Sex differences in employment history and old age cognition: Evidence from the China Health and Retirement Longitudinal Study.

Abstract

Prior research on employment history and old age health has focused on the US and Europe, leaving studies of developing countries underexplored. This study characterizes the employment history of Chinese men and women and examines their associations with cognition. Individuals (aged 60+) enrolled in the 2011 China Health and Retirement Longitudinal Study were included ($N_{\text{men}}$=2,733, $N_{\text{women}}$=2,363) and followed up in 2013 and 2015. Cognition was measured by the sum of memory (word recall) and mental intactness (tasks like serial 7's). Retrospective information on employment history (age 15-60) was retrieved. Sequence analysis grouped similar employment trajectories and mixed-effect models examined the relationship between employment trajectories and cognition. A significant proportion of Chinese were consistently employed in agriculture (45% of men; 70% of women). About 26% men were consistently non-agriculture employed and retired at age 60, while 29% men had fluctuating employment featuring agriculture and early retirement. About 15% women were consistently non-agriculture employed and retired at age 55. Notably, 14% women had fluctuating employment featuring unemployment, home, and early retirement. Compared to the agriculture employment, the non-agriculture employed group reported better cognition (men: β = 1.26, 95%CI = 0.81, 1.66; women: β = 1.63, 95%CI = 1.09, 2.30). Men's fluctuating employment trajectory also had higher cognition than the agriculture employment group. Older Chinese experienced distinct life course employment trajectories reflecting the economic and historic development in China. Sex difference was evident as women were more involved in agricultural work and working at home. Agricultural employment was associated with worse cognition, highlighting the disadvantaged health status of Chinese farmers.