Content uploaded by Chenkai wu
Author content
All content in this area was uploaded by Chenkai wu on Jan 11, 2018
Content may be subject to copyright.
Association of retirement age with mortality:
a population-based longitudinal study among
older adults in the USA
Chenkai Wu,
1
Michelle C Odden,
1
Gwenith G Fisher,
2
Robert S Stawski
3
▸Additional material is
published online only. To view
please visit the journal online
(http://dx.doi.org/10.1136/jech-
2015-207097).
1
School of Biological and
Population Health Sciences,
College of Public Health and
Human Sciences, Oregon State
University, Corvallis, Oregon,
USA
2
Department of Psychology,
Colorado State University, Fort
Collins, Colorado, USA
3
School of Social and Human
Health Sciences, College of
Public Health and Human
Sciences, Oregon State
University, Corvallis, Oregon,
USA
Correspondence to
Chenkai Wu, School of
Biological and Population
Health Sciences, College of
Public Health and Human
Sciences, Oregon State
University, 206 Bates Hall,
Corvallis, OR 97331, USA;
wuche@onid.orst.edu
Received 15 December 2015
Revised 23 February 2016
Accepted 4 March 2016
To cite: Wu C, Odden MC,
Fisher GG, et al.J Epidemiol
Community Health Published
Online First: [please include
Day Month Year]
doi:10.1136/jech-2015-
207097
ABSTRACT
Background Retirement is an important transitional
process in later life. Despite a large body of research
examining the impacts of health on retirement, questions
still remain regarding the association of retirement age
with survival. We aimed to examine the association
between retirement age and mortality among healthy
and unhealthy retirees and to investigate whether
sociodemographic factors modified this association.
Methods On the basis of the Health and Retirement
Study, 2956 participants who were working at baseline
(1992) and completely retired during the follow-up
period from 1992 to 2010 were included. Healthy
retirees (n=1934) were defined as individuals who self-
reported health was not an important reason to retire.
The association of retirement age with all-cause
mortality was analysed using the Cox model.
Sociodemographic effect modifiers of the relation were
examined.
Results Over the study period, 234 healthy and 262
unhealthy retirees died. Among healthy retirees, a 1-year
older age at retirement was associated with an 11%
lower risk of all-cause mortality (95% CI 8% to 15%),
independent of a wide range of sociodemographic,
lifestyle and health confounders. Similarly, unhealthy
retirees (n=1022) had a lower all-cause mortality risk
when retiring later (HR 0.91, 95% CI 0.88 to 0.94).
None of the sociodemographic factors were found to
modify the association of retirement age with all-cause
mortality.
Conclusions Early retirement may be a risk factor for
mortality and prolonged working life may provide
survival benefits among US adults.
INTRODUCTION
Retirement is one of most important transitional
processes in later life. It has huge impacts on indivi-
duals’financial resources, daily activities, family
relations and social network.
1
Over the past several
decades and until recently, workers have retired at
younger ages in the USA as well as in many other
developed countries.
23
This trend towards early
retirement along with several other ongoing demo-
graphic trends, including declining fertility rates,
prolonged life expectancy and delayed workforce
entry by young adults, has contributed to a shrink-
ing working population that may not be able to fis-
cally support a rapidly growing retired
population.
45
To alleviate fiscal pressure on the US
Social Security, the age eligibility for claiming full
retirement benefits has been gradually increased
from 65 to 67 years, and benefits available at age
62 years have been reduced.
6
Most recently,
research has pointed to a trend towards increased
retirement age.
78
Therefore, it is timely and critical
to develop a better understanding of whether and
how retirement age impacts retirees’health and
longevity. Understanding the association of retire-
ment age with longevity has important implications
for postretirement survival and may elucidate cri-
teria for evaluating the current policies that aim to
encourage older workers to retire later and to
remain in the workforce.
There is a developing body of literature on the
relation between retirement age and longevity,
although the findings are mixed. Several studies
reported higher mortality among early retirees than
those who retired around the institutionally norma-
tive age,
9–14
whereas others found no differences in
longevity between early and on-time retirees
15–18
or even a lower mortality among individuals retir-
ing early.
19
In sum, no consensus has been reached
on the existence, direction and magnitude of the
association between retirement age and longevity.
