The impact of retirement on health: quasi-experimental methods using administrative data

The effects of an increase in the retirement age on health care costs: evidence from administrative data

In this paper, we use unique health record data that cover outpatient care and the associated costs to quantify the health care costs of a sizable increase in the retirement age in Germany. For the identification, we exploit a sizable cohort-specific pension reform which abolished an early retirement program for all women born after 1951. Our results show that health care costs significantly increase by about 2.9% in the age group directly affected by the increase in the retirement age (women aged 60-62). We further show that the cost increase is mainly driven by the following specialist groups: Ophthalmologists, general practitioners (GPs), neurology, orthopedics, and radiology. While the effects are significant and meaningful on the individual level, we show that the increase in health care costs is modest relative to the positive fiscal effects of the pension reform. Specifically, we estimate an aggregate increase in the health costs of about 7.7 million euro for women born in 1952 aged 60-62 which amounts to less than 2% of the overall positive fiscal effects of the pension reform.

Voluntary Unemployment Is Associated With Increased Prevalence of Stroke and its Risk Factors in Middle-Aged Adults

OBJECTIVE

The aim of the study is to investigate the association between the prevalence of stroke, its risk factors, and occupational status, with a differentiation between voluntary and involuntary unemployment.

METHODS

This is a cross-sectional study, which included 3013 individuals aged 40 to 65 years. We compared the prevalence of stroke, comorbidities, self-reported stroke-like symptoms, healthy behaviors, and knowledge about stroke among the voluntarily and involuntarily unemployed versus the employed.

RESULTS

Voluntary unemployment was associated with increased chances of stroke (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.05-3.57), hypertension (OR, 1.18; 95% CI, 1.06-1.32), diabetes (OR, 1.16; 95% CI, 1.01-1.35), and obesity (OR, 1.16; 95% CI, 1.05-1.29). Involuntary job loss was associated with increased odds of hypertension (OR, 1.69; 95% CI, 1.16-2.50) and more frequent self-reported stroke-like symptoms.

CONCLUSIONS

We found higher chances of stroke among the voluntarily unemployed middle-aged adults, presumably because of increased prevalence of hypertension, diabetes, and obesity.

Respiratory Function and Muscle Strength Vs. Past Work Type: a Cross-Sectional Study Among Retirees

Objectives

The aim of this cross-sectional study was to assess the effects of past occupational activity on muscle strength and respiratory function among retirees.

Methods

A total of 205 community-dwelling older adults participated in the study. Age (≥60 years) and cessation of professional activity (retirement) constituted the inclusion criteria. The International Standardized Classification of Occupations (ISCO-08) was used to stratify the participants into white- or blue-collar groups. Forced vital capacity (FVC), forced expiratory volume (FEV) in the first second, inspiratory vital capacity (IVC) parameters, and hand grip strength were tested.

Results

Statistically significant differences in IVC and FVC scores were found in white- and blue-collar workers after adjusting for sex and age (ANCOVA). White-collar men had significantly higher IVC as compared to blue-collar men.

Conclusions

Blue-collar male workers may be prone to deteriorating respiratory function in older age. It is vital to promote physical activity and educate blue-collar workers about the need to use respiratory protective equipment.

The Longitudinal Association Between Retirement and Depression: A Systematic Review and Meta-Analysis

The purpose of this study was to collect evidence of the relationship between retirement and depression through meta-analysis and further analyze the heterogeneity of results. The quality of the studies was rated based on 10 predefined criteria. We searched for articles published between 1980 and 2020, and a total of 25 longitudinal studies were included in the meta-analysis. The meta-analysis results showed that retirement was associated with more depressive symptoms (d = 0.044, 95% confidence interval (CI): 0.008, 0.080). The association of more depressive symptoms with involuntary retirement (d = 0.180, 95% CI: 0.061, 0.299) was stronger than with voluntary retirement (d = 0.086, 95% CI: -0.018, 0.190) and regulatory retirement (d = 0.009, 95% CI: -0.079, 0.097). Retirement was significantly associated with more depressive symptoms in Eastern developed countries (d = 0.126, 95% CI: 0.041, 0.210), and the association was stronger than that in Western developed countries (d = 0.016, 95% CI: -0.023, 0.055). We found that the transition to retirement was associated with higher risk of depression, and this association varied by the type of retirement and country. Further empirical studies are needed to explore the mechanism of retirement and depression and whether such an association is linked with socioeconomic position.

