Work-Family Trajectories and the Higher Cardiovascular Risk of American Women Relative to Women in 13 European Countries

Lifetime employment trajectories and cancer

Working life is associated with lifestyle, screening uptake, and occupational health risks that may explain differences in cancer onset. To better understand the association between working life and cancer risk, we need to account for the entire employment history. We investigated whether lifetime employment trajectories are associated with cancer risk. We used data from 6809 women and 5716 men, average age 70 years, from the Survey of Health, Ageing, and Retirement in Europe. Employment history from age 16 to 65 was collected retrospectively using a life calendar and trajectories were constructed using sequence analysis. Associations between employment trajectories and self-reported cancer were assessed using logistic regression. We identified eight employment trajectories for women and two for men. Among women, the risk of cancer was higher in the trajectories "Mainly full-time to home/family", "Full-time or home/family to part-time", "Mainly full-time", and "Other" compared with the "Mainly home/family" trajectory. Among men, the risk of cancer was lower in the "Mainly self-employment" trajectory compared with "Mainly full-time". We could show how employment trajectories were associated with cancer risk, underlining the potential of sequence analysis for life course epidemiology. More research is needed to understand these associations and determine if causal relationships exist.

Work-family trajectories across Europe: differences between social groups and welfare regimes

Introduction

Work and family trajectories develop and interact over the life course in complex ways. Previous studies drew a fragmented picture of these trajectories and had limited scope. We provide the most comprehensive study of early-to-midlife work-family trajectories to date.

Methods

Using retrospective data from waves 3 and 7 of the Survey of Health, Aging and Retirement in Europe (SHARE), we reconstructed work-family trajectories from age 15 to 49 among almost 80,000 individuals born between 1908 and 1967 across 28 countries. We applied multichannel sequence and cluster analysis to identify typical trajectories and multinomial logistic regression models to uncover their social composition.

Results

The results revealed six common trajectories. The dominant and therefore standard trajectory represents continuous full-time employment with having a partner and children. Women, the lower educated and persons from conservative and liberal welfare regimes are underrepresented in this trajectory, whereas men, higher educated people and those from social-democratic, Eastern European and Baltic welfare regimes are overrepresented. The other trajectories denote a deviation from the standard one, integrating a non-standard form of work with standard family formation or vice versa. Mothers in a stable relationship generally work part-time or not at all. When mostly in full-time employment, women are more likely to be divorced. Lower educated persons are less likely to have work-family trajectories characterized by full-time work and a non-standard family, yet more likely to be non-employed for large parts of their life with standard family formation. Younger cohorts are underrepresented in non-employment trajectories, but overrepresented in part-time employment trajectories along with a partner and children as well as full-time employment trajectories with divorce. Individuals from Southern European and liberal regimes are more likely to be non-working and self-employed partnered parents and those from social-democratic regimes are more likely to be full-time employed divorced parents. We also found pronounced gender differences in how educational level, birth cohort and welfare regime are associated with work-family trajectories from early to midlife.

Discussion

Our findings highlight the socially stratified nature of earlier-life work-family trajectories in Europe. Potential implications for inequalities in later life are discussed.

Risk Factors and Short-Term Prognosis of Lymphocele After Kidney Transplant

OBJECTIVES

Lymphocele is a frequent complication after kidney transplant and needs attention. This study was undertaken to analyze perioperative risk factors and short-term outcomes associated with lymphocele after kidney transplant.

MATERIALS AND METHODS

Our single-center study retrospectively analyzed 264 recipients of kidney allografts from January 2018 to October 2021. Patients were classified into 2 groups according to the occurrence of lymphocele. Perioperative clinical data and follow-up indicators were compared between groups.

RESULTS

The incidence of lymphocele after kidney transplant was 19.7%. Univariate analysis showed that percentage of male patients, hypothermic machine perfusion proportion, and postoperative hemoglobin and albumin were lower and flow velocity of renal artery was higher in the lymphocele group compared with the control group. Multivariate logistic regression revealed that postoperative hemoglobin <95 g/L (odds ratio = 2.01; 95% confidence interval, 1.01-4.05; P = .03) was an independent risk factor and hypothermic machine perfusion (odds ratio = 0.27; 95% confidence interval, 0.08-0.96; P = .04) was a protective factor for the determination of lymphocele. Comparisons of related complications indicated that drainage tube and urinary catheter removal times were longer and urinary tract infection and moderate to severe anemia proportions were higher in the lymphocele group. Follow-up data showed that postoperative 1-month serum creatinine was higher and 1-month estimated glomerular filtration rate was lower in lymphocele group compared with the control group, but no significant differences were shown at 12 months.