One major methodological challenge in studying
retirement age and mortality is how to account for
the healthy worker bias.
20
Poor health is an import-
ant reason for early retirement
21 22
and is also a
well-established risk factor for mortality.
23 24
Therefore, the adverse effects of early retirement
on longevity may be, at least partially, attributable
to workers’pre-retirement health status.
Knowledge of the association of retirement age
with longevity is also limited by the use of non-
representative samples such as German firefigh-
ters,
13
US petrochemical workers
18
and Austrian
blue-collar workers.
11
This study aimed to investigate the association of
retirement age with mortality among US adults to
determine whether there is an optimal retirement
timing to preserve longevity. This study also
explored whether sociodemographic factors modi-
fied this relation. We addressed these issues using
data from the Health and Retirement Study (HRS),
a large, nationally representative prospective study
of US adults aged ≥51 years. To rigorously address
the healthy worker bias, we restricted the primary
analysis to participants who reported health had no
impact on their decision to retire.
METHODS
Participants
We used data from the HRS collected between
1992 and 2010. The HRS is a co-operative agree-
ment between the National Institute on Aging and
the University of Michigan (U01 AG009740) and
aims to describe changes in life patterns through
Wu C, et al.J Epidemiol Community Health 2016;0:1–7. doi:10.1136/jech-2015-207097 1
Research report
JECH Online First, published on March 21, 2016 as 10.1136/jech-2015-207097
Copyright Article author (or their employer) 2016. Produced by BMJ Publishing Group Ltd under licence.
the retirement transition among US adults by collecting infor-
mation about their health conditions, family network, social
relations, financial situation and employment status.
25
Ethical
approval was obtained from the University of Michigan
Institutional Review Board. Further details about the recruit-
ment strategies, design and sampling approaches of the HRS
have been documented elsewhere.
26
There are currently six
cohorts enrolled in the HRS. This study focused on the initial
HRS cohort because it has the most waves of data for tracking
the occurrence of retirement and death events, and other study
cohorts comprised individuals who are either too young or too
old, providing limited information on retirement.
The sample was first limited to 8756 participants who were
primary interview respondents (ie, not from a proxy respond-
ent) and had ≥2 valid assessments. The sample was further
restricted to 4092 participants who self-reported being working
at baseline and had retired by the end of the 2010 wave of data
collection. Moreover, because occupation and preretirement
health status were important confounders, 524 individuals
whose occupation information was unavailable and 454 indivi-
duals who did not report whether health was an important
reason to retire were excluded. Last, 158 individuals who were
lost to follow-up in the year when they reported being com-
pletely retired were also excluded. These selection criteria
resulted in a sample of 2956 eligible participants. The flow of
participants through each stage of selection based on inclusion
criteria is shown in figure 1.
To account for the healthy worker bias, the sample was strati-
fied into two subgroups, healthy and unhealthy retirees, based
on the question, ‘Was poor health very important, moderately
important, somewhat important, or not important at all for
retirement?’. Individuals who answered ‘not important at all’
were classified as healthy retirees, whereas individuals who
chose one of the other three answers were considered unhealthy
Figure 1 Flow chart of participants
excluded from the present study,
Health and Retirement Study, 1992–
2010.
2WuC,et al.J Epidemiol Community Health 2016;0:1–7. doi:10.1136/jech-2015-207097
Research report
retirees. Consequently, the analytic sample consisted of 1934
healthy retirees (from 1782 households) and 1022 unhealthy
retirees (from 922 households).
Measures
Outcomes: The outcome was all-cause mortality. Participants
were censored when lost to follow-up or the end of the analytic
period (2010 survey wave). Mortality was ascertained on the
basis of a variable recording participants’year and month of
death taken from an exit interview or a spouse/partner’s core
interview. Information on mortality was available through 2011.
Predictors: Retirement status was ascertained according to a
question asking respondents in each wave: ‘At this time do you
consider yourself partly retired, completely retired or not
retired at all?’An individual was defined as retired if they
responded, ‘completely retired’. Retirement age was defined as
the age when an individual, for the first time, reported being
completely retired.
