Unequal tracks? Studies on work, retirement and health

Background. In Sweden, the proportion of people aged 65 and older has doubled since 1950, and is projected to continue to increase. The increased longevity and proportion of older people in the population pose a challenge for financing and maintaining of the welfare, social security and pension systems. One way to address this challenge is through policy reforms aimed at raising the retirement age, increasing financial incentives for working beyond the official retirement age, abandoning or restricting early retirement routes, and prolonging the total employment period over the life span in order to receive full pension. The success of such reforms will partly depend on the health and working capacity of people in the upper end of their labour market career. In general, women have poorer health than men at all ages, and people with more socioeconomic resources have better health than those with fewer resources. Thus, women and men, as well as different socioeconomic groups, have varying prospects for extending working life. Moreover, an extended working life might have different health effects across gender and socioeconomic position. Aim. The overarching aim of this dissertation is to empirically study how retirement is influenced by health status, socioeconomic position, and gender in Sweden; and in turn how the timing of exit from the labour market is associated with health and functioning in late life. Data. The four studies in this thesis were based on nationally representative longitudinal data from the Swedish Level-of-Living Survey (LNU), the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), the Swedish Longitudinal Occupational Survey of Health (SLOSH), Swedish Cause of Death Register, and income register data from Statistics Sweden: the Income and Taxation Register (IoT) and the Longitudinal Integration Database for Health Insurance and Labour Market Studies (LISA). Study I. There is no consensus on how retirement age is defined and operationalized, neither in research nor in the social policy debate. By comparing a series of four commonly used measures of retirement age assessed on the basis of the LNU survey and LISA register data (n=540), the findings show that different operationalisations give different retirement ages and different empirical results e.g. the size and even direction of the association between self-rated health and retirement age varies depending on the operationalisation. This highlights the importance that readers are aware of the definition of retirement age used when evaluating results from studies on retirement, and that researchers clearly state the definition of retirement age in their studies. Study II. The period from 1980 to 2010 was characterised by technological advancements and reconstruction of the labour market, financial crisis, and several policy reforms with implications for retirement and labour market exit. This study includes four population-based cohorts aged 50-70 at inclusion year (LNU 1981, 1991, 2000 and 2010) that were followed prospectively for two years each, using waves of LNU survey data together with IoT and LISA income register data (n=3690). The aim was to study the predictive value of physical functioning for retirement over a three-decade period. The results show that mobility limitations and musculoskeletal pain were not as predictive of retirement in 2010 compared to the early 1980s, especially for women. Along with changes to the labour market, and to the social security and pension systems, the importance of good physical functioning for continued work is decreasing. Study III. The increased need for people to prolong working life raises concerns about possible consequences on health in later life for people in various socioeconomic position. This study used data from LNU, SWEOLD, LISA, and the Swedish Cause of Death Register, and the quasi-experimental method of propensity score matching (n=1852 for mortality analysis and n=1461 for late life health analysis). The findings show no significant average effects of prolonging working life to age 66 or above, on mortality, the ability to climb stairs without difficulty, self-rated health, limitations in activities of daily living (ADL), or musculoskeletal pain in late life. Overall, there were no systematic socioeconomic differences in the health effects of prolonging working life. This indicates that there are no long-term physical health consequences of prolonging working life past the normative retirement age. Study IV. When and how retirement takes place, can be affected by and have an impact on health. The aim was to identify trajectories of self-rated health (n=2181) and physical working capacity (n=2151) over the retirement transition using latent trajectory analysis utilising seven waves of SLOSH data covering up to 11 years before and 11 years after retirement. The findings show that most people maintained their pre-retirement levels of self-rated health and physical working capacity during the transition to retirement. The majority had good health throughout the study period (70-75%). People in the trajectory characterised by poor health before and after retirement were more likely to have had a poor working environment and low socioeconomic position. A small group (8-15%), characterised by poor psychosocial working environment and lower socioeconomic position, saw a decline in self-rated health and physical working capacity after retirement. Conclusions. The findings of this thesis indicate that the large majority of people in the upper end of their working career have good enough physical health to meet the terms of pension reforms aimed at raising the retirement age. Moreover, physical health in late life is not negatively impacted by prolonged working life. However, the results also show a group of people with low socioeconomic position and poor working environment that have poor health years before retirement. Therefore, it is still important for policymakers to recognise that those who have a poor working environment and lower socioeconomic position might not have the health capacity to continue working, despite reforms raising the retirement age. Preventing early exit from the labour force for people with physical limitations might increase health inequalities in late life and result in more demands on the social security system and the health care system. This is important for policymakers to consider, as current and future policy reforms might have to be adapted for people who have spent many years on the labour market in harmful working conditions

