Influence of illness and unhealthy behavior on health‐related early retirement in Korea: Results from a longitudinal study in Korea

Cardiometabolic risk indicators in individuals with bipolar disorders: a replication study

OBJECTIVES

We recently conducted the first longitudinal study comparing cardiometabolic risk indicators (CMRIs) between a cohort of individuals with bipolar disorders (BDs) and controls from the general population. Here, we sought to validate the findings in that study using an independent case-control sample.

METHODS

We used data from the St. Göran project's Gothenburg cohort. The BDs group and the control group were examined at baseline and after a median of eight and seven years, respectively. Data collection occurred between March 2009 and June 2022. We used multiple imputation to handle missing data and linear mixed effects model to examine the annual change in CMRIs over the study period.

RESULTS

The baseline cohort included 407 individuals with BDs (mean age 40 years, 63% women) and 56 controls (mean age 43 years, 54% women). Of those, 63 persons with BDs and 42 controls participated at follow-up. At baseline, individuals with BDs had significantly higher mean values of body mass index (β = 0.14, p = 0.003) than controls. Over the study period, the difference in average annual change between the patient and the control group indicated an increase in patients relative to controls in waist-to-hip ratio (0.004 unit/year, p = 0.01), diastolic (0.6 mm Hg/year, p = 0.048), and systolic (0.8 mm Hg/year, p = 0.02) blood pressure.

CONCLUSIONS

This study replicated the main findings from our previous study and showed that central obesity and measures of blood pressure worsened over a relatively short time in individuals with BDs relative to controls. It is vital for clinicians to monitor CMRIs in persons with BDs and to be proactive in preventing cardiometabolic diseases in this high-risk group.

The public economic burden of suboptimal type 2 diabetes control upon taxpayers in Sweden: Looking beyond health costs

AIM

To estimate the fiscal burden for taxpayers in Sweden associated with type 2 diabetes (T2D) attributed to diabetes-related complications in patients failing to meet HbA1c targets.

MATERIAL AND METHODS

We developed a public economic framework to assess how changes in diabetes-related complications influenced projected tax contributions and government disability payments for people with T2D. The analysis applied accepted disease-modelling practices to estimate different rates of diabetes-related complications based on an HbA1c of 6.9% (52 mmol/mol) and of 6.0% (42 mmol/mol). We adjusted the employment activity rates for those experiencing T2D-related events, applying age-specific earnings to estimate lifetime tax losses. Furthermore, the likelihood of receiving payments for health-related employment inactivity was estimated. Direct healthcare costs are excluded from this analysis.

RESULTS

The estimated per person earnings loss for immediate and delayed HbA1c control was Swedish krona (SEK) 42 299 and SEK 44 157, respectively, over 10 years. The lost employment activity of people with T2D translates to lost tax revenues of SEK 23 265 and SEK 24 287 for immediate and delayed control, respectively. The estimated difference in disability payments was SEK 538. Combining the tax revenue loss and excess disability payments defines the broader fiscal costs, where we observe combined fiscal losses that favour immediate and sustained control by SEK 1560 over 10 years.

CONCLUSIONS

We show that conducting fiscal analysis of diabetes interventions offers an enriched perspective capturing a range of costs that fall on government in relation to lost tax revenue and disability payments. Tax-financed health systems may benefit from broadening the consideration of costs and benefits when evaluating new interventions and treatment practices.

Factors Influencing Retirement Decisions among Blue-Collar Workers in a Global Manufacturing Company-Implications for Age Management from A System Perspective

The maintenance of older workers and determining the appropriate age for retirement are growing issues related to the fact that fewer people, still active in working life, have to provide for more non-working people due to increased life expectancy. As a result, retirement age has started to rise in many countries, and employers need to find ways to maintain an older and healthy work force, not least to avoid the loss of important experience. The aim of the current study was to increase the knowledge of factors influencing the retirement decisions among blue-collar workers in different national settings. A survey and semi-structured interviews were conducted with a sample of 100 blue-collar workers in Sweden, the Netherlands, and France, aged 55 years and older, within a global manufacturing company. Based on the results, implications for companies' age management strategies were discussed from a system perspective. Factors contributing to both retirement and to a prolonged work life were found on individual, organisational, and societal levels. This indicates the importance of a system perspective when planning for age management interventions.

