Unequal tracks? Studies on work, retirement and health

Abstract: 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.