The effect of retirement on biomedical and behavioral risk factors for cardiovascular and metabolic disease

Longitudinal Associations between 24-h Movement Behaviors and Cardiometabolic Biomarkers: A Natural Experiment over Retirement

INTRODUCTION

Physical activity, sedentary behavior, and sleep, that is, 24-h movement behaviors, often change in the transition from work to retirement, which may affect cardiometabolic health. This study investigates the longitudinal associations between changes in 24-h movement behaviors and cardiometabolic biomarkers during the retirement transition.

METHODS

Retiring public sector workers ( n = 212; mean (SD) age, 63.5 (1.1) yr) from the Finnish Retirement and Aging study used a thigh-worn Axivity accelerometer and filled out a diary to obtain data on daily time spent in sedentary behavior (SED), light physical activity (LPA), and moderate-to-vigorous physical activity (MVPA), and sleep before and after retirement (1 yr in-between). Cardiometabolic biomarkers, including LDL-cholesterol, HDL-cholesterol, total/HDL-cholesterol ratio, triglycerides, C-reactive protein, fasting glucose, and insulin, were measured. Associations between changes in 24-h movement behaviors and cardiometabolic biomarkers were analyzed using compositional robust regression and isotemporal substitution analysis.

RESULTS

Increasing LPA in relation to remaining behaviors was associated with an increase in HDL-cholesterol and decrease in total/HDL-cholesterol ratio ( P < 0.05 for both). For instance, reallocation of 30 min from sleep/SED to LPA was associated with an increase in HDL-cholesterol by 0.02 mmol·L -1 . Moreover, increasing MVPA in relation to remaining behaviors was associated with a decrease in triglycerides ( P = 0.02). Reallocation of 30 min from SED/sleep to MVPA was associated with 0.07-0.08 mmol·L -1 decrease in triglycerides. Findings related to LDL-cholesterol, C-reactive protein, fasting glucose, and insulin were less conclusive.

CONCLUSIONS

During the transition from work to retirement, increasing physical activity at the expense of passive behaviors was associated with a better lipid profile. Our findings suggest that life transitions like retirement could be utilized more as an optimal time window for promoting physical activity and health.

The effect of retirement on physical and mental health in China: a nonparametric fuzzy regression discontinuity study

BACKGROUND

With the rapid aging of the domestic population, China has a strong incentive to increase the statutory retirement age. How retirement affects the health of the elderly is crucial to this policymaking. The health consequences of retirement have been debated greatly. This study aims to investigate the effects of retirement on physical and mental health among Chinese elderly people.

METHODS

The data we use in this study comes from four waves (2011, 2013, 2015, and 2018) of the Harmonized China Health and Retirement Longitudinal Study (Harmonized CHARLS), a prospective cohort. We use the nonparametric fuzzy regression discontinuity design to estimate the effects of retirement on physical and mental health. We test the robustness of our results with respect to different bandwidths, kernel functions, and polynomial orders. We also explore the heterogeneity across gender and education.

RESULTS

Results show that retirement has an insignificant effect on a series of physical and mental health outcomes, with and without adjusting several sociodemographic variables. Heterogeneity exists regarding gender and education. Although stratified analyses indicate that the transition from working to retirement leaves minimal effects on males and females, the effects go in the opposite direction. This finding holds for low-educated and high-educated groups for health outcomes including depression and cognitive function. Most of the results are stable with respect to different bandwidths, kernel functions, and polynomial orders.

CONCLUSIONS

Our results suggest that it is possible to delay the statutory retirement age in China as retirement has insignificant effects on physical and mental health. However, further research is needed to assess the long-term effect of retirement on health.

Does Retirement and Work Stoppage Impact Body Weight and Waist Circumference Changes in Middle- and Older-Aged Women and Men? Results From the Canadian Longitudinal Study on Aging

This study aimed to examine the impact of employment transitions (ETs) on anthropometric changes among middle-aged and older workers (ages 45y+). Using two waves of data from the Canadian Longitudinal Study on Aging, we analyzed the impact of ETs (stayed working, entered retirement, and stopped working) on change in body weight and waist circumference (WC) on continuous scales as well as categories (≥5% cut-off). Analyses were sex/gender-stratified. Women did not show significant weight or WC change that differed across ETs, but estimated directions suggested those who stopped working were more likely to have ≥5% change in weight. Estimated directions of continuous outcomes for women who stopped working relative to continued workers showed less weight gain and more WC gain. Men who retired gained less weight and had smaller WC gain compared to reference. The findings imply that the short-run impact of exiting the labor force may not exacerbate weight gain.