Covariates: To account for potential confounders, sociodemo-
graphic (birth cohort, gender, race dichotomised as white/non-
white, marital status dichotomised into married/non-married,
education categorised as <high school, high school and >high
school, non-housing wealth and preretirement occupation cate-
gorised into blue-collar, white-collar and service), lifestyle infor-
mation (smoking status, alcohol use and physical activity) and
health-related variables (body mass index, self-rated health, dis-
ability measured by difficulties performing activities in daily
livings including walking across a room, bathing, eating, dress-
ing and getting into and out of bed, and medical history includ-
ing hypertension, diabetes, cancer, lung disease, heart problem,
stroke, arthritis and psychiatric problems) were included in the
multivariable analyses. All covariates were measured at baseline.
Statistical analysis
We first compared the mean values of baseline characteristics
between healthy and unhealthy retirees, using a t test for con-
tinuous variables and a χ
2
test for categorical variables. We then
evaluated the distribution of retirement age for healthy and
unhealthy retirees separately.
We investigated the unadjusted association of retirement age
with mortality among healthy retirees in a Cox model.
Retirement age and its squared term were the primary predic-
tors. The purpose of including this quadratic term was to test
for a potential curvilinear relationship between retirement age
and mortality. The quadratic term was included in subsequent
models if it was associated with mortality at a significance level
of p<0.05. Subsequently, we included all of the aforementioned
sociodemographic, lifestyles and health-related variables as con-
founders in the model to estimate the adjusted HRs for the mor-
tality risk per 1-year increase in retirement age. Additionally, we
examined the association of retirement age with mortality, mod-
elling the continuously measured retirement age in categories to
allow non-linear association. We first classified healthy retirees
as early, on-time and late retirees using the first and the third
quartiles of retirement age as cut-offs. Alternatively, we used
mean±1SD as cut-offs to classify healthy retirees into three
categories.
We evaluated effect modification by including interaction
terms between retirement age (continuous) and sociodemo-
graphic (birth cohort, gender, race, education, wealth, occupa-
tion and marital status) factors in the model and testing for
statistical significance. Interaction terms that did not reach statis-
tical significance (p≥0.05) were excluded from the final model.
We used Schoenfeld residuals to assess the proportional hazards
assumption of Cox models.
As secondary analyses, Cox models were repeated for
unhealthy retirees. Additionally, pooled models including
healthy and unhealthy retirees were fitted to test whether the
association of retirement age with mortality differed across two
subgroups. Furthermore, to assess the sensitivity of study results
to classification of healthy retirees, we repeated the analyses
using two more broad definitions of healthy retirees. Initially,
we categorised participants who reported health was ‘somewhat
important’to retiring as healthy retirees (n=2143).
Alternatively, we categorised participants as healthy retirees
(n=2342) if they reported health was ‘not at all’,‘somewhat’or
‘moderately important’for retirement. We used
inverse-probability-of-attrition weights (IPAW) to account for
potential selective attrition that may have arisen during
follow-up.
We centred retirement age at 65 years to reduce collinearity
between linear and quadratic terms and to improve
Table 1 Demographic, behavioural and health characteristics of
participants (healthy retirees vs unhealthy retirees), Health and
Retirement Study, 1992–2010
Healthy retirees
(n=1934)
Unhealthy retirees
(n=1022)
Mean±SD or count (%) p Value
a
Male 967 (50.0) 457 (44.7) **
White (vs non-White) 1628 (84.2) 775 (75.8) ***
Age 55.5±3.0 55.1±3.1 ***
Education ***
<High school 307 (15.9) 285 (27.9)
High school 1092 (56.4) 562 (55.0)
>High school 535 (27.7) 175 (17.1)
Married (vs others) 1487 (76.9) 666 (65.2) ***
Non-housing wealth ***
Min—1st quartile 405 (20.9) 351 (34.3)
1st quartile—median 472 (24.4) 262 (25.6)
Median—3rd
quartile
498 (25.8) 251 (24.6)
3rd quartile—max 559 (28.9) 158 (15.5)
Occupation ***
White-collar 680 (35.2) 231 (22.6)
Service 756 (39.1) 446 (43.6)
Blue-collar 498 (25.8) 345 (33.8)
Smoking ***
Never-smoker 754 (39.0) 337 (33.0)
Former 756 (39.1) 373 (36.5)
Current 424 (21.9) 312 (30.5)
Alcohol use (yes) 1307 (67.6) 622 (60.9) ***
Frequent exercise 1041 (53.8) 498 (48.7) **
Body mass index ***
Underweight/normal 728 (37.6) 282 (27.6)
Overweight 843 (43.6) 422 (41.3)
Obese 363 (18.8) 318 (31.1)
Self-rated health 3.9±0.9 3.3±1.1 ***
Limitation in ≥1 ADL 42 (2.2) 81 (7.9) ***
Chronic conditions 0.9±0.9 1.5±1.2 ***
Death 234 (12.1) 262 (25.6) ***
*p<0.05. **p<0.01. ***p<0.001.
a
Two-sample t test for continuous variables and χ
2
test for categorical variables.