Association of perceived job security and chronic health conditions with retirement in older UK and US workers

Background

The relationship between job insecurity, chronic health conditions (CHCs) and retirement among older workers are likely to differ between countries that have different labor markets and health and social safety nets. To date, there are no epidemiological studies that have prospectively assessed the role of job insecurity in retirement incidence, while accounting for CHC trajectories in two countries with different welfare systems. We investigated the strength of the association between baseline job insecurity and retirement incidence over an 11-year period while accounting for CHC trajectories, among workers 50–55 years of age at baseline in the UK and USA.

Methods

We performed Cox proportional hazards regression analysis, using 2006–2016 data from the Health and Retirement Study (US cohort, n = 570) and English Longitudinal Study on Aging (UK cohort n = 1052).

Results

Job insecurity was associated with retirement after adjusting for CHC trajectories (HR = 0.69, 95% CI = 0.50–0.95) in the UK cohort only. CHC trajectories were associated with retirement in both cohorts; however, this association was attenuated in the US cohort, but remained significant for the medium-increasing trajectory in the UK cohort (HR = 1.41, 95% CI = 1.01–1.97) after adjustment for all covariates. Full adjustment for relevant covariates attenuated the association between job insecurity and retirement indicating that CHCs, social and health factors are contributing mechanistic factors underpinning retirement incidence.

Conclusions

The observed differences in the two cohorts may be driven by macro-level factors operating latently, which may affect the work environment, health outcomes and retirement decisions uniquely in different settings.

Newly diagnosed disease and job loss: a nationwide longitudinal study among middle-aged Japanese

OBJECTIVES

Since previous studies have only used past or current medical history of disease, there is no information on newly diagnosed disease in relation to job loss. Our objective was therefore to investigate whether newly diagnosed chronic disease increased job loss among middle-aged Japanese.

METHODS

We analysed data on 31 403 Japanese workers aged 50-59 years from a nationally representative longitudinal study. We defined two types of job loss; later job loss (within 1 year of disease diagnosis) and concurrent/later job loss (at around the time of diagnosis and within 1 year of diagnosis). Generalised estimating equation models were used to calculate ORs for job loss among current workers after a new-diagnosis of chronic disease (diabetes, hypertension, hyperlipidaemia, heart disease, stroke and cancer), using a discrete-time design and adjusting for demographic, socioeconomic and health behavioural factors. We used inverse probability weighting to account for non-response at follow-up.

RESULTS

ORs for concurrent/later job loss were 1.17 (95% CI 1.03-1.31) for diabetes, 1.01 (95% CI 0.93-1.09) for hypertension, 1.01 (95% CI 0.94-1.09) for hyperlipidaemia, 1.21 (95% CI 1.06-1.40) for heart disease, 1.48 (95% CI 1.21-1.81) for stroke and 1.38 (95% CI 1.17-1.62) for cancer diagnosed patients. The corresponding ORs for later job loss were 1.14 (95% CI 0.96-1.35), 1.00 (95% CI 0.90-1.12), 0.98 (95% CI 0.88-1.08), 1.24 (95% CI 1.02-1.49), 1.16 (95% CI 0.86-1.55) and 1.39 (95% CI 1.11-1.73).

CONCLUSIONS

New diagnosis of diabetes, heart disease, cancer and stroke increased the risk of job loss; loss was concurrent for diabetes mellitus and stroke, and concurrent/later for cancer and heart disease. Our results provide fundamental information for employment support for patients with chronic disease.

