Retirement and coronary mortality

Health Consequences of Major Role Losses in Later Life

Based on a subsample of older adults from the Longitudinal Retirement History Study, a generic model for identifying the structural relation between poor physical health and five exogenous variables was validated by the LISREL approach. Findings show that elderly persons who have a favorable level of physical health in later life are those who experienced better health at the early stage of the aging process, irrespective of major role losses, economic status, and age.

Retirement effects on health in Europe

What are the health impacts of retirement? As talk of raising retirement ages in pensions and social security schemes continues around the world, it is important to know both the costs and benefits for the individual, as well as the governments' budgets. In this paper we use the Survey of Health, Ageing and Retirement in Europe (SHARE) dataset to address this question in a multi-country setting. We use country-specific early and full retirement ages as instruments for retirement behavior. These statutory retirement ages clearly induce retirement, but are not related to an individual's health. Exploiting the discontinuities in retirement behavior across countries, we find significant evidence that retirement has a health-preserving effect on overall general health. Our estimates indicate that retirement leads to a 35 percent decrease in the probability of reporting to be in fair, bad, or very bad health, and an almost one standard deviation improvement in the health index. While the self-reported health seems to be a temporary impact, the health index indicates there are long-lasting health differences.

Is retirement good or bad for mental and physical health functioning? Whitehall II longitudinal study of civil servants

BACKGROUND

To determine whether retirement at age 60 is associated with improvement or deterioration in mental and physical health, when analysed by occupational grade and gender.

METHODS

Longitudinal study of civil servants aged 54 to 59 years at baseline, comparing changes in SF-36 health functioning in retired (n=392) and working (n=618) participants at follow up. Data were collected from self completed questionnaires.

RESULTS

Mental health functioning deteriorated among those who continued to work, but improved among the retired. However, improvements in mental health were restricted to those in higher employment grades. Physical functioning declined in both working and retired civil servants.

CONCLUSION

The study found that retirement at age 60 had no effects on physical health functioning and, if anything, was associated with an improvement in mental health, particularly among high socioeconomic status groups.

Referral to occupational medicine clinics and resumption of employment after myocardial infarction

Rehabilitation after acute myocardial infarction (AMI) consists of education, exercise, and an encouragement to return to work (RTW). This study attempts to (1) determine whether the time interval between AMI and the visit at occupational medicine (OM) clinics predicts resumption of full employment, and (2) estimate the incidence of work-related recurrent AMI after RTW. We followed 216 consecutive AMI patients at a single OM clinic. The independent variables were clinical and personal data, physical workload and time between AMI, and first visit to the OM clinic. The outcome variables were full employment 24 months after the acute event and recurrent AMI during this period. Of all patients, 168 attempted RTW. Of these, 18 stopped working subsequently. Of the remaining 150 patients, 54 returned to part-time work and 96 were employed full-time after 2 years. Logistic regression indicated that a failure to resume full employment was independently associated with diabetes, older age, Q wave AMI, angina before AMI, heavy work, and a late visit to the OM clinic. For each month's delay in referral to the OM clinic, there was a 30% decrease in the chance for full employment 24 months after AMI. Six (4%) of the 150 patients who resumed employment sustained a recurrent AMI, two of them while at work. A delayed referral to the OM clinic was associated with work disability after AMI. Late referrals to OM clinics should receive a more intensive and sustained rehabilitation than early referrals. Whether an earlier referral to OM clinics will result in increased RTW rates is unknown. Patients who attempted to resume employment had a 1.2% risk of a recurrent ischemic event at their workplace.

Identification of patients with coronary disease at high risk for loss of employment. A prospective validation study

BACKGROUND

Work disability is common in patients with coronary artery disease and adversely affects both economic well-being and quality of life. The purpose of this study was to construct a model to predict premature departure from the work force of patients with coronary disease and to validate this model prospectively in an independent cohort of patients.

METHODS AND RESULTS

We enrolled 1,252 coronary disease patients referred for diagnostic cardiac catheterization who were less than age 65, employed, and without prior coronary angioplasty or coronary bypass surgery. Medical, functional, psychological, economic, and job-related variables were measured at the time of baseline diagnostic cardiac catheterization, and all patients were followed for 1 year. Three hundred twelve patients underwent percutaneous transluminal coronary angioplasty (PTCA) within 60 days of catheterization, and 449 had coronary artery bypass graft surgery (CABG) within 60 days of catheterization. The remaining 491 patients were treated with initial medical therapy. Logistic regression was used to develop a multivariable model for predicting 1-year work status in the training sample patients (872 patients enrolled between March 1986 and February 1989). This model was then validated in the independent prospective test sample (380 patients enrolled between March 1989 and June 1990). Eight factors were independent predictors of departure from the work force: lower initial functional status (as assessed by the Duke Activity Status Index), followed by older age, black race, presence of congestive heart failure, lower education level, presence of extracardiac vascular disease, poorer psychological status, and lower job classification. Standard clinical variables provided only 20% of the total predictive information available from the model about follow-up work outcomes, whereas functional measures provided 27%, and demographic and socioeconomic measures provided 45%. In the test sample, the area under the receiver operating characteristic curve for the model predictions was 0.74, compared with 0.80 in the training sample, and model predictions agreed well with observed prevalences of return to work. After adjustment for baseline imbalances, there was no significant difference in 1-year return-to-work rates among the patients receiving initial PTCA or CABG therapy versus initial medical therapy.