ADL, activities of daily living.
Wu C, et al.J Epidemiol Community Health 2016;0:1–7. doi:10.1136/jech-2015-207097 3
Research report
interpretation of the statistical results. We used robust SEs to
account for nested data structure of the HRS (ie, participants
nested within households). All statistical tests were two sided.
All analyses were conducted using Stata V.13.1.
RESULTS
A total of 2632 excluded participants were generally compar-
able to the included participants, except they were more often
males and more likely to be white-collar workers (see online
supplementary table S1).
Among 2956 participants included, 1934 (65.4%) and 1022
(34.6%) were classified as healthy and unhealthy retirees,
respectively. Over an average follow-up period of 16.9 years,
234 (12.1%) healthy and 262 (25.6%) unhealthy retirees died.
Compared with unhealthy retirees, healthy retirees were more
often men and white, more highly educated and more likely
married (table 1). They were also more likely to be white-collar
workers and had more wealth than unhealthy retirees. In add-
ition, healthy retirees were more physically active, less likely to
smoke, less likely to have a limitation in one or more activities
of daily living, had a lower body mass index, fewer chronic con-
ditions and better self-reported health than unhealthy retirees.
Overall, healthy retirees had relatively advantaged socio-
economic, behavioural and health profiles.
The distribution of retirement age was similar among healthy
and unhealthy retirees, with a majority of people retiring
around the age of 65 years (figure 2). The average retirement
age (SD) was 64.9 (3.8) and 64.3 (4.1) years and the range was
53.3–78.0 and 54.7–79.4 years for healthy and unhealthy retir-
ees, respectively.
Among healthy retirees, older retirement age was significantly
associated with lower mortality in the unadjusted model (table 2).
The addition of a quadratic term for retirement age did not
add significantly to the model or alter the HR associated with
the linear term for retirement age. The association of retirement
age with mortality for healthy retirees remained nearly identical,
after adjusting for sociodemographic, lifestyle and health-related
covariates; retiring 1 year later was associated with an 11%
(95% CI 8% to 15%) lower mortality risk. Based on the χ
2
tests, there was no strong evidence suggesting that the propor-
tional hazards assumption was violated for any of the covariates
in the adjusted model (p >0.01; p=0.38 for global test).
Results of interaction analysis showed that none of the sociode-
mographic factors significantly modified the association of
retirement age and mortality.
When retirement age was modelled categorically, 466 and
483 healthy retirees were classified as early (<62.4 years) and
late (>67.0 years) retirees using the first and the third quartiles
as cut-offs, respectively. Alternatively, 252 and 297 healthy retir-
ees were considered early (<61.1 years) and late (>68.7 years)
retirees using mean±1SD as cut-offs, respectively. The findings
obtained using two categorisation approaches consistently
showed that early and late retirees had significantly higher and
lower mortality risk, respectively, compared with on-time retir-
ees (figure 3).
In the pooled analysis, unhealthy retirees had an 84% (95%
CI 51% to 126%) higher mortality risk than healthy retirees
(table 2). However, the association of retirement age with mor-
tality did not differ between these subgroups (p=0.83). When
unhealthy retirees were analysed separately, retiring 1 year later
was associated with a 9% (95% CI 6% to 12%) lower mortality
risk. The estimates for the association of retirement with mortal-
ity in healthy retirees remained almost unchanged when categor-
ising healthy retirees differently (see online supplementary table
S2). Results were virtually unchanged when we applied IPAW to
deal with potential selective attrition due to non-response (data
not shown).
