Socioeconomic differences in working life expectancy: a scoping review.

BACKGROUND: In the last decade, interest in working life expectancy (WLE) and socioeconomic differences in WLE has grown considerably. However, a comprehensive overview of the socioeconomic differences in WLE is lacking. The aim of this review is to systematically map the research literature to improve the insight on differences in WLE and healthy WLE (HWLE) by education, occupational class and income while using different ways of measuring and estimating WLE and to define future research needs. METHODS: A systematic search was carried out in Web of Science, PubMed and EMBASE and complemented by relevant publications derived through screening of reference lists of the identified publications and expert knowledge. Reports on differences in WLE or HWLE by education, occupational class or income, published until November 2022, were included. Information on socioeconomic differences in WLE and HWLE was synthesized in absolute and relative terms. RESULTS: A total of 26 reports from 21 studies on educational and occupational class differences in WLE or HWLE were included. No reports on income differences were found. On average, WLE in persons with low education is 30% (men) and 27% (women) shorter than in those with high education. The corresponding numbers for occupational class difference were 21% (men) and 27% (women). Low-educated persons were expected to lose more working years due to unemployment and disability retirement than high-educated persons. CONCLUSIONS: The identified socioeconomic inequalities are highly relevant for policy makers and pose serious challenges for equitable pension policies. Many policy interventions aimed at increasing the length of working life follow a one-size-fits-all approach which does not take these inequalities into account. More research is needed on socioeconomic differences in HWLE and potential influences of income on working life duration.

Maternal health, well-being, and employment transitions: A longitudinal comparison of partnered and single mothers in Germany.

Balancing parenthood and employment can be challenging and distressing, particularly for single mothers. At the same time, transitioning to employment can improve the financial situations of single mothers and provide them with access to social networks, which can have beneficial effects on their health and well-being. Currently, however, it is not well understood whether the overall impact of employment on single mothers is positive or negative, and to what extent it differs from the impact of employment on partnered mothers. Building on the literature on work-family conflict, we investigate the differential effects of employment transitions on the health and well-being of single mothers and partnered mothers. Using longitudinal data from the German Socio-Economic Panel (1992-2016), we apply panel regression techniques that address the potential endogeneity of maternal employment, as well as the dynamic nature of the relationship between employment transitions and maternal health and well-being. We find that employment has a positive impact on single mothers, and that single mothers benefit from employment significantly more than partnered mothers. Surprisingly, income does not appear to be an important driver of these results. Overall, our findings suggest that employment plays a key role in the well-being of single mothers.

The Extension of Late Working Life in Germany: Trends, Inequalities, and the East-West Divide.

The extension of late working life has been proposed as a potential remedy for the challenges of aging societies. For Germany, surprisingly little is known about trends and social inequalities in the length of late working life. We use data from the German Microcensus to estimate working life expectancy from age 55 onward for the 1941‒1955 birth cohorts. We adjust our calculations of working life expectancy for working hours and present results for western and eastern Germany by gender, education, and occupation. While working life expectancy has increased across cohorts, we find strong regional and socioeconomic disparities. Decomposition analyses show that among males, socioeconomic differences are predominantly driven by variation in employment rates; among women, variation in both employment rates and working hours are highly relevant. Older eastern German women have longer working lives than older western German women, which is likely attributable to the German Democratic Republic legacy of high female employment.

US Racial-Ethnic Mortality Gap Adjusted for Population Structure.

BACKGROUND: US racial-ethnic mortality disparities are well documented and central to debates on social inequalities in health. Standard measures, such as life expectancy or years of life lost, are based on synthetic populations and do not account for the real underlying populations experiencing the inequalities. METHODS: We analyze US mortality disparities comparing Asian Americans, Blacks, Hispanics, and Native Americans/Alaska Natives to Whites using 2019 CDC and NCHS data, using a novel approach that estimates the mortality gap, adjusted for population structure by accounting for real-population exposures. This measure is tailored for analyses where age structures are fundamental, not merely a confounder. We highlight the magnitude of inequalities by comparing the population structure-adjusted mortality gap against standard metrics' estimates of loss of life due to leading causes. RESULTS: Based on the population structure-adjusted mortality gap, Black and Native American mortality disadvantage exceedsmortality from circulatory diseases. The disadvantage is 72% among Blacks (men: 47%, women: 98%) and 65% among Native Americans (men: 45%, women: 92%), larger than life expectancy measured disadvantage. In contrast, estimated advantages for Asian Americans are over three times (men: 176%, women: 283%) and, for Hispanics, two times (men: 123%; women: 190%) larger than those based on life expectancy. CONCLUSIONS: Mortality inequalities based on standard metrics' synthetic populations can differ markedly from estimates of the population structure-adjusted mortality gap. We demonstrate that standard metrics underestimate racial-ethnic disparities through disregarding actual population age structures. Exposure-corrected measures of inequality may better inform health policies around allocation of scarce resources.