Heterogeneous effects of retirement on the biomedical risk factors for cardiovascular and metabolic diseases: New evidence based on the physical examination database in Shanghai, China

Retirement has a heterogeneous impact depending on gender and occupation. This study aimed to analyze and evaluate the heterogeneity and potential mechanism of retirement on the biomedical risk factors for cardiovascular and metabolic diseases. Physical examination data from 2017 to 2020 were extracted from a hospital database in Shanghai. The fluctuation tendency of biomedical risk factor indicators for cardiovascular and metabolic diseases was evaluated by gender and occupation shortly after retirement using fuzzy regression discontinuity design and was analyzed for internal mechanism. Retirement had a significantly negative influence on body weight (β = -3.943), body mass index (β = -2.152), and diastolic blood pressure (β = -5.180) in women working in public institutions or state-owned enterprises, but a positive influence on their blood glucose level (β = 0.696). Retirement had a significantly positive effect on high-density lipoprotein in men (β = 0.138), particularly those employed in private enterprises (β = 0.339). The internal influencing mechanism of retirement showed that the health attention effect after retirement among women in government or public institutions on diastolic blood pressure reduction was better than that before retirement. The body weight, body mass index, and diastolic blood pressure of women in public institutions or state-owned enterprises were reduced at retirement; however, they were exposed to higher risks of elevated blood glucose level. Conversely, high-density lipoprotein level, which is protective against cardiovascular disease, was increased in men at retirement. Retirement has a heterogeneous effect on cardiovascular and metabolic health among people of different genders or occupational experiences. Retirees with low health awareness should be targeted for behavioral interventions and monitored conscientiously by health providers during retirement adaptation.

Socioeconomic Differences in Physical Activity and Sedentary Behavior During the Retirement Transition: A Systematic Review of Longitudinal Studies

BACKGROUND

The retirement transition constitutes both a risk and an opportunity for changes in physical activity (PA) and sedentary behavior (SB). The present systematic review aims to summarize the current evidence regarding the differences between socioeconomic status (SES) groups in changes in PA and SB across the retirement transition.

METHODS

The authors searched 5 databases. Inclusion criteria were: investigating statutory retirement, measuring PA and/or SB at least once before and once after retirement, and reporting information on SES differences. Results are reported by means of a narrative synthesis, combined with harvest plots based on direction of effect.

RESULTS

We included 24 papers from 19 studies. Sixteen papers focused on PA, 3 on SB, and 5 investigated both. For total PA, occupational PA, and total sedentary time, nearly all publications reported more favorable changes for high SES groups. For recreational PA, active transport, and screen time, there seemed to be a tendency toward more favorable changes for high SES groups. Changes in household/caregiving PA did not appear to differ between SES groups.

CONCLUSIONS

Changes in movement behavior during the retirement transition are potentially more favorable for high SES adults. Nonetheless, the differences between SES groups seem to depend on the domain of movement behavior.

A systematic review of evidence on employment transitions and weight change by gender in ageing populations

Background

Becoming unemployed is associated with poorer health, including weight gain. Middle- and older-age adults are a growing segment of workforces globally, but they are also more vulnerable to changes to employment status, especially during economic shocks. Expected workforce exits over the next decade may exacerbate both the obesity epidemic and the economic burden of obesity. This review extends current knowledge on economic correlates of health to assess whether employment transitions impact body weight by sex/gender among middle-aged and older adults.

Methods

Eight bibliometric databases were searched between June and July 2021, supplemented by hand-searches, with no restriction on publication date or country. Longitudinal studies, or reviews, were eligible when examining body weight as a function of employment status change in adults ≥50 years. Data extraction and quality appraisal used predefined criteria; reported findings were analysed by narrative synthesis.

Results

We screened 6,001 unique abstracts and identified 12 articles that met inclusion criteria. All studies examined retirement; of which two also examined job-loss. Overall, studies showed that retirement led to weight gain or no difference in weight change compared to non-retirees; however, reported effects were not consistent for either women or men across studies or for both women and men within a study. Reported effects also differed by occupation: weight gain was more commonly observed among retirees from physical occupations but not among retirees from sedentary occupations. Few studies assessed the role of health behaviours; sleep was the least studied. Most studies were medium quality.

Conclusions

Existing studies do not provide a clear enough picture of how employment transitions affect body weight. Firm conclusions on the impact of employment transitions on weight cannot be made without further high-quality evidence that considers the role of gender, job-type, other health behaviours, and other transitions, like job-loss.

Transitioning out of work and metabolic syndrome incidence: a longitudinal study among 13 303 older workers from the Lifelines Cohort Study and Biobank

BACKGROUND

This study investigates (1) whether different employment transition types (ie, unemployment, work disability, early retirement and regular retirement) are associated with metabolic syndrome (MetS) incidence among older workers (50-64 years) and (2) whether occupational group moderates the association between employment transition type and MetS incidence.