DISCUSSION
In a population-based longitudinal study of US adults, we found
early retirement was associated with increased mortality risk,
and prolonged working life may be related to survival benefits
among healthy and unhealthy retirees, independent of a wide
range of sociodemographic, lifestyle and health-related con-
founds. By using a cohort of US adults who do not face manda-
tory retirement and have a flexible retirement arrangement, we
Figure 2 Distribution of retirement
age for healthy and unhealthy retirees,
Health and Retirement Study,
1992–2010.
4WuC,et al.J Epidemiol Community Health 2016;0:1–7. doi:10.1136/jech-2015-207097
Research report
were able to extend previous research by showing late retire-
ment was independently related to a reduced risk of mortality.
Our findings were consistent with previous investigations of
Austrian, German, Greek, Swedish and US populations showing
an increased mortality risk associated with early retirement.
9–14
Bamia et al
9
found early exit from the workforce was a risk
factor for mortality in Greek retirees who were free of chronic
conditions prior to retirement. In a more recent investigation of
Swedish residents who were healthy and employed at age
60 years, Carlsson et al
10
showed early retirement was associated
with an increased likelihood of death over the follow-up period.
The mechanisms behind the association of retirement age
with mortality are generally not well understood. One possible
explanation is employment is a key component of individuals’
identity that provides them with substantial financial, psycho-
social and cognitive resources. Additionally, retirement could be
a stressful life event associated with cognitive decline, difficulties
in daily activities, morbidities, anxiety and depression.
20 27–31
Delayed transition into retirement and continued participation
in volunteer activities and paid work in old age after retirement
could delay the declines in physical, cognitive and mental func-
tioning and reduce the risk of morbidities,
32–36
which leads to
better survival. This may be particularly true for individuals in
work-oriented countries, where work is highly valued and
considered a necessary part of life.
37
Work characteristics (eg,
more physically demanding or stressful jobs) may prompt earlier
retirement that may have longer term effects on health and mor-
tality even if workers do not retire due to health reasons.
8
Moreover, from the life course perspective, the decision about
when to retire is shaped by many factors, including cultural and
institutional norms; delayed transition into retirement may
become more socially and culturally desirable.
738
There was no evidence that the effects of retirement age on
mortality were modified by sociodemographic characteristics,
suggesting that the beneficial effect of retiring late may be uni-
versal across different sociodemographic profiles. Our findings
are consistent with previous studies reporting an increased risk
of mortality associated with retiring early in homogeneous
populations.
11 13 14
Wagner et al
13
found early retirement was a
mortality risk among German firefighters. Kuhn et al
11
reported
a higher probability of dying before age 67 years among male
blue-collar workers who had access to early retirement than
those who were ineligible.
Pooled analyses including healthy and unhealthy retirees
showed unhealthy retirees had relatively high mortality. These
findings were in line with previous studies showing individuals
who retired due to health-related reasons had relatively high
mortality risk.
13
Table 2 Association of retirement age with mortality, stratified by healthy versus unhealthy retirees, Health and Retirement Study, 1992–2010
Healthy retirees (n=1934) Unhealthy retirees (n=1022) Pooled analysis* (n=2956)
HR 95% CI
Unadjusted
Retirement age (centred at 65) 0.89 0.86 to 0.92 0.90 0.87 to 0.92 0.89 0.87 to 0.91
Adjusted†
Retirement age (centred at 65) 0.89 0.85 to 0.92 0.91 0.88 to 0.94 0.90 0.88 to 0.92
Retired due to health (yes) –– –– 1.84 1.51 to 2.26
Male 1.66 1.21 to 2.27 1.79 1.33 to 2.43 1.75 1.41 to 2.17
White (vs non-white) 1.11 0.75 to 1.66 1.03 0.76 to 1.40 1.04 0.82 to 1.33