CONCLUSIONS

Postoperative hemoglobin may be a risk factor and hypothermic machine perfusion may be a protective factor for lymphocele after kidney transplant. Lymphocele only temporarily affects short-term kidney function, especially during hospitalization.

Intersectionality in Alzheimer's Disease: The Role of Female Sex and Black American Race in the Development and Prevalence of Alzheimer's Disease

It is well known that vascular factors and specific social determinants of health contribute to dementia risk and that the prevalence of these risk factors differs according to race and sex. In this review, we discuss the intersection of sex and race, particularly female sex and Black American race. Women, particularly Black women, have been underrepresented in Alzheimer's disease clinical trials and research. However, in recent years, the number of women participating in clinical research has steadily increased. A greater prevalence of vascular risk factors such as hypertension and type 2 diabetes, coupled with unique social and environmental pressures, puts Black American women particularly at risk for the development of Alzheimer's disease and related dementias. Female sex hormones and the use of hormonal birth control may offer some protective benefits, but results are mixed, and studies do not consistently report the demographics of their samples. We argue that as a research community, greater efforts should be made to not only recruit this vulnerable population, but also report the demographic makeup of samples in research to better target those at greatest risk for the disease.

Work-family trajectories in young adulthood: Associations with mental health problems in adolescence

During young adulthood, several transitions in work and family lives occur, but knowledge of the work-family trajectories of the current generation of young adults, i.e. people born in the 1990s, is lacking. Moreover, little is known about whether the mental health status before the start of the working life may shape work-family trajectories. We used 18-year follow-up data from the TRAILS cohort study of individuals born between 1989 and 1991 (n = 992; 63.2% women). Internalising and externalising problems were measured with the Youth Self-Report at ages 11, 13 and 16 years. Monthly employment, education and parenthood states were recorded between 18 and 28 years. Applying sequence analysis, we identified six work-family trajectories in women and men. The first five trajectories were labelled: long education, continuous education and work, education and work to work, early work, and inactive. The main difference between trajectories of women and men was in the timing of parenthood, thus the remaining trajectory of women was labelled active with children, and the remaining trajectory of men active. Women who experienced externalising problems in adolescence were more likely to belong to the trajectory characterised by parenthood. Men who experienced internalising problems in adolescence were more likely to belong to the trajectory characterised by a long time spent in education. The TRAILS data allowed us to consider timing, duration and ordering of the work and family states in young adulthood, and to use multiple assessments of mental health in adolescence. Further research needs to examine the mechanisms through which early mental health affects later work and family outcomes.

Gendered work-family life courses and late-life physical functioning: A comparative analysis from 28 European countries

Combining work and family roles can have beneficial consequences on health but could also result in chronic stress and adverse health outcomes at older ages. This study aimed to examine combined employment, parenthood, and partnership histories of men and women during the childbearing period (ages 15-49), and to investigate the links of these work and family roles with physical functioning later in life. We used data from the Survey of Health, Ageing and Retirement in Europe (SHARE) with retrospective information on employment, parenthood, and partnership histories for 18,057 men and 20,072 women (n = 38,129) living in 28 different countries belonging to six European welfare clusters. We applied multichannel sequence analysis (MCSQA) and hierarchical clustering to group work-family trajectories into 12 clusters for men and 15 clusters for women. We assessed the association between work-family life courses and grip strength by estimating multivariable linear regression models. Delayed work and family transitions, unstable employment, and the absence of combinations of work and family roles between age 15 and 49 were associated with weaker grip strength in later life for both men and women. Results differed by gender and were framed by the welfare context in which gendered work and family responsibilities unfold across individual life courses. The findings make an important contribution to the domain of gender and health in later life and stress the need to engage more with issues related to the mechanisms linking work and family trajectories to poor health in later life.

Work-family trajectories and health: A systematic review

BACKGROUND

Work and family lives interact in complex ways across individuals' life courses. In the past decade, many studies constructed work-family trajectories, some also examined the relation with health. The aims of this systematic review were to summarise the evidence from studies constructing work-family trajectories, and to synthesise the evidence on the association between work-family trajectories and health.