METHODS

A sample of 13 303 older Dutch workers from the Lifelines Cohort Study and Biobank was examined using longitudinal data from two comprehensive measurement waves with a mean follow-up time of 3.7 years. MetS components were based on physical measures, blood markers and medication use. Employment transitions were determined using questionnaires. Logistic regression analysis was performed to examine the association between employment transition type and MetS incidence.

RESULTS

Older workers who transitioned from employment to unemployment (adjusted OR 1.39, 95% CI 1.05 to 1.82) or work disability (adjusted OR 1.89, 95% CI 1.15 to 3.10) had a significantly higher MetS incidence than the working control group. No association between early retirement or regular retirement with MetS incidence was found after adjusting for sociodemographic, educational and occupational factors. Occupational group did not moderate the association between employment transition type and MetS incidence.

CONCLUSION

The results suggest that older workers who transition from employment to unemployment or work disability are at risk for developing MetS. More awareness among occupational physicians and general practitioners about MetS incidence in late working life is needed in general and more specific among older workers who transition into unemployment or work disability.

Aneurysmal subarachnoid hemorrhage in Germany between 2005 and 2018: a nationwide observational study

BACKGROUND

In recent decades, the global incidence of aneurysmal subarachnoid hemorrhage (aSAH) has declined. However, significant regional differences exist. We present the first comprehensive analysis of time trends in the incidence of aSAH and case fatality in Germany.

METHODS

All patients hospitalized with aSAH in Germany between 2005 and 2018 were identified using International classification of disease (ICD10) codes I60.0 to I60.7.

RESULTS

A total of 101,105 cases were included. The incidence of aSAH in Germany decreased at a mean annual rate of 0.5 % (p=0.003) from 8.9 per 100,000 population in 2005 to 8.2 in 2018. Over time, incidences of aSAH declined among patients younger than 55 years and patients aged 70-79 years, increased among ages 60-64 years and remained stable in age groups 65-69 and 85-89 years. This corresponded to an increase in the mean age of aSAH onset from 55.6 (±14.3) to 59.0 (±14.0) years. Throughout the study period, the mean age of aSAH onset was higher in women compared to men (58.3 ±14.4 years vs. 56.1 ±14.1 years). There were no changes in in-hospital case fatality (16.2 vs. 16.6%, p=0.18), but the duration of hospital stay increased significantly from 19.7 to 24.8 days (p<0.001). The most frequent aSAH associated aneurysm location was the anterior circulation throughout the entire study period.

CONCLUSIONS

In Germany, the incidence of aSAH decreased between 2005 and 2018, especially in younger parts of the population. This may reflect effects of lifestyle adjustments most pronounced in younger age groups.

The modifying role of major cardiovascular risk factors in the association between retirement and cardiovascular disease: Results from SHARE Portugal

BACKGROUND

Despite the actual demographic trends and the global burden of cardiovascular diseases, there is little knowledge concerning the effects of retirement on this health outcome.

OBJECTIVE

We aimed to quantify the associations between retirement, and retirement age, with cardiovascular disease (heart disease and stroke) in the Portuguese population.

METHODS

We used data from the first Portuguese wave of the Survey of Health Ageing and Retirement in Europe. Logistic regression was applied to quantify the associations. The major risk factors for cardiovascular diseases and several features of retirement were considered as possible confounders or effect modifiers. Analysis was restricted to retirees in retirement process (retired for 5 years or less) and not retired because of illness.

RESULTS

An opposite direction of the association between retirement and heart disease was observed according to hypertension status, although not significant. Early retirement increased the odds of having a stroke, merely in individuals without heart disease (OR = 8.87; 95% CI 1.63-48.26). On the contrary, in individuals with heart disease, decreased the odds of having a stroke in (OR = 0.08; 95% CI 0.01-0.68).

CONCLUSIONS

Our findings suggest that retirement and retirement age may be beneficial or harmful, respectively, in the presence or absence of major risk factors for heart disease and stroke. We suggest that work-related stress affecting differently workers with and without these risk factors may eventually explain these findings.

The importance of workplace accommodation for cancer survivors - The role of flexible work schedules and psychological help in returning to work

We investigate whether accommodating job attributes influence the probability of returning to work three years after a cancer diagnosis. Using a combination of Danish administrative data and a survey carried out among Danish breast, colon, and melanoma skin cancer survivors, we find that the probability of returning to work is significantly and positively correlated with a flexible work schedule during and after cancer treatment. The result is robust when controlling for pre-cancer work experience, job seniority, pre-cancer job dissatisfaction, and post-cancer ability to work. Furthermore, we show that the influence of a flexible schedule varies with respect to cancer survivors' ability to work, level of education, and type of cancer.