Birth cohort (centred at 1931) 1.02 0.96 to 1.09 1.01 0.96 to 1.07 1.02 0.98 to 1.06
Education (ref. <high school)
High school 0.67 0.47 to 0.96 0.85 0.63 to 1.15 0.79 0.62 to 0.99
>High school 0.66 0.40 to 1.07 1.21 0.73 to 2.00 0.90 0.63 to 1.28
Married (vs others) 0.81 0.59 to 1.13 0.98 0.73 to 1.33 0.90 0.72 to 1.13
Wealth (ref. <1st quartile)
1st quartile—median 1.21 0.83 to 1.76 0.96 0.69 to 1.35 1.09 0.85 to 1.39
Median—3rd quartile 0.97 0.64 to 1.47 0.90 0.63 to 1.30 0.93 0.71 to 1.22
3rd quartile—max 0.97 0.63 to 1.49 0.90 0.57 to 1.42 0.91 0.67 to 1.23
Occupation (ref. white-collar)
Service 0.93 0.64 to 1.35 1.30 0.84 to 2.01 1.11 0.84 to 1.48
Blue-collar 0.97 0.64 to 1.46 1.19 0.77 to 1.83 1.09 0.81 to 1.46
Smoking (ref. never-smokers)
Former smokers 1.25 0.88 to 1.77 1.37 0.96 to 1.93 1.33 1.04 to 1.71
Current smokers 2.66 1.88 to 3.77 2.55 1.82 to 3.57 2.59 2.03 to 3.31
Drinking (yes) 0.94 0.70 to 1.27 0.85 0.65 to 1.12 0.90 0.73 to 1.10
Frequent exercise (yes) 1.04 0.80 to 1.34 0.74 0.57 to 0.95 0.87 0.72 to 1.04
BMI (ref. normal/low)
Overweight 0.89 0.66 to 1.19 1.07 0.78 to 1.47 0.97 0.78 to 1.20
Obese 1.24 0.86 to 1.77 1.09 0.76 to 1.55 1.13 0.88 to 1.46
Self-rated health 0.90 0.77 to 1.05 0.91 0.80 to 1.05 0.91 0.82 to 1.01
Chronic conditions 1.22 1.05 to 1.40 1.12 1.00 to 1.26 1.16 1.06 to 1.27
Limitation in any ADL 2.32 1.18 to 4.56 0.97 0.64 to 1.48 1.14 0.79 to 1.66
*Both healthy and unhealthy retirees were included. p Value for interaction, retirement age×retired due to health (yes or no)=0.834.
†Estimates adjusted for sociodemographic (birth cohort, gender, marital status, education, wealth), lifestyle (smoking status, alcohol use, body mass index) and health-related (self-rated
health, medical history and activities of daily living) measures.
ADL, activities of daily living; BMI, body mass index.
Wu C, et al.J Epidemiol Community Health 2016;0:1–7. doi:10.1136/jech-2015-207097 5
Research report
This study had several distinct substantive and methodological
strengths. First, we used a large sample from a nationally repre-
sentative study with rich sociodemographic, lifestyle and health
information. Second, we rigorously accounted for the confound-
ing effects of preretirement health status by restricting the
primary analysis to retirees who self-reported health was not
important for retirement. Using self-reported information to
define healthy retirees appeared valid, as evidenced by the fact
that healthy retirees had relatively advantaged socioeconomic,
behavioural and health profiles. Additionally, self-reported
health is arguably better than objectively measured health since
subjective evaluations of health may have the largest impact on
an individual’s choice to retire.
39 40
Third, unlike most previous
studies, we examined the health effect of both early and late
retirement. Fourth, in addition to examining the main effect of
retirement age on mortality, we investigated whether this rela-
tion differed across sociodemographic subgroups. Finally, this
study had a long follow-up period, which allows the investiga-
tion of long-term survival and provides sufficient death events
to achieve statistical power.
We acknowledge several limitations in this study. First, this
study focused exclusively on retirement age and mortality.
Future research should investigate the mechanisms by which
retirement age impacts longevity to have a better understanding
of the relationship between retirement age and trajectories of
health and quality of life before and after retirement. Second,
the question used in this study to define healthy retirees does
not necessarily identify whether their health was the dominant
reason for them to retire. The decision about when to retire is
multifactorial and complex;
8
it is possible that individuals who
considered health was important for retirement indeed left the
workforce owing to a variety of reasons related to, but not dir-
ectly indicative of, poor health, although we argue this defin-
ition was the most conservative approach to control for
confounding by poor health status. Third, as with any observa-
tional study, residual confounding may persist if important con-
founders were omitted.