How to measure retirement age? : a comparison of survey and register data

Due to an increasing heterogeneity in retirement transitions, the measurement of retirement age constitutes a major challenge for researchers and policymakers. In order to better understand the concept of retirement age, we compare a series of measures for retirement age assessed on the basis of survey and register data. We use data from Sweden, where flexible retirement schemes are implemented and register data are available. We link survey data from the Swedish Level of Living Survey with register data from the Swedish Longitudinal Integration Database for Health Insurance and Labour Market Studies. We create four measures of retirement age based on these datasets, applying approaches that have been used in previous literature. We analyse the means and distributions of these measures and evaluate the correlations between them. Finally, we regress common predictors of retirement age such as gender or education on the four measures of retirement age to examine potential differences in size, direction and statistical significance of the associations. We find that the survey measure of retirement age resembles the following two ways of defining retirement age in the register data: first, the age at which people receive more than half their income from old-age or disability pension and second, the age at which they were not gainfully employed for at least two years. This insight gives us a better understanding of when in the retirement transition process individuals identify with retirement. Moreover, it provides decision support for researchers working with register data to determine which measure to use

Prolongation of working life and its effect on mortality and health in older adults : propensity score matching

Many countries are raising the age of pension eligibility because of increases in life expectancy. Given the social gradient in life expectancy and health, it is important to understand the potential late-life health effects of prolonging working life and whether any effects differ by socioeconomic position. We examined the effect of prolonging working life beyond age 65 on mortality and a series of indicators of late-life physical health (the ability to climb stairs without difficulty, self-rated health, ADL limitations, and musculoskeletal pain) in a representative sample of the Swedish population. In addition to average effects, we also examined heterogeneous effects, for instance by occupational social class. To do this, we use propensity score matching, a method suitable for addressing causality in observational data. The data came from two linked Swedish longitudinal surveys based on nationally representative samples with repeated follow-ups; The Swedish Level of Living Survey and the Swedish Panel Study of Living conditions of the Oldest Old, and from national income and mortality registries. The analytical sample for the mortality outcome included 1852 people, and for late-life physical health outcomes 1461 people. We found no significant average treatment effect on the treated (ATT) of working to age 66 or above on the outcomes, measured an average of 12 years after retirement: mortality (ATT -0.039), the ability to climb stairs (ATT -0.023), self-rated health (ATT -0.009), ADL limitations (ATT -0.023), or musculoskeletal pain (ATT -0.009) in late life. Analyses of whether the results varied by occupational social class or the propensity to prolong working life were inconclusive but suggest a positive effect of prolonging working life on health outcomes. Accordingly, more detailed knowledge about the precise mechanisms underlying these results are needed. In conclusion, working to age 66 or above did not have effect on mortality or late-life physical health

Do cognitively stimulating activities affect the association between retirement timing and cognitive functioning in old age?

