Projections of healthy working life expectancy in England to the year 2035

Better Mobility Is Associated With Higher Incomes and Longer Working Years Among Older Adults

BACKGROUND

Robust physical mobility is the key to healthy independent aging. Although the association between socioeconomic status and health is well documented, it is unclear whether there is a relationship between mobility and income, because income data are not readily available.

QUESTIONS/PURPOSES

(1) Do individuals with better mobility have higher incomes? (2) Does maintaining mobility over time allow individuals to keep working? (3) Is exercise associated with higher mobility over time?

METHODS

We obtained longitudinal income and health data from the nationally representative Health and Retirement Study. Three cohorts were used. First, we studied the relationship between household income and mobility (on a 6-point index of walking impairment) in 19,430 adults who were assessed in 2016 (representing 93% of the 20,805-person total cohort). We measured the association of mobility and household income in a multivariate linear regression analysis of age, gender, health conditions, and education. We then identified a second group of 1094 individuals with unrestricted mobility in the year 2000 and compared differences in income and working rates between those who maintained mobility and those who lost mobility after 10 years. Finally, we identified a third group of 7063 individuals who were 60 to 80 years old in 2012, divided the group by how often they engaged in exercise, and observed differences in mobility after 4 years.

RESULTS

After adjusting for covariates, a drop of one level of mobility was associated with a USD 3410 reduction in annual household income (95% CI USD 2890 to USD 3920; p < 0.001). After 10 years, individuals who maintained their mobility had incomes that were USD 6500 higher than that of individuals who were not working (95% CI USD 2300 to USD 10,300; p < 0.001) and were more likely to be working (40% versus 34.5%; p < 0.001). Exercising at least once per week was associated with better mobility 4 years later (mobility score 4.46 ± 0.08 versus 3.66 ± 0.08; p < 0.001).

CONCLUSION

Better mobility was associated with more than USD 3000 in annual income. Regular exercise and other interventions that improve mobility may have meaningful returns on investment.

CLINICAL RELEVANCE

Because greater mobility is strongly associated with higher income, orthopaedic interventions may be undervalued.

The Individual-Level Productivity Costs of Physical Inactivity

PURPOSE

This study estimated the long-term individual-level productivity costs of physical inactivity.

METHODS

The data were drawn from the Northern Finland Birth Cohort 1966, to which the productivity cost variables (sick leaves and disability pensions) from Finnish registries were linked. Individuals ( N = 6261) were categorized into physical activity groups based on their level of physical activity, which was measured in three ways: 1) self-reported leisure-time moderate- to vigorous-intensity physical activity (MVPA) at 46 yr old, 2) longitudinal self-reported leisure-time MVPA at 31-46 yr old, and 3) accelerometer-measured overall MVPA at 46 yr old. The human capital approach was applied to calculate the observed costs (years 2012-2020) and the expected costs (years 2012-2031).

RESULTS

The results showed that the average individual-level productivity costs were higher among physically inactive compared with the costs among physically active. The results were consistent regardless of the measurement type of physical activity or the period used. On average, the observed long-term productivity costs among physically inactive individuals were €1900 higher based on self-reported MVPA, €1800 higher based on longitudinal MVPA, and €4300 higher based on accelerometer-measured MVPA compared with the corresponding productivity costs among physically active individuals. The corresponding difference in the expected costs was €2800, €1200, and €8700, respectively.

CONCLUSIONS

The results provide evidence that productivity costs differ according to an individual's level of physical activity. Therefore, investments in physical activity may decrease not only the direct healthcare costs but also the indirect productivity costs paid by the employee, the employer, and the government.

A systematic review of the global prevalence and incidence of shoulder pain

BACKGROUND AND OBJECTIVES

Studies reporting on the population burden of people living with shoulder pain show wide heterogeneity in terms of case definition, study samples, and occurrence. This systematic review aims to summarize evidence pertaining to the prevalence and incidence of shoulder pain, including variability based on sex and geography. We also explored the potential influence of methodological limitations and important sources of heterogeneity (case definition and reference period) on reported estimates of shoulder pain prevalence.

DATABASES AND DATA TREATMENT

The study protocol was registered on Prospero under CRD42021243140. We searched EMBASE, CINAHL, Web of Science and Medline from inception to March 2021. Study selection, data extraction and risk of bias assessment was conducted by a team of three researchers. We performed a narrative synthesis of the data, using forest plots to summarize study findings, and stratified data presentation to explore the potential association of risk of bias, case definition, and reference period with estimates of prevalence and incidence of shoulder pain.