Inequalities in Retirement Life Span in the United States.

OBJECTIVES: The length of retirement life may be highly unequal due to persistent and significant discrepancies in old-age mortality. This study assesses gender and educational differences in the average retirement life span and the variation in retirement life span, taking into account individual labor force exit and reentry dynamics. METHODS: We used longitudinal data from the Health and Retirement Study from 1996 to 2016, focusing on respondents aged 50 and older (N = 32,228). Multistate life tables were estimated using discrete-time event history models. The average retirement life span, as well as absolute and relative variation in retirement life span, were calculated analytically. RESULTS: Among women, we found a persistent educational gradient in average retirement life span over the whole period studied; among men, the relationship between education and retirement expectancy differed across periods. Women and the lower-educated had higher absolute variation in retirement life span than men and the higher-educated-yet these relationships were reversed when examined by relative variation. DISCUSSION: Our multistate approach provides an accurate and comprehensive picture of the retirement life span of older Americans over the past two decades. Such findings should be considered in high-level discussions on Social Security. Potential reforms such as raising the eligibility age or cutting benefits may have unexpected implications for different social groups due to their differential effects on retirement initiation and reentry dynamics.

Large socioeconomic gap in period life expectancy and life years spent with complications of diabetes in the Scottish population with type 1 diabetes, 2013-2018.

BACKGROUND: We report the first study to estimate the socioeconomic gap in period life expectancy (LE) and life years spent with and without complications in a national cohort of individuals with type 1 diabetes. METHODS: This retrospective cohort study used linked healthcare records from SCI-Diabetes, the population-based diabetes register of Scotland. We studied all individuals aged 50 and older with a diagnosis of type 1 diabetes who were alive and residing in Scotland on 1 January 2013 (N = 8591). We used the Scottish Index of Multiple Deprivation (SIMD) 2016 as an area-based measure of socioeconomic deprivation. For each individual, we constructed a history of transitions by capturing whether individuals developed retinopathy/maculopathy, cardiovascular disease, chronic kidney disease, and diabetic foot, or died throughout the study period, which lasted until 31 December 2018. Using parametric multistate survival models, we estimated total and state-specific LE at an attained age of 50. RESULTS: At age 50, remaining LE was 22.2 years (95% confidence interval (95% CI): 21.6 - 22.8) for males and 25.1 years (95% CI: 24.4 - 25.9) for females. Remaining LE at age 50 was around 8 years lower among the most deprived SIMD quintile when compared with the least deprived SIMD quintile: 18.7 years (95% CI: 17.5 - 19.9) vs. 26.3 years (95% CI: 24.5 - 28.1) among males, and 21.2 years (95% CI: 19.7 - 22.7) vs. 29.3 years (95% CI: 27.5 - 31.1) among females. The gap in life years spent without complications was around 5 years between the most and the least deprived SIMD quintile: 4.9 years (95% CI: 3.6 - 6.1) vs. 9.3 years (95% CI: 7.5 - 11.1) among males, and 5.3 years (95% CI: 3.7 - 6.9) vs. 10.3 years (95% CI: 8.3 - 12.3) among females. SIMD differences in transition rates decreased marginally when controlling for time-updated information on risk factors such as HbA1c, blood pressure, BMI, or smoking. CONCLUSIONS: In addition to societal interventions, tailored support to reduce the impact of diabetes is needed for individuals from low socioeconomic backgrounds, including access to innovations in management of diabetes and the prevention of complications.

Male-Female Fertility Differentials Across 17 High-Income Countries: Insights From A New Data Resource.