In response to the rising financial pressure on old-age pension systems in industrialised economies, many European countries plan to increase the eligibility age for retirement pensions. We used data from Sweden to examine whether (and if so, how) retirement after age 65 – the eligibility age for basic pension – compared to retiring earlier affects older adults’ (between ages 70 and 85) cognitive functioning. Using a propensity score matching (PSM) approach, we addressed the selection bias potentially introduced by non-random selection into either early or late retirement. We also examined average and heterogeneous treatment effects (HTEs). HTEs were evaluated for different levels of cognitive stimulation from occupational activities before retirement and from leisure activities after retirement. We drew from a rich longitudinal data-set linking two nationally representative Swedish surveys with a register data-set and found that, on average, individuals who retire after age 65 do not have a higher level of cognitive functioning than those who retire earlier. Similarly, we did not observe HTEs from occupational activities. With respect to leisure activities, we found no systematic effects on cognitive functioning among those working beyond age 65. We conclude that, in general, retirement age does not seem to affect cognitive functioning in old age. Yet, the rising retirement age may put substantial pressure on individuals who suffer from poor health at the end of their occupational career, potentially exacerbating social- and health-related inequalities among older people

Félagsauður, heilsa og mikilvægi svefns

Meistaraprófsritgerð frá CHESS, Centre for Health Equity Studies. CHESS stofnunin byggir á samstarfi milli Stokkhólmsháskóla og Karolinska Institutet.Abstract The frequently studied concept of social capital has often been related to health, but the conceptualisation and measurement of the concept is an on-going debate. The main aim of this thesis is to study the relationship of four different indicators of social capital; informal social capital, formal social capital, trust towards institutions and trust towards others, with self-rated physical health and self-rated mental health in Iceland in 2009, shortly after a harsh economic crash. Insomnia symptoms will be studied as a possible mediator or moderator in the relationship. Furthermore, longitudinal data on informal social capital will be used to see the causal effect of social capital on health and to see if informal social capital decreased after the economic collapse. Population-based panel data from Iceland in 2007 and 2009 will be used to perform both cross-sectional analysis (n = 3,243) and longitudinal analysis (n = 3,131). The main results are that the four indicators of social capital all relate differently to physical and mental self-rated health, and insomnia symptoms seem to mediate the relationship between social capital and health, especially physical health. Surprisingly, informal social capital did increase during the economic collapse. The panel analysis further suggests that having poor informal social capital has causal effects on poor self-rated mental health when adjusted for symptoms of insomnia, age, gender, family status, education and smoking. Key words: Social capital, self-rated physical health, self-rated mental health, symptoms of insomnia, Iceland, cross-sectional study, longitudinal study

Þekkingarþjóðfélag: Nýsköpunargeta Íslands og möguleikar á uppbyggingu þekkingarhagkerfis

Í þessari ritgerð mun vera skoðað hvað þekkingarhagkerfið sé. Farið verður í hlutverk ríkis og sveitafélaga í uppbyggingu þekkingarhagkerfis og kröfu þegna um samfélagsleg skilyrði. Gerð verða skil á nýsköpun og leið Finna að mikilli nýsköpun og sömuleiðis hver staða hennar er á Íslandi. Loks verður farið í mikilvægi menntakerfis í þekkingarþjóðfélagi og stöðu menntakerfis Íslands. Farið verður almennt í hvað þekkingarþyrpingar eru og þróun þeirra í Finnlandi og Kísildalnum í Bandaríkjunum borin saman. Loks verður rætt hvort raunhæft sé fyrir Íslendinga að stofna til þekkingarhagkerfis og mögulegar leiðir til þess. Niðurstöður sýna að Íslendingar verji talsverðu fé til rannsókna og þróunar og í menntakerfið en árangur nýsköpunar sé ekki í samræmi við framlög. Til að auka nýsköpun er nauðsynlegt að efla menntakerfið umtalsvert, og þá sérstaklega á sviði náttúruvísinda, stærðfræði og verkfræði. Við uppbyggingu þekkingarþyrpingar hér á landi er skynsamlegast að feta í spor Finna. Sú leið tryggir mikinn hagvöxt auk þess sem jöfnuður í samfélaginu er mikill