The impact of retirement on mental health

After 2020, with Chinese baby boomers growing old, more and more working people will step into retirement. What kind of influence retirement behaviour will have on the mental health of the older adults and whether the existing findings of retirement on the mental health of the older adults are applicable to China's current conditions? The answers are related to the improvement of the well being of older adults and future policy orientation. Based on the China Family Tracking Survey data in 2016 and 2018, the paper employed the Ordinary Least Squares, Two Stage Least Squares, and Propensity Score Matching methods to investigate the effect of retirement on the mental health of older adults in China. Results show that retirement can significantly reduce the depression and has a positive impact on the their mental health, and no chronic diseases, poor economic status and shorter education years are conducive to improve mental health of the elderly. Further, the mechanisms differ between the sexes that while exercise is a positive mediator for both sexes, reading and family dinners are positive mediators for men but not for women.

The Impact of Retirement on Cardiovascular Disease and Its Risk Factors: A Systematic Review of Longitudinal Studies

Background and Objectives

People are now spending longer in retirement than ever before and retirement has been found to influence health. This study systematically reviewed the impact of retirement on cardiovascular disease (CVD) and its risk factors (metabolic risk factors, blood biomarkers, physical activity, smoking, drinking, and diet).

Research Design and Methods

Longitudinal studies published in Medline, Embase, Social Science Citation Index, PsycINFO, and Social Policy and Practice were searched. No language restrictions were applied if there was an English abstract. Eighty-two longitudinal studies were included after critical appraisals.

Results

Studies in the United States often found no significant effect of retirement on CVD, while studies in European countries, except France, showed a detrimental effect of retirement on CVD. Results from the United States and several European countries consistently show that retirement increase adiposity measures among those retired from physically demanding jobs. For diabetes and hypertension, five out of nine studies suggest no effect of retirement. Retirement has been repeatedly linked to increasing leisure-time physical activity but may reduce work- and transport-related physical activity in turn. Most studies showed that retirement either decreased smoking or had no effect on smoking. The evidence did not show a clear conclusion on drinking. Only a few studies have assessed the impact on diet and blood biomarkers.

Discussion and Implications

Effect of retirement varies according to the health outcomes studied and country of the study population. Policy concerning extending the retirement age needs to focus on ensuring they are suited to the individual.

Geographic and socioeconomic considerations for glioblastoma treatment in the elderly at a national level: a US perspective

Background

Treatment for glioblastoma (GBM) in elderly (age > 65 years) patients can be affected by multiple geographic and socioeconomic parameters. Correspondingly, the aim of this study was to determine trends in treatment of elderly GBM patients in the United States.

Methods

All GBM patients in the U.S. National Cancer Database between 2005 and 2016 were retrospectively reviewed. Status of treatment by triple therapy (resection, chemotherapy, and radiation) were summarized and analyzed by U.S. Census region.

Results

There were 44 338 GBM patients included, with 21 573 (49%) elderly and 22 765 (51%) nonelderly patients with median ages 72 years (range, 65-90 years) and 47 years (range, 40-64 years), respectively. Compared to nonelderly patients, elderly patients had significantly lower odds of being treated by triple therapy (odds ratio, OR = 0.54) as a whole, and its individual elements of resection (OR = 0.78), chemotherapy (OR = 0.46), radiation therapy (OR = 0.52). This was reflected in each U.S. Census region, with the lowest odds of being treated with triple therapy, surgical resection, chemotherapy, and radiation therapy in New England (OR = 0.51) Mountain (OR = 0.66), West North Central (OR = 0.38), and the Middle Atlantic (OR = 0.44), respectively. Multivariable analysis revealed multiple socioeconomic parameters that significantly predicted lower odds of triple therapy in the elderly.