How does job dissatisfaction interact with self-rated health in determining the risk of health-related job loss? Prospective findings from the Health and Employment After Fifty (HEAF) study

OBJECTIVES

Health and job satisfaction are key independent determinants of ability to work to older ages. We investigated the interaction of these two important factors on health-related job loss (HRJL) over 2 years of follow-up comparing male and female older workers.

METHODS

A population sample of adults aged 50-64 years, recruited from 24 English general practices in the Health and Employment After Fifty (HEAF) study, completed questionnaires at baseline with follow-ups at 12 and 24 months. Multiple-record Cox proportional hazards models were performed to explore the main effects of, and potential interactions between, job satisfaction and self-rated health (SRH) as predictors of time to first HRJL.

RESULTS

Of the initial 8134 participants, 5143 were ever in work in the study period. Among men, 5.7% and 14.3% reported job dissatisfaction (those in good and poor SRH, respectively), while among women these percentages were 4.6 and 12.9. HRJL was reported by 106 men and 176 women. Men in good health dissatisfied with their job had a sixfold (HR=6.4; 95% CI 3.3 to 12.4) increased risk of HRJL compared with men satisfied with their job (significant multiplicative interaction). Women dissatisfied with their job were more likely to have an HRJL within 2 years of follow-up irrespective of their SRH.

CONCLUSIONS

SRH and job dissatisfaction have important individual effects on the risk of stopping work for health among older workers. These findings point to the importance of job satisfaction in reducing health-related exit from paid work among older workers.

The Association of Pension Income with the Incidence of Type I Obesity among Retired Israelis

Previous studies have identified obesity and overweight as the fourth leading risk factor for global mortality. The objective of the current study is to investigate gender differences and the impact of wealth and income from pensions, sociodemographic variables, and self-assessment of health conditions on the projected probability to become obese in the postretirement age (67 years and older). We are unaware of previous studies, which explored the direct relationship between obesity, monetary income from pensions, wealth, and self-assessment of health conditions. To conduct this research, we make use of an extensive questionnaire concerning the economic and sociodemographic features and health and housing conditions of individuals administered within the framework of the 2015-2016 longitudinal survey conducted by the Israeli Central Bureau of Statistics (CBS). The survey is representative of the Israeli population and also includes information regarding the weight, height, gender, and age of each household member. Results of our study demonstrate that while for the female respondents older than 67, the projected probability of type I obesity (BMI ≥ 30) drops by 0.41% (p=0.0021) to 0.52% (p=0.0001) with an incremental 10,000 NIS (about $2,500) rise of gross annual income from a pension, for the male respondents above 67 years, the projected probability remains unchanged (p=0.4225). This outcome remains robust even when the 2015 BMI measurement of type I obesity (BMI ≥ 30) is controlled. This drop among women attenuates with a cutoff point increase from BMI ≥ 25 (overweight) to BMI ≥ 30 (type I obesity) to BMI ≥ 35 (type II obesity). Further results indicate that for both genders above 67 years and for men above 62 years, the projected BMI drop of one year decreases with income from a pension (p=0.013, p=0.039, and p=0.007, respectively), although the spread around the projection becomes wider. Compared with other martial status categories, for widowed females, the projected probability of obesity and self-reporting on improved health conditions drops by 6.58% (p=0.0419) to 11.28% (p=0.0048) and 6.55% (p=0.0190) to 7.47% (p=0.0036), respectively. For females older than 67, family status divorced drops the projected probability of obesity by 9.25% (p=0.0319). For males older than 67, results show a rise in projected obesity with car ownership by 6.10% (p=0.0897) to 6.41% (p=0.0469) and a drop in projected obesity with academic degree status by 9.93% (p=0.0106) to 10.14% (p=0.0118) and immigration status from American-European countries by 7.67% (p=0.0821) to 8.99% (p=0.0398) and Asian-African countries by 11.63% (p=0.0245) to 11.99% (p=0.02). Research findings stress the differences and similarities in male-female patterns of obesity after the retirement age of 67 years and may be of assistance to welfare and public health experts.