METHODS

We searched MEDLINE, EMBASE, PsycINFO, SocINDEX and Web of Science databases. Key search terms related to work, family and trajectories. Studies that built combined work-family trajectories or examined the relationship between work and family trajectories were included. Risk of bias was assessed independently by two authors. The identified work-family trajectories were summarised and presented for men and women, age cohorts and contexts. The evidence on the association with health as antecedent or consequence was synthesised.

RESULTS

Forty-eight studies, based on 29 unique data sources, were included. Thirty-two studies (67%) were published in 2015 or later, and sequence analysis was the primary analytic technique used to construct the trajectories (n = 43, 90%). Trajectories of women were found to be more diverse and complex in comparison with men. Work-family trajectories differed by age cohorts and contexts. Twenty-three studies (48%) examined the association between work-family trajectories and health and most of these studies found significant associations. The results indicate that work-family trajectories characterised by an early transition to parenthood, single parenthood, and weak ties to employment are associated with worse health outcomes.

CONCLUSIONS

Work-family trajectories differed greatly between men and women, but differences seemed to decrease in the youngest cohorts. Given the current changes in labour markets and family formation processes, it is important to investigate the work and family lives of younger cohorts. Work-family trajectories were associated with health at different life stages. Future research should examine longitudinal associations of work-family trajectories with health and focus on elucidating why and under which circumstances some trajectories are associated with better or worse health compared with other trajectories.

Work-family life courses and psychological distress: Evidence from three British birth cohort studies

This study uses multi-channel sequence analysis to characterize work-family life course types between the ages of 16 and 42, and multivariable logistic regression to examine their association with psychological distress at age 42/43 for men and women in three nationally-representative British birth cohorts born in 1946 (N = 2,858), 1958 (N = 9,140), and 1970 (N = 7,095). We hypothesised that work-family life courses characterized by weaker links to employment and earlier transitions to partnerships and parenthood would be associated with a greater probability of psychological distress at age 42, and that this association would be become more pronounced across cohorts. Levels of psychological distress were higher amongst men and women with weaker long-term ties to employment, although these were largely explained by early life factors. Teen mothers had higher levels of psychological distress in the two later-born cohorts, and this remained unexplained in adjusted models for the 1970 cohort.

Double Trouble: The Burden of Child-rearing and Working on Maternal Mortality

We document increased old-age mortality rates among Swedish mothers of twins compared with mothers of singletons, using administrative data on mortality for 1990-2010. We argue that twins are an unplanned shock to fertility in the cohorts of older women considered. Deaths due to lung cancer, chronic obstructive pulmonary disease, and heart attacks-all of which are associated with stress during the life course-are significantly increased. Stratifying the sample by education and pension income shows the highest increase in mortality rates among highly educated mothers and those with above-median pension income. These results are consistent with the existence of a double burden on mothers' health resulting from simultaneously child-rearing and working.

Lifetime employment, tobacco use, and alcohol consumption trajectories and cardiovascular diseases in old age

Despite the great advances of life course epidemiology studies during the last decade in understanding the general health effects of employment trajectories, research has yet to evaluate the effects of employment trajectories along with other major risk factors, such as tobacco and alcohol consumption, on cardiovascular diseases (CVDs)-the main cause of deaths worldwide. This is highly relevant, since health advantages in one domain (e.g., being a permanent formal full-time worker) may offset health disadvantages in other domains (e.g., being a regular smoker or alcohol consumer); conversely, disadvantages in both domains may interact, leading to even greater health risks. Considering these knowledge gaps, this research has two main objectives: (1) to reconstruct simultaneous employment, tobacco use, and alcohol consumption trajectories over the life course (from birth to old age) and (2) to measure the association between these trajectories and CVD in old age. Drawing on a rich and comprehensive life history dataset and using multichannel sequence and regression analyses, we analyzed a cohort of individuals aged 65-75 in Chile, a Latin American country with high social inequalities and scarce research on this matter. Our study shows that following a trajectory of formal employment together with no tobacco and alcohol use reduces CVD risk by 36 percentage points relative to a similar employment trajectory but with regular tobacco and alcohol use. Even with an employment trajectory characterized by constant informal employment or permanent inactivity, a life course free of regular tobacco and alcohol use shows protective effects against CVD. This study stresses the importance of health policies that consider CVD as a condition that strongly depends on individual experiences in multiple life domains and across different life stages.

The effect of the lone parent household on cardiovascular health (National Health and Nutrition Examination Survey, 2015-2016)

STUDY OBJECTIVE

Single parenthood is associated with adverse health outcomes. How cardiovascular risk differs by parenthood status has had limited study. We hypothesized that single parents would have worse cardiovascular risk profiles compared to those in partnered-parent households.