CONCLUSIONS

Patients with coronary disease who are at high risk for premature departure from the work force can be accurately identified from a combination of medical and nonmedical risk factors. The model developed in this study provides a tool to identify patients at high risk for premature loss from the work force. Such patients may benefit from special multidimensional intervention programs designed to preserve work status. Our data show that revascularization with either PTCA or CABG is not, by itself, sufficient to accomplish this goal.

Morbidity in Swedish farmers, 1978-1983, according to national hospital records

A number of epidemiological studies have shown that farmers have low mortality rates. To examine morbidity risks for male and female farmers in Sweden, the national hospital care registry was updated with information on occupation derived from the census of 1980. The cause-specific morbidity of farmers was compared with the morbidity of all economically active individuals in the same areas. A total of 60,515 farmers and 2,843,217 controls have been studied. The morbidity rates of the farmers were generally low. Male farmers had a significantly lower risk for cancer diseases, mental diseases, cardiovascular diseases, diseases of the digestive system, the uro-genital system, and skin diseases. Female farmers had a lower risk for diseases of the respiratory system, uro-genital system, skin diseases, diseases of the locomotor system, and accidents. A notable discrepancy between males and females concerning cardiovascular diseases was observed Male farmers had a significantly lower risk than other men while female farmers had the same risk level as other economically active women. The relative risk of hospitalization for mental disease was also low. Male farmers had a risk for alcohol-dependent diseases and attempted suicides which was less than one-third of the risk for all economically active men. Concerning work-environment-related diseases in farming, it was shown that young male farmers had low rate ratios. However, the risks were found to increase with every decade, indicating that occupational health risks contribute to morbidity with advancing age.

Retirement and primary cardiac arrest in males

We investigated the association between retirement and primary cardiac arrest (PCA) in 126 male cases and controls, 25-75 years of age, without prior heart disease or comorbidity. After adjustment for age alone, retirement was not associated with an increased risk of PCA, (OR = 1.1; 95% confidence intervals = 0.5, 2.4). This lack of association was not uniform across age strata, however. In 10 of 19 discordant pairs 60 or more years of age, the control subject had been retired; in all seven discordant pairs under 60, the case had been retired (lower 95% CI of the relative risk = 1.9).

Plausible theories and the development of scientific theory. The case of aging research

The field of aging research, for various reasons, has probably had more "plausible theory" that has gotten attention than occurs in more traditional fields of research. Examples of such theories are provided along with some of the disconfirming evidence.

Pairs of same-sexed siblings discordant for antisocial behaviour

Seventy-one pairs of same-sexed biological adolescent siblings, discordant for antisocial behaviour and service contact, were compared using matched-pairs analyses along several dimensions which included developmental, family, psychiatric, educational, cognitive, pro- and antisocial behaviour. The antisocial youth had significantly more negative perception and experiences than their siblings, who experienced more protective influences. Earlier onset in the antisocial youth of activities such as smoking also significantly differentiated the pairs. The early temperament index alone correctly classified as proband and sibling 95% of the youth, using discriminant analysis procedures. The findings are relevant to the aetiology of antisocial behaviour and to possible treatment interventions.

Change in self-reported health with retirement

Despite evidence to the contrary, the idea that retirement harms health continues to have wide credibility. This article examines the possibility that retirement contributed to decline in self-reported health among a panel of 112 men who retired between baseline measurements in 1975 and follow-up measurement in 1978. Within-individual changes in self-reported health for these retirees were compared with changes among 386 age peers (fifty-six to sixty-seven at follow-up) who continued to work from T1 to T1. For all men working and in favorable health at T1, eventual retirees had no greater age-adjusted incidence of health decline than did continuing workers. Moreover, when retirees were asked directly whether retiring had affected their health, only 2 per cent claimed a "bad" effect. Collating our findings with previous evidence, we concluded that retirement-related changes for the worse in self-perceived health were infrequent events.

The effect of retirement on physical health

This prospective study compared pre- to post-retirement changes in physical health among male retirees with changes among age peers who continued to work. The 229 retirees and 409 workers aged 55-73 at follow-up were all participants in the Veterans Administration Normative Aging Study. Physical health at baseline and follow-up (three to four years apart) was rated on a four-point scale according to the findings of medical examinations. Although physical health declined generally over time, regression analyses showed no significant difference between eventual retirees and continuing workers on health change, after controlling for age and excluding men who retired due to illness or disability. Among retirees alone, pre- to post-retirement health change was also not significantly associated with several circumstances which purportedly make the retirement transition more stressful, such as mandatory retirement or retirement to a reduced standard of living. The results of this study of physical health, which corroborate those of other studies based on self-reported health measures and mortality data, support the conclusion that the event of retirement does not influence the risk of health deterioration.

The effect of retirement on somatic complaints

This study investigated whether the level of somatic complaint increases as men make the supposedly stressful passage from work to retirement. For 171 retirees, pre- to post-retirement changes in the sum of selected somatic complaints from the Cornell Medical Index were compared with changes over a comparable time interval (3-5 yr) in 386 age peers who continued to work. Although there was slightly increased frequency of somatic complaint over time, eventual retirees did not differ from continuing workers in the amount and direction of change. Among retirees only, change from pre-retirement complaint levels did not vary by retirement age, length of time retired, part-time work in retirement, former occupational level or marital status, nor was it affected by the circumstance of compulsory retirement. These results, which are based on a continuous measure of health status, confirm previous findings from categorical data which conclude that retirement's effect on health is negligible.