Job characteristics as risk factors for early retirement due to ill health: The Korean Longitudinal Study of Aging (2006-2014)

Objectives

To investigate work‐related factors that contribute to early retirement due to ill health (ERIH) in middle‐aged and elderly people in Korea.

Methods

Data were collected from a sample from the first through the fifth phases of the Korean Longitudinal Study of Aging which was conducted biennially from 2006 to 2014. ERIH was defined as the retirement of workers due to health problems before their scheduled or regular retirement age as reported in one of the follow‐up surveys. Three broad subdomains of working conditions were examined: work arrangements, physical working conditions, and job satisfactions. Hazard ratios of ERIH were estimated by Cox regression.

Results

Females, older people, unskilled manual workers, and day laborers were more likely to experience ERIH. In adjusted Cox proportional hazard models, the risk for ERIH in male workers was significantly higher among those with the following conditions: high physical demands, awkward posture, dissatisfaction with the working environment, and no industrial compensation insurance or retirement benefits. However, no significant association was found among female participants.

Conclusions

Occupational class, physical working conditions, job satisfaction, and work arrangement were the potential risk factors for ERIH among male workers in Korea. Moreover, our results revealed gender differences in the risk for ERIH.

Employment status and unmet dental care needs in South Korea: a population-based panel study

OBJECTIVES

This study was designed to evaluate whether employment status is associated with the experience of unmet dental care needs.

METHODS

A total of 4620 workers were retrieved from Korea Health Panel data (2010-2013), and potential relationships were explored among their income levels, changes in employment and unmet dental care needs.

RESULTS

Among the 4620 workers, 17.3% said they had failed at least once to get dental treatment or check-up, despite their needs. Precarious workers and those not in employment were more likely to experience unmet dental care needs due to economic burden compared with permanent workers (OR 1.36, 1.40, respectively). In addition, people in low-income group were 4.46 times more likely to experience unmet dental care needs caused by economic burden, compared with those with the highest income.

CONCLUSION

This disparity means that precarious workers and those not in employment are more likely to face barriers in obtaining needed health services. Given the insecure employment status of low income people, meeting their healthcare needs is an important consideration.

The impact of diabetes on labour market participation: a systematic review of results and methods

Background

Diabetes mellitus is a major chronic disease, which is connected to direct and indirect costs and productivity losses. However, its effects on labour market participation are not straightforward to identify, nor are they consistently included in cost-of-illness studies. First, this study aims to synthesise existing evidence regarding the impact of diabetes on labour market outcomes that imply a complete absence of work. Second, the analysis takes a particular look at relevant methodological choices and the resulting quality of the studies included.

Methods

We conducted a systematic literature research (PubMed, Embase, PsychINFO), by applying a standard screening, selection and results extraction process, which considered all types of studies including cross-sectional and longitudinal approaches. Risk-of-bias and quality within the studies were assessed and results were compared. We dedicated special attention to the modelling of potential reverse causality between diabetes and labour market outcomes and the consideration of comorbidities and complications.

Results

Overall, 30 studies satisfied our inclusion criteria. We identified four main labour participation outcomes: absence of employment, unemployment, early retirement, and disability pension. The studies reviewed show a negative impact of diabetes on the labour market participation outcomes considered. However, only a few studies controlled for endogeneity, differentiated between type 1 and type 2 diabetes or modelled the impact of comorbidities. We report how modelling choices affect the directions and interpretations of the effects.

Conclusions

The available evidence mainly suggests a negative impact of diabetes on several outcomes indicating labour market participation. The methodological limitations identified can guide future research with respect to both outcomes and methods. This study provides therefore an empirical contribution to the discussion on how to model the economic impact of diabetes.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6324-6) contains supplementary material, which is available to authorized users.

The Impact of Depression on Ill-Health Retirement and Its Moderating Factors: Analysis From the Korean Longitudinal Study of Aging (2006 to 2014)

OBJECTIVE

To investigate the effect of depressive symptoms on ill-health retirement (IHR).