Social class and infirmity. The role of social class over the life-course

In an aging society, it is important to promote the compression of poor health. To do so, we need to know more about how life-course trajectories influence late-life health and health inequalities. In this study, we used a life-course perspective to examine how health and health inequalities in late-midlife and in late-life are influenced by socioeconomic position at different stages of the life course. We used a representative sample of the Swedish population born between 1925 and 1934 derived from the Swedish Level of Living Survey (LNU) and the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) to investigate the impact of socioeconomic position during childhood (social class of origin) and of socioeconomic position in young adulthood (social class of entry) and late-midlife (social class of destination) on infirmity in late-midlife (age 60) and late-life (age 80). The results of structural equation modelling showed that poor social class of origin had no direct effect on late-midlife and late-life infirmity, but the overall indirect effect through chains of risks was significant. Thus, late-midlife and late-life health inequalities are the result of complex pathways through different social and material conditions that are unevenly distributed over the life course. Our findings suggest that policies that break the chain of disadvantage may help reduce health inequalities in late-midlife and in late-life. Keywords: Life course, Socioeconomic position, Late-life healt

Social class and infirmity. The role of social class over the life-course

In an aging society, it is important to promote the compression of poor health. To do so, we need to know more about how life-course trajectories influence late-life health and health inequalities. In this study, we used a life-course perspective to examine how health and health inequalities in late-midlife and in late-life are influenced by socioeconomic position at different stages of the life course. We used a representative sample of the Swedish population born between 1925 and 1934 derived from the Swedish Level of Living Survey (LNU) and the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD) to investigate the impact of socioeconomic position during childhood (social class of origin) and of socioeconomic position in young adulthood (social class of entry) and late-midlife (social class of destination) on infirmity in late-midlife (age 60) and late-life (age 80). The results of structural equation modelling showed that poor social class of origin had no direct effect on late-midlife and late-life infirmity, but the overall indirect effect through chains of risks was significant. Thus, late-midlife and late-life health inequalities are the result of complex pathways through different social and material conditions that are unevenly distributed over the life course. Our findings suggest that policies that break the chain of disadvantage may help reduce health inequalities in late-midlife and in late-life. Keywords: Life course, Socioeconomic position, Late-life healt

The role of cognitively stimulating activities in explaining the association between retirement timing and cognitive functioning in old age

Background: In light of the rising life expectancy and financial pressure on old-age pension systems in industrialized economies, many European countries – including Switzerland – are currently reforming related policies. Some of the countries have increased or plan to increase the eligibility age for old-age pension. In this context, we examine the association between the prolongation of working life and cognitive health in late-life based on data from Sweden, where retirement age is more flexible than in most other countries. The aim of our study is to analyze whether the level of job-related cognitive stimulation affects the association between retirement age and cognitive functioning in old age. Methods: We use a representative dataset from Sweden, linking survey data from the Level of Living Survey (LNU), the Swedish Panel Study of Living conditions of the Oldest Old (SWEOLD) and annual tax register data. Using a propensity score matching approach, we create a quasi-experimental study design comparing individuals who extend their working life beyond age 65 with those who retire earlier. In addition, we use ordered logistic regression analysis to examine the effect of working longer by occupational groups. Results: We observe that on average, individuals who retire at age 65 or later do not have a higher level of cognitive functioning around age 80 than those who retired earlier. We observe higher levels of cognitive functioning around age 80 for individuals who retire at age 65 or later as compared to those who retire earlier. In addition, our analysis shows that if we control only for socio-demographic and occupational characteristics, individuals who worked in more complex and non-manual occupations have a better cognitive functioning in old age. However, if we include leisure activities that individuals attend during their retirement into the analysis, the effect of occupational characteristics becomes less strong and loses statistical significance whereas the effect for leisure activities is significant. Conclusion: Using longitudinal data and a causal approach that allows for tapping into mechanisms underlying the association between retirement and cognition, our results suggest that engaging in stimulating activities contributes to the maintenance of cognitive abilities in old-age. This finding allows informing the policy debate about the transition from employment to retirement