DESIGN

We compared associations of parenthood status and the American Heart Association's Life Simple 7 (LS7), an established metric measuring modifiable components of cardiovascular health (smoking status, body mass index, physical activity, diet, cholesterol, glycohemoglobin, and blood pressure) in multivariable-adjusted models.

PARTICIPANTS

We selected adults (age ≥ 25) from the National Health and Nutrition Examination Survey (NHANES) 2015-16 cycle. We defined single parenthood as reporting a child <18 years residing in the home and marital status other than married or living with partner.

MAIN OUTCOME MEASURES

LS7, continuous (range 0-14) and categorized as poor (0-4), intermediate (5-9), or ideal (10-14).

RESULTS

In total, 2180 NHANES participants identified as parents and 1782 (82%) had complete LS7 scores. Of these, 462 identified as single parents, of whom 356 (74.9%) were women. Single parents were more likely to smoke, have poor physical activity, and have high blood pressure (p < 0.01) than partnered parents. Single parents had 1.3-fold greater likelihood of poor cardiovascular health compared with partnered parents, adjusting for age, sex, race/ethnicity, health insurance, healthcare access, poverty index, educational attainment and number of children (95% confidence interval [CI] 1.01-1.71).

CONCLUSIONS

We identified an association between single parenthood and adverse cardiovascular health. Our results demonstrate the importance of considering household composition in risk assessment and cardiovascular disease prevention.

Association of work-family experience with mid- and late-life memory decline in US women

OBJECTIVE

To test the hypothesis that life course patterns of employment, marriage, and childrearing influence later-life rate of memory decline among women, we examined the relationship of work-family experiences between ages 16 and 50 years and memory decline after age 55 years among US women.

METHODS

Participants were women ages ≥55 years in the Health and Retirement Study. Participants reported employment, marital, and parenthood statuses between ages 16 and 50 years. Sequence analysis was used to group women with similar work-family life histories; we identified 5 profiles characterized by similar timing and transitions of combined work, marital, and parenthood statuses. Memory performance was assessed biennially from 1995 to 2016. We estimated associations between work-family profiles and later-life memory decline with linear mixed-effects models adjusted for practice effects, baseline age, race/ethnicity, birth region, childhood socioeconomic status, and educational attainment.

RESULTS

There were 6,189 study participants (n = 488 working nonmothers, n = 4,326 working married mothers, n = 530 working single mothers, n = 319 nonworking single mothers, n = 526 nonworking married mothers). Mean baseline age was 57.2 years; average follow-up was 12.3 years. Between ages 55 and 60, memory scores were similar across work-family profiles. After age 60, average rate of memory decline was more than 50% greater among women whose work-family profiles did not include working for pay after childbearing, compared with those who were working mothers.

CONCLUSIONS

Women who worked for pay in early adulthood and midlife experienced slower rates of later-life memory decline, regardless of marital and parenthood status, suggesting participation in the paid labor force may protect against later-life memory decline.

Women's Work-Family Histories and Cognitive Performance in Later Life

Long-term exposures to the stress and stimulation of different work, parenting, and partnership combinations might influence later life cognition. We investigated the relationship between women's work-family life histories and cognitive functioning in later life. Analyses were based on data from women born between 1930 and 1957 in 14 European countries, from the Survey of Health, Ageing and Retirement in Europe (2004-2009) (n = 11,908). Multichannel sequence analysis identified 5 distinct work-family typologies based on women's work, partnership, and childrearing statuses between ages 12 and 50 years. Multilevel regressions were used to test the association between work-family histories and later-life cognition. Partnered mothers who mainly worked part-time had the best cognitive function in later life, scoring approximately 0.63 (95% confidence interval (CI): 0.18, 1.07) points higher than mothers who worked full-time on a 19-point scale. Partnered mothers who were mainly unpaid caregivers or who did other unpaid activities had cognitive scores that were 1.19 (95% CI: 0.49, 1.89) and 0.93 (95% CI: 0.20, 1.66) points lower than full-time working mothers. The findings are robust to adjustment for childhood advantage and educational credentials. This study provides new evidence that long-term exposures to certain social role combinations after childhood and schooling are linked to later-life cognition.