METHODS

Data were collected from the Korean Longitudinal Study of Ageing which conducted biennially from 2006 to 2014. IHR were defined as those who retired due to their health problems. The short-form Center for Epidemiological Studies-Depression scale served as outcome measure for definition of depressive symptoms. Hazard ratios of IHR were estimated by Cox regression.

RESULTS

We observed that depressive symptoms significantly increased risk of IHR during 8-year follow-up period. Compared with those without depressive symptoms, depressed worker had 1.27-fold elevated risk for IHR. Subgroup analysis showed that the association between depressive symptoms and IHR is greater in the elders, women, and lower income group than the others.

CONCLUSION

Depressive symptoms independently predicted IHR. Moreover, age, sex, and socioeconomic status modified these effects.

Predictors and estimation of risk for early exit from working life by poor health among middle and older aged workers in Korea

The aims of this study were to investigate the predictors and estimate the risk for early exit from work owing to poor personal health status of the retirees. This study analysed the longitudinal data of 2,708 workers aged more than 45 years old from the Korean Longitudinal Study of Ageing. Multivariate Cox regression analyses were conducted to identify the predictors and to build a prediction model for early exit from work due to poor health. Internal validation was performed using random split, and external validation using the English Longitudinal Study of Ageing. Over the 8-year follow-up, 124 workers exited work early because of poor health. Significant predictors for early exit from work due to poor health included hypertension (hazard ratio [HR], 1.52; 95% confidence interval [CI], 1.01-2.28), abnormal body mass index (HR, 1.60; 95% CI, 1.10-2.35), decreased grasping power index, and perceived health status. The prediction model designed to estimate the risk of unwanted early exit from work because of poor health status showed fair performance in both the internal and external validations. The current study revealed the specific determinants and the possibility of prediction of shortened working life due to poor health status.

Health, lifestyle and employment beyond state-pension age

Background

The factors influencing one’s choice to retire vary, with financial and health considerations being some of the main factors impacting or associated with people’s timing of retirement. The aim of the study is to investigate the differences in current health and health-related behaviours, such as smoking, drinking and exercising, between people who kept on working beyond state-pension age and those who retired before or at state-pension age.

Methods

Data from six waves (2003, 2008–2012) of the Scottish Health Survey (SHeS) are used. Descriptive analyses were used to characterise the population. Multivariate logistic regression was undertaken to analyse the relationship between retirement groups and gender, age, deprivation, marital status, housing tenure, general health, longstanding illness, cigarette smoking status, amount of exercise and mental health, using Stata.

Results

Reporting poor self-rated health or having a long-standing illness was associated with increased odds of retiring before state pension age (SPA) in groups with a medium deprivation profile in almost all the survey years. For the least deprived there was little evidence of an association between poor health and extended-working-life, while significant associations were observed for the most deprived. An increasing trend was observed for both genders in the number of people extending their working life. Similar associations between reporting poorer self-rated health and extended working lives were observed for men and women. Distinct gender differences were observed for the associations with reporting poor mental health and no exercise. In the adjusted models, both were significantly associated with retiring at or before SPA in almost every year for women, whereas no significant associations were observed (except in 1 year) for men.

Conclusions

This study shows an increasing trend in the number of people extending their working lives and demonstrates significant associations between health and lifestyle behaviours and employment status past SPA. The results suggest that good health – both physically and mentally – along with either a need or a want to stay in employment could be important reasons for continuing to work beyond SPA.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4957-5) contains supplementary material, which is available to authorized users.

