Do type, timing and duration of life course non-employment differentially predict dementia risk? An application of sequence analysis

IF 4.9 2区 医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Lucia Pacca , S. Amina Gaye , Willa D. Brenowitz , Kaori Fujishiro , M. Maria Glymour , Amal Harrati , Anusha M. Vable
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引用次数: 0

Abstract

Periods out of employment may influence dementia, but characterizing lifecourse employment is difficult and prior research is sparse. This study used sequence and cluster analysis to characterize type, timing, and duration of lifecourse work gaps and estimate associations with dementia risk.
Life History Mail Survey supplement to the U.S. Health Retirement Study participants (N = 5,945, 13.6 % of the Health and Retirement Study sample) reported lifecourse employment (full time or part time) and reasons and age of work gaps (unemployment, schooling, caregiving, or disability). Our exposure was gender-stratified employment trajectories from age 18–65, characterized using sequence analysis and cluster analysis. Our outcomes were algorithmically defined dementia probability scores and memory scores. We estimated the association between employment trajectories and dementia risk using generalized estimating equations and memory decline using linear mixed effect models, adjusted for age, gender, birthplace, and childhood socioeconomic status.
We identified 11 employment trajectories for women (including predominant work, disability, unemployment, caregiving, retirement) and 10 for men (similar, but no caregiving). Compared to “predominant work”, “disability” and “unemployment” trajectories were associated with higher dementia risk for men and women (e.g., disability among women: OR = 3.62; 95 % CI = 2.25, 5.81). Among women who cared for family, those who did not re-enter the labor force full-time had higher dementia risk (e.g. “family gap, go back part time”: OR = 1.79; 95 % CI = 1.15, 2.79) compared to the predominant work cluster. Women who cared for family and returned to full-time work had similar cognitive outcomes to those in the predominant work cluster. Men who had long spells of part-time work also had elevated dementia risk (e.g. part time earlier: OR = 1.64; 95 % CI = 1.16, 2.57). Finally, women and men with long periods of unreported employment status had higher dementia risk than those in the predominant work trajectory.
Results suggest the type, timing and duration of work gaps are differentially associated with dementia risk. Work gaps due to disability, unemployment or unreported employment status predicted higher dementia risk. Permanently leaving full-time work for caregiving predicted worse cognitive outcomes but temporary caregiving-related work interruptions did not.
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来源期刊
Social Science & Medicine
Social Science & Medicine PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
9.10
自引率
5.60%
发文量
762
审稿时长
38 days
期刊介绍: Social Science & Medicine provides an international and interdisciplinary forum for the dissemination of social science research on health. We publish original research articles (both empirical and theoretical), reviews, position papers and commentaries on health issues, to inform current research, policy and practice in all areas of common interest to social scientists, health practitioners, and policy makers. The journal publishes material relevant to any aspect of health from a wide range of social science disciplines (anthropology, economics, epidemiology, geography, policy, psychology, and sociology), and material relevant to the social sciences from any of the professions concerned with physical and mental health, health care, clinical practice, and health policy and organization. We encourage material which is of general interest to an international readership.
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