In general, this study adds to the retirement literature by study-
ing a representative US cohort and using a rigorous definition of
healthy retirees. The study findings may have important implica-
tions for policies concerning the labour market, retirement and
later life health. In the context of rising longevity, changes in
retirement ages across cohorts and young adults delaying entry
into the workforce, policymakers have pressed for policy changes
encouraging late retirement to alleviate the old-age dependency
ratio. In addition to the economic and social impacts of delaying
retirement age, it is also important to consider the health conse-
quences of retirement for policy evaluation. This study suggests
late retirement has a beneficial effect on longevity and early
retirement is associated with higher mortality. In this sense, redu-
cing early retirement benefits, providing social and economic
incentives to prolong working life and enacting policies that aim
to postpone retirement may be beneficial for individuals’health.
What is already known on this subject
▸Previous studies reported conflicting results regarding the
health effects of retirement age.
▸Prior research has not sufficiently accounted for the healthy
worker bias.
▸The health effects of late retirement have been rarely
examined.
What this study adds
▸Early retirement may be a risk factor for mortality and
prolonged working life may provide survival benefits.
▸The relation between retirement age and mortality did not
vary across sociodemographic subgroups.
Figure 3 Association of categorised retirement age with mortality in healthy retirees, Health and Retirement Study, 1992–2010. Note: On-time
retirees were considered reference group.
6WuC,et al.J Epidemiol Community Health 2016;0:1–7. doi:10.1136/jech-2015-207097
Research report
Acknowledgements The authors wish to thank Dr Richard A Settersten and Dr
Adam J Branscum for their review of earlier versions of this manuscript.
Contributors CW conceived of and designed the study, conducted the analyses,
interpreted the findings and wrote and revised the manuscript. RSS contributed to
the study design, subject matter expertise, interpretation of the data and drafting of
the manuscript. MCO contributed statistical expertise, interpretation of the data and
drafting of the manuscript. GGF contributed to subject matter expertise and drafting
of the manuscript. All authors were involved in article revisions and have approved
the final version.
Funding This work was supported by a grant from National Institute on Aging
(NIA): R03-AG042919-01, and a Pilot Grant from the Michigan Center on the
Demography of Aging: P30-AG012846.
Competing interests None declared.
Ethics approval University of Michigan Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
REFERENCES
1 Doyle Y, McKee M, Rechel B, et al. Meeting the challenge of population ageing.
BMJ 2009;339:b3926.
2 Gendell M. Retirement age declines again in 1990s. Monthly Lab Rev
2001;124:12.
3 Wheaton F, Crimmins EM. The demography of aging and retirement. In: Wang M, ed.
Handbook of retirement. Oxford University Press, 2013.
4 Leibfritz W. Retiring later makes sense. Korea 2002;60:68.
5 Vaupel JW, Loichinger E. Redistributing work in aging Europe. Science
2006;312:1911–13.
6 McGee JP, Wegman DH. Health and safety needs of older workers. National
Academies Press, 2004.
7 Fisher GG, Chaffee DS, Sonnega A. Retirement Timing: A Review and
Recommendations for Future Research. Work, Aging and Retirement 2016; doi:10.
1093/workar/waw001.
8 Munnell AH. The Average Retirement Age: An Update. Issue in Brief 15–4.
Chestnut Hill, MA: Center for Retirement Research at Boston College; 2015.
9 Bamia C, Trichopoulou A, Trichopoulos D. Age at retirement and mortality in a
general population sample: the greek EPIC study. Am J Epidemiol 2008;167:561–9.
10 Carlsson S, Andersson T, Michaëlsson K, et al. Late retirement is not associated
with increased mortality, results based on all Swedish retirements 1991–2007. Eur J
Epidemiol 2012;27:483–6.
11 Kuhn A, Wuellrich JP, Zweimüller J. Fatal attraction? Access to early retirement and
mortality. IZA Discussion Papers 5160, The Institute for the Study of Labor (IZA)
2010.
12 Kühntopf S, Tivig T. Early retirement and mortality in Germany. Eur J Epidemiol
2012;27:85–9.
13 Wagner NL, Berger J, Flesch-Janys D, et al. Mortality and life expectancy of
professional fire fighters in Hamburg, Germany: a cohort study 1950–2000. Environ
Health 2006;5:27.
14 Waldron H. Links between early retirement and mortality. Social Security
Administration, Office of Policy, Office of Research, Evaluation, and Statistics, 2001.
15 Hernaes E, Markussen S, Piggott J, et al. Does retirement age impact mortality?
J Health Econ 2013;32:586–98.
