Health trajectories across the work exit transition in the 1990s, 2000s, and 2010s: the role of working conditions and policy

In this study, we examined health trajectories in self-rated health and physical limitations across the work exit transition for older workers exposed to higher versus lower physical demands, psychosocial demands, and psychosocial resources. We did this for the 1990s, 2000s, and 2010s, i.e., during a period in which Dutch policy measures to extend working lives accumulated and a steady increase in the age at exit from the workforce took place. We hypothesized that differences in health trajectories between workers exposed to less favourable and more favourable working conditions increased from the 1990s to the 2010s. Our hypothesis was not supported, neither for self-rated health nor for physical limitations. Regardless of work exposure, we did observe that for both health measures, the level of poor health was somewhat higher in later than in earlier decades. Changes in pre-post-exit health were not observed for self-rated health. In physical limitations, however, pre-post-exit increases were observed in the 1990s and 2010s regardless of work exposure, whereby the increase was especially steep in the 2010s.

Our hypothesis of gradually diverging health trajectories for workers with favourable and unfavourable work exposures was based on our expectation of a cumulative effect of policy measures that were implemented since the early 2000s. The lack of support for our hypothesis calls for a closer look at the successive policy measures and their effects on pre-post exit health trajectories. At our starting point in the 1990s, many workers used one of the several opportunities to leave the workforce well before the statutory retirement age, including early retirement schemes and disability pensions [16, 17]. This is reflected in our data by the low level of physical limitations in workers in the 1990s. In the 2000s, exiting from the workforce via disability pensions was restricted, but most important was the abolishment of early retirement schemes [18, 19]. Thus, both workers with favourable and workers with unfavourable working conditions extended their working lives. Our findings for the 2000s show that this did not coincide with a significant divergence in pre-post-exit health trajectories. However, both groups of workers tended to report poorer self-rated health and a higher level of physical limitations than in the 1990s. In the 2010s, to the extant policy measures a gradual rise in the statutory retirement age was added, access to disability benefits was further restricted, and the maximum unemployment benefit period was limited [15, 20]. At the same time, the measures taken in the 2000s reached their full effect, so that it became increasingly necessary to continue working. We again observed a slightly poorer self-rated health in the 2010s. The latter finding may reflect that older workers had expected to exit earlier [33]. The frustration of having to work for more years may negatively affect their perception of their health, even after exit from the workforce. Regarding physical limitations, their pre-exit level was similar to the level in the previous decade, but their pre-post-exit increase was substantial and contrasted with the stability of physical limitations in the 2000s. Thus, in the 2010s workers did not recover from their pre-exit physical limitations, but became more limited after exiting from work. This is consistent with evidence that with increasing age, older workers become more vulnerable to any work exposure, regardless of level of education, and that recovery becomes more difficult even after elimination of work exposures [2,3,4].

Another possible reason that our hypothesis of diverging health trajectories does not hold, is that the effect of working conditions was counteracted by adjustments. Our descriptive data (Table 1) show that over the decades, the average number of working hours decreased. In our analytic models, shorter working hours were associated with poorer health. Reducing the number of working hours is one strategy to boost workability [34]. Furthermore, the correlation of physical demands with psychosocial resources was positive, while a negative association would have been expected: workers exposed to high physical demands are likely to have jobs with little autonomy and variation. A tentative explanation may be that our samples include older workers in physically demanding jobs who have been able to remain in the workforce thanks to the availability of a relatively high level of psychosocial resources. Regardless, even with adjustments in working hours and the possible presence of psychosocial resources, in the 2010s physical health declined.

In sum, it appears that working conditions did not play the hypothesised role, suggesting that their potential effects on pre-post-exit health trajectories were overshadowed by more powerful influences. Because new retirement policy measures were implemented in the course of the decades studied, it seems reasonable to attribute the observed health decline to these new policies, which effectively increased the age at exit from the labour market. In other words, it seems reasonable to attribute our findings to period effects rather than to cohort effects. Period effects affect all individuals living in a certain historic period, whereas cohort effects result from influences associated with cohort membership and may have their origin earlier in the life course [35]. In our analyses we attempted to rule out cohort effects by adjusting for some major cohort characteristics, including level of education, sex, and number of working hours. These characteristics capture the rise in educational level and in women’s – often part-time – labour market participation across cohorts. However, unobserved cohort or period effects may have influenced our findings as well. Before our findings are replicated in future research, caution is warranted in stressing policy measures as the only influence.

Several specific findings deserve discussion. Corresponding to the policy measures taken earlier, our data show that in the 2010s substantially fewer workers exited with a disability benefit scheme. We did not adjust our models for type of exit, because this would preclude the reflection of policy measures in our findings. Yet, this also precluded an assessment of the extent to which workers who exited with a disability scheme affected the health trajectories that we found. As expected, our data show that these workers had poorer health both pre- and post-exit compared to workers with other exit routes (Table S1). Therefore, we reanalysed our models excluding the workers with a disability exit (n = 50; Supplementary tables S2-S4). This did not essentially change our findings: although at slightly better levels of health, we still observed poorer levels of self-rated health across the successive periods, and a substantial increase in physical limitations in the 2010s regardless of working conditions. The similarity in findings when including and excluding disability exits ties in with the findings from a Swedish study, which showed that the relationship between exit route and post-exit health disappeared once pre-exit health was added to the model [36]. These researchers concluded that both exit route and post-exit health can be considered as outcomes of a lifelong process of accumulation of differential work exposures. This implies that the type of exit has no added value to pre-post exit health trajectories, provided that pre-exit health is properly accounted for.