RESULTS

We obtained data from 61 studies reporting data from high-, middle- and low-income countries. The overall risk of bias was low, with most rated as "low-risk" and no studies rated as "high-risk". The community prevalence of shoulder pain varied widely across the countries included in our review, with a median of 16% (range 0.67 to 55.2%). Longer reference periods were typically associated with higher prevalence estimates. Primary care prevalence ranged from 1.01 to 4.84% (median 2.36%). Estimates were generally higher for women than men and were higher in high-income nations. The incidence of shoulder pain ranged from 7.7 to 62 per 1000 persons per year (median 37.8 per 1000 persons per year). Risk of bias did not clearly explain variability in study findings, but there was considerable variation in study samples, methods used, and a relative absence of data from low-income countries.

CONCLUSIONS

Our review demonstrates that a significant proportion of the population across the world will experience shoulder pain daily, yearly, and throughout a lifetime. Regional gaps in evidence and methodological inconsistencies must be addressed in order to establish a more definitive global burden.

Retirement and elderly health in China: Based on propensity score matching

Background

The relationship between retirement and health is important to the formulation of retirement related policies but is a controversial topic, perhaps because selection bias has not been well-addressed in previous studies through traditional analysis methods. Using data from the China Health and Retirement Longitudinal Study (CHARLS), this study explored the potential impact of retirement on the health of elderly Chinese individuals, adjusting for selection bias.

Methods

We balanced the baseline differences between retirement groups and working groups based on nearest neighbor matching and genetic matching with a generalized boosted model (GBM), and regression analysis was used to evaluate the impact of retirement on the health of elderly individuals.

Results

No significant difference was found in any of the covariates between the two groups after matching. Genetic matching performed better than nearest neighbor matching in balancing the covariates. Compared to the working group, the retirement group had a 0.78 (95% CI: 0.65-0.94, P = 0.026) times higher probability of self-reported physical pain, a 0.76 (95% CI: 0.62-0.93, P = 0.023) times higher probability of depression, and a 0.57-point (95% CI: 0.37-0.78, P < 0.001) improvement in cognitive status score. Among male, the retirement group had a 0.89-point (95% CI: 0.45-1.33, P < 0.001) improvement in cognitive status score for low education, a 0.65 (95% CI: 0.46-0.92, P = 0.042) times higher probability of self-reported physical pain for middle education. For female with low education, the cognitive status of the retirement group was significantly higher by 0.99 points (95% CI: 0.42-1.55, P = 0.004), the probability of depression was 0.56 (95% CI: 0.36-0.87, P = 0.031) times higher in the retirement group than in the working group. There was no difference for the middle and high education.

Conclusion

Retirement can exert a beneficial effect on the health of elderly individuals. Therefore, the government and relevant departments should consider this potential effect when instituting policies that delay retirement.

Sustainable Working Life Patterns in a Swedish Twin Cohort: Age-Related Sequences of Sickness Absence, Disability Pension, Unemployment, and Premature Death during Working Life

We aimed to investigate sustainable working life via age-related sequences of sickness absence (SA), disability pension (DP), unemployment (UE), premature death, and the influence of individual characteristics, accounting for familial confounding. The sample included monozygotic (MZ) and dizygotic (DZ) same-sexed twin pairs with register data (n = 47,450) that were followed for 10 years in four age cohorts: 26-35 (n = 9892), 36-45 (n = 10,620), 46-55 (n = 12,964) and 56-65 (n = 13,974). A sequence analysis was done in a 7-element state space: 1. "Sustainable working life": SA/DP 0-30 days and UE 0-90 days; 2. "Unemployment >90 days": SA/DP 0-30 days and UE > 90 days; 3. "Moderate SA/DP": SA/DP 30-180 days; 4. "Almost full year of SA/DP": SA/DP 180-365 days; 5. "Full year of SA/DP": SA/DP ≥ 365 days; 6. Death; 7. Old-age pension. The largest cluster had a sustainable working life and never experienced states 2-6 (34-59%). Higher education and being married predicted a lower likelihood of experiencing states 2-6. The MZ twin pairs (vs. DZ) were more often in the same cluster suggesting the role of genetic factors. To conclude, the sustainable working life was the largest cluster group. Few individuals had prolonged periods of interruptions of sustainable working life meriting actions, especially in early adulthood for interventions to support workability.