16 Hult C, Stattin M, Janlert U, et al. Timing of retirement and mortality—a cohort
study of Swedish construction workers. Soc Sci Med 2010;70:1480–6.
17 Litwin H. Does early retirement lead to longer life? Ageing Soc 2007;27:739–54.
18 Tsai SP, Wendt JK, Donnelly RP, et al. Age at retirement and long term survival of
an industrial population: prospective cohort study. BMJ 2005;331:995.
19 Brockmann H, Müller R, Helmert U. Time to retire—time to die? A prospective
cohort study of the effects of early retirement on long-term survival. Soc Sci Med
2009;69:160–4.
20 Dave D, Rashad I, Spasojevic J. The effects of retirement on physical and mental
health outcomes. South Econ J 2008;75:497–523.
21 Mein G, Martikainen P, Stansfeld SA, et al. Predictors of early retirement in British
civil servants. Age Ageing 2000;29:529–36.
22 Rice NE, Lang IA, Henley W, et al. Common health predictors of early retirement:
findings from the English Longitudinal Study of Ageing. Age Ageing
2011;40:54–61.
23 Harris SE, Deary IJ, MacIntyre A, et al. The association between telomere length,
physical health, cognitive ageing, and mortality in non-demented older people.
Neurosci Lett 2006;406:260–4.
24 Lee Y. The predictive value of self assessed general, physical, and mental health on
functional decline and mortality in older adults. J Epidemiol Community Health
2000;54:123–9.
25 Juster FT, Suzman R. An overview of the Health and Retirement Study. J Human
Resources 1995:S7–S56.
26 Heeringa SG, Connor JH. Technical description of the health and retirement survey
sample design. Ann Arbor: University of Michigan, 1995.
27 Bossé R, Aldwin CM, Levenson MR, et al. Mental health differences among retirees
and workers: findings from the Normative Aging Study. Psychol Aging 1987;2:383.
28 Elwell F, Maltbie-Crannell AD. The impact of role loss upon coping resources and
life satisfaction of the elderly. J Gerontol 1981;36:223–32.
29 Kim JE, Moen P. Retirement transitions, gender, and psychological well-being a
life-course, ecological model. J Gerontol B Psychol Sci Soc Sci 2002;57:P212–22.
30 Olesen K, Rugulies R, Rod NH, et al. Does retirement reduce the risk of myocardial
infarction? A prospective registry linkage study of 617 511 Danish workers. Int J
Epidemiol 2014;43:160–7.
31 Roberts BA, Fuhrer R, Marmot M, et al. Does retirement influence cognitive
performance? The Whitehall II Study. J Epidemiol Community Health
2011;65:958–63.
32 Dufouil C, Pereira E, Chêne G, et al. Older age at retirement is associated with
decreased risk of dementia. Eur J Epidemiol 2014;29:353–61.
33 Fisher GG, Stachowski A, Infurna FJ, et al. Mental work demands, retirement, and
longitudinal trajectories of cognitive functioning. J Occup Health Psychol
2014;19:231.
34 Luoh MC, Herzog AR. Individual consequences of volunteer and paid work in old
age: health and mortality. J Health Soc Behav 2002;43:490–509.
35 Rennemark M, Berglund J. Decreased cognitive functions at the age of 66, as
measured by the MMSE, associated with having left working life before the age of
60: results from the SNAC study. Scand J Public Health 2014;42:304–9.
36 Stenholm S, Westerlund H, Salo P, et al. Age-related trajectories of physical
functioning in work and retirement: the role of sociodemographic factors, lifestyle
and disease. J Epidemiol Community Health 2014;68:503–9.
37 Oakman J, Wells Y. Retirement intentions: what is the role of push factors in
predicting retirement intentions? Ageing Soc 2013;33:988–1008.
38 Fisher GG, Ryan LH, Sonnega A. Prolonged working years: consequences and
directions for interventions. In: Vuori J, Blonk R, Price RH (eds) Sustainable working
lives. Springer, 2015:269–88.
39 Bound J. Self-reported vs. objective measures of health in retirement models.
National Bureau of Economic Research, 1989.
40 Adams GA, Beehr TA. Retirement: reasons, processes, and results. Springer
Publishing Company, 2003.
Wu C, et al.J Epidemiol Community Health 2016;0:1–7. doi:10.1136/jech-2015-207097 7
Research report