According to the life course perspective, working conditions are a result of selection into certain occupations, which is amongst others based on prior levels of education [37]. It was our intention to examine working conditions per se, unconfounded by level of education. As in our study working conditions turned out to have little effect on health trajectories, it may be argued that the accumulation of earlier exposures culminate in pre-exit work exposures, but that these work exposures are not in themselves causal. In order to test if the role of educational level is predominant, we conducted additional analyses defining level of education as the work exposure instead of working conditions. The results were very similar to our original analyses, with the exception that physical limitations showed a steeper pre-post exit rise in lower than in higher educated workers in the 2010s (Table S5). This analysis stresses the close link between educational level and later-life working conditions.

In our study, workers with high psychosocial demands reported better self-rated health than workers with low psychosocial demands. This contrasts with studies showing that psychosocial demands negatively affect health. This may be due to the inclusion of different items in the psychosocial demands scale. For example, we included cognitive demands in addition to time pressure and work load, whereas other studies included only the latter two items (e.g., [9]). Workers experiencing high cognitive demands are likely to have higher-status jobs, and job status is positively associated with good self-rated health (e.g., [14]).

Pre-post-exit trajectories were different for self-rated health and for physical limitations. Particularly in the 2010s, the latter increased across the exit from the workforce, but the former remained stable. Possibly, a certain relief after exiting from work plays a role [12, 13], which may compensate for increases in physical limitations. Self-rated health is known to be influenced by both physical and mental health [38], and in contrast to mixed evidence on physical health, mental health has been shown to improve after work exit [7, 22]. Another potential explanation for the relatively flat trajectories of self-rated health as opposed to physical limitations is the phenomenon of response shift [39]. This phenomenon entails that in the face of health problems, people lower their standard of good health, so that their experience of their health remains stable.

Strengths and limitations

A strength of this study is the use of a representative sample of the older working population. In addition, the cohort-sequential design of LASA enabled us to compare the health trajectories during different time periods. The distinction of different periods is novel and adds to the literature, where other studies aggregated findings over historic time (e.g., [40, 41]).

Limitations of our study include, first, the relatively low number of respondents eligible for our study sample. However, our sample was representative of the general older population. This is supported by a comparison of the average age at retirement in our sample with national data from Statistics Netherlands. At the national level, for persons aged 60–65 the average retirement age was 60.8 in the late 1990s, which compares well with our average age of 60.7 years for the 1990s, as the retirement age did not change in this decade. In the mid-2010s, the average national retirement age for this age group was 64.4 [42]. This is somewhat higher than our 62.9 years, but our sample was capped at the statutory retirement age, so that the exit age of those who worked beyond statutory retirement age did not raise the average. Regardless, our results need to be confirmed using larger samples.

Second, the health trajectories were based on two waves, one before and one after work exit. This allowed inclusion of a maximal number of participants in each decade. By using more than two waves, we could have addressed the possibility that health trajectories differ pre- and post-exit [40] or are more heterogeneous post-exit [41]. The availability of only one wave pre-exit precluded the possibility to determine if working conditions had changed prior to this wave. It is possible that the pre-exit working conditions no longer reflect the work exposures during the longest-held job. Likewise, the availability of only one post-exit wave also precluded the possibility to differentiate short-term from long-term health trajectories. Schmälzle and colleagues [41], for example, found that life satisfaction tended to decline pre-exit, but showed a certain recovery at one year post-exit. As in our study the time interval between waves was three years, inclusion of more waves per participant pre- and post-exit would have discarded the clear separation between decades, while the main objective of our study was to address decade-specific trajectories.

Third, working conditions are derived from a General Population Job-Exposure Matrix (GPJEM) for workers aged 55 and over [28]. This GPJEM does not take heterogeneity within job categories into account. However, the advantage of a GPJEM is that it is not influenced by individual characteristics, such as health, which may lead to reversed causality [43] or common-method bias [44]. Furthermore, our GPJEM is developed based on working conditions reported by workers over the period 2005–2010 [28]. Therefore, it is possible that it does not correctly capture the working conditions in the 1990s and 2010s. For example, the same job may have higher physical demands in the 1990s and lower physical demands in the 2010s due to technological developments [45, 46]. Also, to keep older workers in the workforce, the working conditions of workers showing declines in work ability may have been adapted while the job description remained the same. However, this is not very likely, as employers have been shown to prefer retiring older workers over offering work adaptations [47]. Although both self-reported and GPJEM-based working conditions have biases, arguably a GPJEM describes working conditions more objectively.

留言 (0)

沒有登入
gif