The Association Between Symptomatic and Diagnostic Depression and Pain Among the Elderly Population in South Korea

The exact nature of pain (amount or severity) associated with in depression in the elderly population has not been studied extensively yet. We investigated the association between the characteristics of pain and both symptomatic and diagnostic depression using data from the 2012 Korean Longitudinal Study of Aging (2164 men, 2066 women). Symptomatic depression was identified a score of 12 or higher on the 10-item Center for Epidemiologic Studies-Depression Scale. Odds ratios with a 95% confidence interval was calculated for depression using multiple logistic regression models after adjusting for age, sex, socioeconomic status, health behavioral factors, and chronic diseases. The fully adjusted odds ratio (95% confidence interval) for symptomatic/diagnostic depression were "1" = 2.09 (1.62-2.49)/1.71 (1.03-2.86), "2" = 1.88 (1.42-2.49)/1.82 (1.05-3.13), and ">3" = 2.27 (1.71-3.01)/3.21 (1.94-5.32), and 1.86 (1.48-2.33)/1.57 (1.00-2.49) for mild, 1.74 (1.22-2.48)/2.10 (1.11-3.98) for moderate, and 5.41 (3.77-7.77)/7.34 (4.15-12.99) for severe of pain. The results indicated a significant association between the number of sites and severity of pain and the prevalence of depression in the Korean elderly.

Chronic Diseases, Health Behaviors, and Demographic Characteristics as Predictors of Ill Health Retirement: Findings from the Korea Health Panel Survey (2008-2012)

Purpose

The research aim was to identify demographic characteristics, chronic diseases, and unhealthy behaviors predicting ill health retirement in South Korea.

Methods

Data were collected from 15,407 individuals enrolled in the first through the fifth phases of the Korea Health Panel Survey (2008–2012) using structured questionnaires examining retirement, morbidities, and health-related behaviors. The Cox proportional hazard model was used to examine demographic and clinical characteristics’ effects on ill health retirement. Lost years of working life expectancy were calculated for demographic and clinical characteristics.

Results

Older, female, and manual workers were more likely to experience ill health retirement, as were respondents reporting poor health-related habits (e.g., heavy drinking, irregular meals, less sleep hours, obesity, and no regular exercise). The chronic diseases most closely associated with ill health retirement were, in order, psychiatric disease, ophthalmologic disease, neurologic disease, infectious disease, and musculoskeletal diseases. The average reduction in working life expectancy was 9.73 years.

Conclusions

Our study results can help contribute to the development of strategies for reducing the risk of ill health retirement and promoting sustainable labor force participation in an aging society.

Socio-Economic Differences in Cardiovascular Health: Findings from a Cross-Sectional Study in a Middle-Income Country

BACKGROUND

A relatively consistent body of literature, mainly from high-income countries, supports an inverse association between socio-economic status (SES) and risk of cardiovascular disease (CVD). Data from low- and middle-income countries are scarce. This study explores SES differences in cardiovascular health (CVH) in the Republic of Srpska (RS), Bosnia and Herzegovina, a middle-income country.

METHODS

We collected information on SES (education, employment status and household's relative economic status, i.e. household wealth) and the 7 ideal CVH components (smoking status, body mass index, physical activity, diet, blood pressure, total cholesterol, and fasting blood glucose) among 3601 participants 25 years of age and older, from the 2010 National Health Survey in the RS. Based on the sum of all 7 CVH components an overall CVH score (CVHS) was calculated ranging from 0 (all CVH components at poor levels) to 14 (all CVH components at ideal levels). To assess the differences between groups the chi-square test, t-test and ANOVA were used where appropriate. The association between SES and CVHS was analysed with multivariate linear regression analyses. The dependent variable was CVHS, while independent variables were educational level, employment status and wealth index.

RESULTS

According to multiple linear regression analysis CVHS was independently associated with education attainment and employment status. Participants with higher educational attainment and those economically active had higher CVHS (b = 0.57; CI = 0.29-0.85 and b = 0.27; CI = 0.10-0.44 respectively) after adjustment for sex, age group, type of settlement, and marital status. We failed to find any statistically significant difference between the wealth index and CVHS.

CONCLUSION

This study presents the novel information, since CVHS generated from the individual CVH components was not compared by socio-economic status till now. Our finding that the higher overall CVHS was independently associated with a higher education attainment and those economically active supports the importance of reducing socio-economic inequalities in CVH in RS.