The Effect of Commercial Activity Tracker Based Physical Activity Intervention on Body Composition and Cardiometabolic Health Among Recent Retirees

The REACT is a commercial activity tracker based intervention, which primarily aimed to increase physical activity. This study examines the secondary outcomes of the physical activity intervention on body composition and cardiometabolic health indicators. Overall 231 recently retired Finnish men and women [65.2 (SD 1.1) years, 83% women] took part to the study. The participants were randomized into intervention (n = 117) and control (n = 114) groups. The intervention group members used a commercial activity tracker (Polar Loop 2, Polar, Kempele, Finland) with a daily activity goal and inactivity alerts every day for 12 months. Controls received no intervention. Secondary health outcomes included body weight, fat mass, fat free mass, waist circumference, blood pressure, indicators of glucose and lipid metabolisms, and high-sensitivity C-reactive protein, and they were measured at baseline and at 12-months end point. Hierarchical linear mixed models were used to examine the differences between the groups over time, and no differences in the mean changes of the body composition and cardiometabolic health indicators between the groups were found (group*time interaction &gt;0.20 for all measures). Fat free mass, waist circumference, blood pressure, and low density lipoprotein levels decreased in both groups over the 12 months. These findings state that 1-year daily use of commercial activity tracker does not induce different cardiometabolic health effects when compared to the non-user controls among general population of recent retirees.

Physical Activity during the Retirement Transition of Men and Women: A Qualitative Longitudinal Study

The retirement transition is a major life change affecting people's lifestyles and behaviors, including those in relation to physical activity (PA), which is a key component of active ageing. Previous research analyzing the effect of retirement on PA levels has shown mixed results, and few studies investigated this issue in a gender perspective, thus, highlighting a need of knowledge in this respect. Aims of this study focused on the experience of PA during the retirement transition were to understand typologies of PA and possible changes in these typologies, to identify behavioural types relative to PA practice and levels, and to distinguish the main drivers and barriers for practicing PA associated with the different behavioural types. A further goal of the study was to investigate the abovementioned aims considering differences between women and men. Analyses were carried out within a three-year qualitative longitudinal study (2014-2016), which explored the individual experience of PA during the transition from work to retirement of 24 women and 16 men in Italy, with interviews carried out one year before and one and two years after retirement. Results show that preferred PA for both women and men was walking, along the transition to retirement. Over time, several participants replaced physically demanding activities with lighter ones. Six behavioural types were identified, describing individuals who incremented, started, or maintained the same level of PA, people who decreased PA levels or stopped it, and individuals who had a fluctuant behavior towards PA, or who had never practiced it. In general, poor health represented the main barrier to PA. For men, the main driver to PA was its effects on body shape, while for women, socialization/networking. In order to stimulate a more effective promotion of PA during the retirement transition, policy implications were discussed in light of the results obtained.

Socioeconomic and behavioral determinants of cardiovascular diseases among older adults in Belgium and France: A longitudinal analysis from the SHARE study

Despite advances in the healthcare system, cardiovascular diseases (CVDs) are still an important public health problem with disparities in the burden within and between countries. Studies among the adult population documented that socioeconomic and environmental factors play a role in the incidence and progression of CVDs. However, evidence is scarce on the socioeconomic determinants and the interplay with behavioral risks among older adults. Therefore, we identified socioeconomic and behavioral determinants of CVDs among older adults. Our sample consisted of 14,322 people aged 50 years and above from Belgium and France who responded to the waves 4, 5, 6 and/or 7 of the Survey of Health Ageing and Retirement in Europe. The effect of determinants on the occurrence of CVD was examined using a Generalized Estimating Equation (GEE) approach for binary longitudinal data. The overall rate of heart attack was 8.3%, which is 7.6% in Belgium and 9.1% in France. Whereas, 2.6% and 2.3% in Belgium and France, respectively, had experienced stroke. In the multivariable GEE model, older age [AOR: 1.057, 95%CI: 1.055-1.060], living in large cities [AOR: 1.14, 95%CI: 1.07-1.18], and retirement [AOR: 1.21, 95%CI: 1.16-1.31] were associated with higher risk of CVD. Furthermore, higher level of education [AOR: 0.82, 95%CI: 0.79-0.90], upper wealth quantile [AOR: 0.82, 95%CI: 0.76-0.86] and having social support [AOR: 0.81, 95%CI: 0.77-0.84] significantly lowers the odds of having CVD. A higher hand grip strength was also significantly associated with lower risk of CVD [AOR: 0.987, 95%CI: 0.984-0.990]. This study demonstrated that older adults who do not have social support, live in big cities, belong to the lowest wealth quantile, and have a low level of education have a higher likelihood of CVD. Therefore, community-based interventions aimed at reducing cardiovascular risks need to give more emphasis to high-risk retired older adults with lower education, no social support and those who live in large cities.