Elsevier

The Lancet

Volume 374, Issue 9705, 5–11 December 2009, Pages 1889-1896
The Lancet

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Self-rated health before and after retirement in France (GAZEL): a cohort study

https://doi.org/10.1016/S0140-6736(09)61570-1Get rights and content

Summary

Background

Governments need to increase the proportion of the population in work in most developed countries because of ageing populations. We investigated longitudinally how self-perceived health is affected by work and retirement in older workers.

Methods

We examined trajectories of self-rated health in 14 714 employees (11 581 [79%] men) from the French national gas and electricity company, the GAZEL cohort, for up to 7 years before and 7 years after retirement, with yearly measurements from 1989 to 2007. We analysed data by use of repeated-measures logistic regression with generalised estimating equations.

Findings

Overall, suboptimum health increased with age. However, between the year before retirement and the year after, the estimated prevalence of suboptimum health fell from 19·2% (95% CI 18·5–19·9) to 14·3% (13·7–14·9), corresponding to a gain in health of 8–10 years. We noted this retirement-related improvement in men (odds ratio 0·68, 95% CI 0·64–0·73) and women (0·74, 0·67–0·83), and across occupational grades (low 0·72, 0·63–0·82; high 0·70, 0·63–0·77), and it was maintained throughout the 7 years after retirement. A poor work environment and health complaints before retirement were associated with a steeper yearly increase in the prevalence of suboptimum health while still in work, and a greater retirement-related improvement; however, people with a combination of high occupational grade, low demands, and high satisfaction at work showed no such retirement-related improvement.

Interpretation

These findings suggest that the burden of ill-health, in terms of perceived health problems, is substantially relieved by retirement for all groups of workers apart from those with ideal working conditions, and that working life for older workers needs to be redesigned to achieve higher labour-market participation.

Funding

Swedish Council for Working Life and Social Research, Academy of Finland, INSERM (France), BUPA Foundation (UK), European Science Foundation, and Economic and Social Research Council (UK).

Introduction

Because of increasingly ageing populations, governments in most developed countries are seeking to increase the proportion of the population in work by raising the age of retirement.1, 2 However, reversing the downward trend in retirement age2, 3, 4 in this way is likely to be difficult,5 especially if older workers have suboptimum health at work4 while looking forward to a fairly healthy life after retirement.

Little is known about the effect of work and retirement on older workers' perceptions of health, which are a strong predictor of morbidity and mortality6, 7, 8 and of early retirement.9 Previous studies have produced conflicting findings, some suggesting that health improves after retirement,10, 11, 12, 13 others that it deteriorates,14, 15, 16 and some that it is not affected.17, 18, 19, 20 However, no evidence has been published for changes in health measured repeatedly over an extended period covering both several years of employment before and several years after retirement.

In this prospective study, we used yearly measurements of self-rated health in a large and varied French occupational cohort to examine trajectories of health from 7 years before retirement to 7 years after. We aimed to establish how people's perceived health is affected when they retire from work.

Section snippets

Study population

The GAZEL cohort was established in 1989 and comprises employees of the French national gas and electricity company, Electricité de France-Gaz de France (EDF-GDF), from which the name of the study is derived.21 At baseline, 20 624 employees (15 010 [73%] men), aged 35–50 years, gave written consent to participate (figure 1). EDF-GDF employees hold civil-servant-like status that entails job security and opportunities for occupational mobility. Typically, employees are taken on when they are in

Results

Most of the 14 714 respondents were men, were married, and, during the observation period, belonged to high or intermediate employment grades because of promotion within the company (table 1). Of the respondents, 10 564 (72%) retired before 56 years of age and 14 635 (99%) before 61 years. 610 (4%) respondents retired for health reasons (early retirees). During the 3 years before retirement, 11% had depression, 29% musculoskeletal complaints, 15% physical illness, and 32% more than 21 days of

Discussion

In this large, French, occupational cohort, retirement was associated with a substantial decrease in prevalence of suboptimum health, corresponding to an 8–10 year gain in perceived health. This pattern was remarkably consistent across occupational grades and sex, and, although the effect was stronger for people who had had a poor work environment or health problems before retirement, we also recorded a significant improvement in other groups, apart from those with ideal working conditions.

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