The Powerful Combination of Cross-country Comparisons and Life-History Data

In this paper we discuss the value of international comparative empirical studies within the broad field of the economics of ageing. We argue the value is particularly great when such comparative research is based on long life-history data on participants, collected using large-scale autobiographical life-history methods. We identify particular aspects of such comparisons that create value relative to other empirical methods and also briefly survey recent key papers to illustrate each aspect. Finally we provide a short new application of this method, using data from SHARE and ELSA, to look at the question of how labour markets for older workers in Europe have been changing across cohorts and the extent to which this has been associated with changing retirement ages in public pension systems.

Work–family lifecourses and later-life health in the United Kingdom

Socio-economic inequalities in physical and mental health persist at older ages and previous studies have shown that partnership and parenthood histories are also associated with differentials in later-life health. These domains of adult life interact, and both may be influenced by earlier life circumstances, indicating a need for a holistic approach to understanding lifecourse influences on health at older ages. In this paper, we identify classes of lifecourse types for a United Kingdom (UK) cohort born 1933–1945 and investigate differences between the latent classes identified in physical and mental health, and changes in health over a five-year follow-up period. Data were drawn from Waves 1–5 (2009–2013) of the nationally representative UK Household Longitudinal Study. Multi-level models were used to analyse associations with summary indicators of physical and mental health measured using the SF-12, and changes in health, controlling for childhood circumstances and taking account of support from family and friends in later life. Lifecourses characterised by lower socio-economic position, early parenthood and large family size were associated with worse physical and mental health in later life, with respondents who had combined a high socio-economic position and two children being the most advantaged. The study indicates that socio-economic disparities in later-life health vary depending on the way in which individuals combine work and family life.

Who benefits from social investment? The gendered effects of family and employment policies on cardiovascular disease in Europe

BACKGROUND

In the context of fiscal austerity in many European welfare states, policy innovation often takes the form of 'social investment', a contested set of policies aimed at strengthening labour markets. Social investment policies include employment subsidies, skills training and job-finding services, early childhood education and childcare and parental leave. Given that such policies can influence gender equity in the labour market, we analysed the possible effects of such policies on gender health equity.

METHODS

Using age-stratified and sex-stratified data from the Global Burden of Disease Study on cardiovascular disease (CVD) morbidity and mortality between 2005 and 2010, we estimated linear regression models of policy indicators on employment supports, childcare and parental leave with country fixed effects.

FINDINGS

We found mixed effects of social investment for men versus women. Whereas government spending on early childhood education and childcare was associated with lower CVD mortality rates for both men and women equally, government spending on paid parental leave was more strongly associated with lower CVD mortality rates for women. Additionally, government spending on public employment services was associated with lower CVD mortality rates for men but was not significant for women, while government spending on employment training was associated with lower CVD mortality rates for women but was not significant for men.

CONCLUSIONS

Social investment policies were negatively associated with CVD mortality, but the ameliorative effects of specific policies were gendered. We discuss the implications of these results for the European social investment policy turn and for future research on gender health equity.

Work-family spillover and metabolic syndrome indicators: Findings from a national sample

This study examines the link between negative work-family spillover and metabolic risk factors over a 9-year period. Data from two waves of the Midlife in the United States Survey were used to explore relationships between negative work-family spillover and four indicators of metabolic syndrome-blood pressure, triglycerides, body mass index, and glucose levels. In a sample of full-time working men and women (N = 630), increased negative spillover at baseline significantly predicted higher body mass index nearly a decade later, with a marginally significant effect for triglyceride levels. Increases in spillover also body mass index and glucose levels at follow-up. This study extends research tying work-life spillover to health and suggests that further investigation is needed to fully understand the long-term effects of work stress.

Educational inequalities in self-rated health across US states and European countries

OBJECTIVES

The US shows a distinct health disadvantage when compared to other high-income nations. A potential lever to reduce this disadvantage is to improve the health situation of lower socioeconomic groups. Our objective is to explore how the considerable within-US variation in health inequalities compares to the health inequalities across other Western countries.

METHODS

Representative survey data from 44 European countries and the US federal states were obtained from the fourth wave of the European Values Study (EVS) and the 2008 wave of the Behavioral Risk Factor Surveillance System. Using binary logistic regression, we analyze different forms of educational inequalities in self-rated health (SRH), adjusted for age and sex.

RESULTS

The extent of educational inequalities in SRH varies considerably over European countries and US states; with US states in general showing greater inequality, however, differences between US states and European countries are less clear than commonly assumed.

CONCLUSIONS

The US has considerable differences in educational inequalities in SRH across geographic locations. To understand the reasons for the US health disadvantage, comparative research has to take into account the vast variation in health inequalities within the US.