Conclusions

In the United States alone, there exists geographic disparity in the treatment outcomes of elderly GBM patients. Multiple socioeconomic parameters can influence access to treatment modalities for elderly patients compared to younger patients in different geographic regions, and public health initiatives targeting these aspects may prove beneficial conceptually to optimize and homogenize clinical outcomes.

Mental Health Before and After Retirement-Assessing the Relevance of Psychosocial Working Conditions: The Whitehall II Prospective Study of British Civil Servants

Objectives

Retirement could be a stressor or a relief. We stratify according to previous psychosocial working conditions to identify short-term and long-term changes in mental health.

Method

Using data from the Whitehall II study on British civil servants who retired during follow-up (n = 4,751), we observe mental health (General Health Questionnaire [GHQ] score) on average 8.2 times per participant, spanning up 37 years. We differentiate short-term (0–3 years) and long-term (4+ years) changes in mental health according to retirement and investigate whether trajectories differ by psychosocial job demands, work social support, decision authority, and skill discretion.

Results

Each year, mental health slightly improved before retirement (−0.070; 95% CI [−0.080, −0.059]; higher values on the GHQ score are indicative of worse mental health), and retirees experienced a steep short-term improvement in mental health after retirement (−0.253; 95% CI [−0.302, −0.205]), but no further significant long-term changes (0.017; 95% CI [−0.001, 0.035]). Changes in mental health were more explicit when retiring from poorer working conditions; this is higher psychosocial job demands, lower decision authority, or lower work social support.

Discussion

Retirement was generally beneficial for health. The association between retirement and mental health was dependent on the context individuals retire from.

The effect of retirement on biomedical and behavioral risk factors for cardiovascular and metabolic disease

Retirement is a major life event potentially associated with changes in relevant risk factors for cardiovascular and metabolic conditions. This study analyzes the effect of retirement on behavioral and biomedical risk factors for chronic disease, together with subjective health parameters using Southern German epidemiological data. We used panel data from the KORA cohort study, consisting of 11,168 observations for individuals 45-80 years old. Outcomes included health behavior (alcohol, smoking, physical activity), biomedical risk factors (body-mass-index (BMI), waist-to-hip ratio (WHR), glycosylated hemoglobin (HbA1c), total cholesterol/HDL quotient, systolic/diastolic blood pressure), and subjective health (SF12 mental and physical scales, self-rated health). We applied a parametric regression discontinuity design based on age thresholds for pension eligibility. Robust results after p-value corrections for multiple testing showed an increase in BMI in early retirees (at the age of 60) [β = 1.11, corrected p-val. < 0.05] and an increase in CHO/HDL in regular retirees (age 65) [β = 0.47, corrected p-val. < 0.05]. Stratified analyses indicate that the increase in BMI might be driven by women and low educated individuals retiring early, despite increasing physical activity. The increase in CHO/HDL might be driven by men retiring regularly, alongside an increase in subjective physical health. Blood pressure also increased, but the effect differs by retirement timing and sex and is not always robust to sensitivity analysis checks. Our study indicates that retirement has an impact on different risk factors for chronic disease, depending on timing, sex and education. Regular male, early female, and low educated retirees should be further investigated as potential high-risk groups for worsening risk factors after retirement. Future research should investigate if and how these results are linked: in fact, especially in the last two groups, the increase in leisure time physical activity might not be enough to compensate for the loss of work-related physical activity, leading thus to an increase in BMI.

