and productivity loss (OR 1.26, 95% CI 0.66–2.39).

Conclusions

We found no evidence that sustained smokers have less favorable work-related outcomes than non-smokers or that quitters have more favorable work-related outcomes than sustained smokers. The benefits of smoking cessation for employers might take a longer time to develop.

Biomarkers as precursors of disability

Some social surveys now collect physical measurements and markers derived from biological samples, in addition to self-reported health assessments. This information is expensive to collect; its value in medical epidemiology has been clearly established, but its potential contribution to social science research is less certain. We focused on disability, which results from biological processes but is defined in terms of its implications for social functioning and wellbeing. Using data from waves 2 and 3 of the UK Understanding Society panel survey as our baseline, we estimated predictive models for disability 2-4 years ahead, using a wide range of biomarkers in addition to self-assessed health (SAH) and other socio-economic covariates. We found a quantitatively and statistically significant predictive role for a large set of nurse-collected and blood-based biomarkers, over and above the strong predictive power of self-assessed health. We also applied a latent variable model accounting for the longitudinal nature of observed disability outcomes and measurement error in in SAH and biomarkers. Although SAH performed well as a summary measure, it has shortcomings as a leading indicator of disability, since we found it to be biased in the sense of over- or under-sensitivity to certain biological pathways.

Changes in sleep duration associated with retirement transitions: The role of naps

This study examined the changes in sleep duration (total sleep time, night-time sleep and daytime naps) after retirement transitions in China using a panel dataset of the China Health and Retirement Longitudinal Study in 2011, 2013 and 2015 with a total of 48,458 respondents. Linear regression analysis with generalized estimating equations was employed to examine the changes in sleep duration after transitions between different types of employment status. After controlling for the confounders, the results showed that the retired population and the population working in agricultural sectors slept 8.02 (p < .01) and 5.19 (p < .01) minutes longer than the population working in non-agricultural sectors, respectively. Employment transition also had significant effects on sleep duration. Transition from non-agricultural sectors to retirement increased total sleep time by 13.58 (p < .01) minutes and also raised the probability of daytime naps by 18% (OR = 1.18, p < .01). Transition from agricultural employment to retirement did not significantly affect the total sleep time, but significantly increased the probability of daytime naps (OR = 1.12, p = .02). Reentering the non-agricultural sectors for the retirees did not significantly affect night-time sleep, but decreased the probability of daytime naps (OR = 0.73, p < .01) and daytime nap duration (by 5.26 min, p = .01). In conclusion, people in China increased their sleep duration after transitions to retirement, but the magnitudes were much smaller than those in Western countries. Differences may be attributed to an abundant amount of Chinese people working in agricultural sectors, the high volume of retired people reentering the work force and the large proportion of people in China that had daytime naps at baseline.

Health and transitions into nonemployment and early retirement among older workers in Canada

Extending working lives is considered a viable solution to fiscal and macroeconomic challenges related to population ageing. Opportunities for sustained employment, however, are not experienced equally among older population, particularly among those with a health problem. This study aims to examine the longer-term effect of health on employment trajectories in later part of working life using a unique survey-administrative linked dataset for Canada. Specifically, we apply competing-risks models to analyze whether different aspects of health conditions at baseline predict subsequent exit routes, including nonemployment and early retirement. The nonparametric findings of the paper show that only about 33% of workers aged 50-62 with a health problem at baseline remained employed at age 64, compared to 55% of healthy workers. Exiting into nonemployment seemed more common among leavers with activity limitations, while early retirement was more likely among healthy leavers. These results are robust even when individuals' preferences for work and financial factors were controlled for. Moreover, we identify differential impacts of specific chronic diseases on early work exit. Not all symptoms affect employment transitions to a similar extent. Older workers who reported the comorbidity of mental and musculoskeletal disorders faced an increased risk of nonemployment, while the presence of diabetes and cardiovascular problems at baseline were more predictive of early retirement.

Retirement and Unexpected Health Shocks

Is retirement good for your health? We complement previous studies by exploring the effect of retirement on unexpected health evolution. Using panel data from the Household, Income and Labour Dynamics in Australia survey (2001-2014), we construct measures of the mismatch between individual expected and actual health evolution (hereafter "health shocks"). In our approach, reverse causation running from health shocks to retirement is highly unlikely, because we look at shocks that happen after retirement, and those shocks are, by definition, unanticipated. We find that retirement decreases the probability of negative shocks (by approximately 16% to 24% for men and 14% to 23% for women) while increasing the likelihood of positive shocks (by 9% to 14% for men and 10% to 13% for women). This result is robust to the use of different lead-lag structures and of alternative measures of health change. Our findings are thus consistent with a positive impact of retirement on health.

The effect of smoking cessation on work disability risk: a longitudinal study analysing observational data as non-randomized nested pseudo-trials

BACKGROUND

Smoking increases disability risk, but the extent to which smoking cessation reduces the risk of work disability is unclear. We used non-randomized nested pseudo-trials to estimate the benefits of smoking cessation for preventing work disability.

METHODS

We analysed longitudinal data on smoking status and work disability [long-term sickness absence (≥90 days) or disability pension] from two independent prospective cohort studies-the Finnish Public Sector study (FPS) (n = 7393) and the Health and Social Support study (HeSSup) (n = 2701)-as 'nested pseudo-trials'. All the 10 094 participants were smokers at Time 1 and free of long-term work disability at Time 2. We compared the work disability risk after Time 2 of the participants who smoked at Time 1 and Time 2 with that of those who quit smoking between these times.

RESULTS

Of the participants in pseudo-trials, 2964 quit smoking between Times 1 and 2. During the mean follow-up of 4.8 to 8.6 years after Time 2, there were 2197 incident cases of work disability across the trials. Quitting smoking was associated with a reduced risk of any work disability [summary hazard ratio = 0.89, 95% confidence interval (CI) 0.81-0.98]. The hazard ratio for the association between quitting smoking and permanent disability pension (928 cases) was of similar magnitude, but less precisely estimated (0.91, 95% CI 0.81-1.02). Among the participants with high scores on the work disability risk score (top third), smoking cessation reduced the risk of disability pension by three percentage points. Among those with a low risk score (bottom third), smoking cessation reduced the risk by half a percentage point.

CONCLUSIONS

Our results suggest an approximately 10% hazard reduction of work disability as a result of quitting smoking.

Intergenerational transmission of nicotine within families: Have e-cigarettes influenced passive smoking?

Using an objective biomarker of active and passive smoking, we estimate Galtonian regressions of nicotine transmission and test whether the use of new nicotine delivery products (NDP) by parents had an influence on the transmission to children through passive smoking. We find evidence of a strong intergenerational transmission through passive smoking and that this is around four times larger for mothers compared to fathers. Moreover, we estimate an intention to treat difference-in-differences (DiD) model using parental cotinine as a continuous measure of exposure to the treatment and we find that the level of transmission of cotinine from parents was reduced to 51 per cent of the previous level just after the spread in the use of e-cigarettes in England and to 77 per cent when considering transmission from mothers. This is confirmed also by a DiD model which considers interaction between cotinine levels and self-reported use of NDP by parents and suggests that lower taxation of these devices may be justified on externality grounds.