How to Undertake Aging in a Healthy Way: Changes and Opportunities

Objective: To know the socio-demographic characteristics of the elderly adults (60-70 years), of the population of Mataró (Barcelona), and their relationship with the knowledge degree and training needs perceived to face a healthy aging. Materials and methods: Descriptive observational cross-sectional study in which a sample of 306 people was analysed. Socio-demographic data and variables related to leisure activities, health status, training, formative needs and predisposition to take a course on aging were evaluated. Results: About a 60 % of the respondents showed interest in receiving training about; healthy habits (59,1 %), proper diet (62,0 %), work out (59,6 %), future limitations (62,6 %), why we grow old (61,0 %), frequent illnesses in the elderly (62,5 %), use of medication (66,1 %), use of the health system (61,9 %), social resources (70,0 %), new technologies (64,0 %), care of sick people (60,5 %), and security aspects (61,6 %). Conclusions: There is a need to receive training among the elderly adult population in order to cope with aging in a healthier way. The main needs perceived by the elderly are: Healthy habits, possible future limitations due to the aging process, use of medication, functioning of the health system and access to social resources, new technologies and, finally, caring for sick relatives.

Health, education and employment status of Europeans aged 60 to 69 years: results from SHARE Survey

The objective of this study was to identify health and education related predictors of employment/self-employment in the age between 60 and 69 yr in Europe. Data were obtained from Survey of Health, Ageing and Retirement in Europe (SHARE) study-Wave 6. Our final sample (n=13,447) was retrieved from 16 European Union member states, Switzerland and Israel. We used logistic regression model including education level, physical and mental health parameters to predict employment/self-employment vs. retired. Employment/self-employment was associated with higher education status, increased risk for depression, and obesity, but with decreased risk for chronic diseases, loneliness and limitations in daily life activities. Age-appropriate working conditions, part-time options, and enhanced job characteristics may contribute to maintain a good health status and prevent negative aspects of work that can induce the risk for stress and depression.

The effects of exit from work on health across different socioeconomic groups: A systematic literature review

Exit from work leads to different effects on health, partially depending on the socioeconomic status (SES) of people in the work exit. Several studies on the effects of exit from work on health across socioeconomic groups have been performed, but results are conflicting. The aim of this review is to systematically review the available evidence regarding the effects of exit from work on health in high and low socioeconomic groups. A systematic literature search was conducted using Pubmed, Embase, Web of Science, CINAHL and PsycINFO. Search terms related to exit from work, health, SES and design (prospective or retrospective). Articles were included if they focused on: exit from work (early/statutory retirement, unemployment or disability pension); health (general, physical or mental health and/or health behaviour); SES (educational, occupational and/or income level); and inclusion of stratified or interaction analyses to determine differences across socioeconomic groups. This search strategy resulted in 22 studies. For general, physical or mental health and health behaviour, 13 studies found more positive effects of exit from work on health among employees with a higher SES compared to employees with a lower SES. These effects were mainly found after early/statutory retirement. In conclusion, the effects of exit from work, or more specific the effects of early/statutory retirement on health are different across socioeconomic groups. However, the findings of this review should be interpreted with caution as the studies used heterogeneous health outcomes and on each health outcome a limited number of studies was included. Yet, the positive effects of exit from work on health are mainly present in higher socioeconomic groups. Therefore, public health policies should focus on improving health of employees with a lower SES, in particular after exit from work to decrease health inequalities.

Designing Solutions for the Retirement System - In Search of Balance between Economy and Health

Social security system currently faces a number of difficulties arising of changes in the demographic structure of societies, like the decrease in fertility, lengthening of life expectancy, and unfavorable change in the proportion of the population receiving retirement benefits to the population in working age. In result, social security systems are being subjected to transition aimed at securing their financial stability, part of which is a tendency to rise the retirement age and eliminate all the incentives to prematurely exit the labor market. On the other hand, this process of transition, as observed in Poland, is being driven mainly by political processes and due to economic reasons, while lacking public health evidence. This raises a danger that in final result the financial savings will be illusory only and that the final configuration of the system will be inconsistent with the actual social needs of the population and will not efficiently protect against the social risks. In this article, we present arguments for using the Healthy Life Years indicator in analyses relating to the performance of social security systems. The indicator may help to reflect differences in health status of different professional groups and adjust system's solutions to conditions characterizing these groups, in terms of both risk protection and prevention.