Obtaining cross-country comparative perspectives on male fertility has long been difficult, as male fertility is usually less well registered than female fertility. Recent methodological advancements in imputing missing paternal ages at childbirth enable us to provide a new database on male fertility. This new resource covers more than 330 million live births and is based on a consistent and well-tested set of methods. These methods allow us to handle missing information on the paternal age, which is missing for roughly 10% of births. The data resource is made available in the Human Fertility Collection and allows for the first time a comparative perspective on male fertility in high-income countries using high-quality birth register data. We analyze trends in male-female fertility quantum and tempo differentials across 17 high-income countries, dating as back as far as the late 1960s for some countries, and with data available for the majority of countries from the 1980s onward. Using descriptive and counterfactual analysis methods, we find substantial variation both across countries and over time. Related to the quantum we demonstrate that disparities between male and female period fertility rates are driven to a large degree by the interplay of parental age and cohort size differences. For parental age differences at childbirth, we observe a development toward smaller disparities, except in Eastern Europe. This observation fits with expectations based on gender theories. However, variation across countries also seems to be driven by factors other than gender equality.

A demographic scaling model for estimating the total number of COVID-19 infections.

BACKGROUND: Understanding how widely COVID-19 has spread is critical information for monitoring the pandemic. The actual number of infections potentially exceeds the number of confirmed cases. DEVELOPMENT: We develop a demographic scaling model to estimate COVID-19 infections, based on minimal data requirements: COVID-19-related deaths, infection fatality rates (IFRs), and life tables. As many countries lack IFR estimates, we scale them from a reference country based on remaining lifetime to better match the context in a target population with respect to age structure, health conditions and medical services. We introduce formulas to account for bias in input data and provide a heuristic to assess whether local seroprevalence estimates are representative for the total population. APPLICATION: Across 10 countries with most reported COVID-19 deaths as of 23 July 2020, the number of infections is estimated to be three [95% prediction interval: 2-8] times the number of confirmed cases. Cross-country variation is high. The estimated number of infections is 5.3 million for the USA, 1.8 million for the UK, 1.4 million for France, and 0.4 million for Peru, or more than one, six, seven and more than one times the number of confirmed cases, respectively. Our central prevalence estimates for entire countries are markedly lower than most others based on local seroprevalence studies. CONCLUSIONS: The national infection estimates indicate that the pandemic is far more widespread than the numbers of confirmed cases suggest. Some local seroprevalence estimates largely deviate from their corresponding national mean and are unlikely to be representative for the total population.

Working and disability expectancies at older ages: The role of childhood circumstances and education.

The ability to work at older ages depends on health and education. Both accumulate starting very early in life. We assess how childhood disadvantages combine with education to affect working and health trajectories. Applying multistate period life tables to data from the Health and Retirement Study (HRS) for the period 2008-2014, we estimate how the residual life expectancy at age 50 is distributed in number of years of work and disability, by number of childhood disadvantages, gender, and race/ethnicity. Our findings indicate that number of childhood disadvantages is negatively associated with work and positively with disability, irrespective of gender and race/ethnicity. Childhood disadvantages intersect with low education resulting in shorter lives, and redistributing life years from work to disability. Among the highly educated, health and work differences between groups of childhood disadvantage are small. Combining multistate models and inverse probability weighting, we show that the return of high education is greater among the most disadvantaged.

Monitoring trends and differences in COVID-19 case-fatality rates using decomposition methods: Contributions of age structure and age-specific fatality.

The population-level case-fatality rate (CFR) associated with COVID-19 varies substantially, both across countries at any given time and within countries over time. We analyze the contribution of two key determinants of the variation in the observed CFR: the age-structure of diagnosed infection cases and age-specific case-fatality rates. We use data on diagnosed COVID-19 cases and death counts attributable to COVID-19 by age for China, Germany, Italy, South Korea, Spain, the United States, and New York City. We calculate the CFR for each population at the latest data point and also for Italy, Germany, Spain, and New York City over time. We use demographic decomposition to break the difference between CFRs into unique contributions arising from the age-structure of confirmed cases and the age-specific case-fatality. In late June 2020, CFRs varied from 2.2% in South Korea to 14.0% in Italy. The age-structure of detected cases often explains more than two-thirds of cross-country variation in the CFR. In Italy, the CFR increased from 4.2% to 14.0% between March 9 and June 30, 2020, and more than 90% of the change was due to increasing age-specific case-fatality rates. The importance of the age-structure of confirmed cases likely reflects several factors, including different testing regimes and differences in transmission trajectories; while increasing age-specific case-fatality rates in Italy could indicate other factors, such as the worsening health outcomes of those infected with COVID-19. Our findings lend support to recommendations for data to be disaggregated by age, and potentially other variables, to facilitate a better understanding of population-level differences in CFRs. They also show the need for well-designed seroprevalence studies to ascertain the extent to which differences in testing regimes drive differences in the age-structure of detected cases.

Estimating the number and length of episodes in disability using a Markov chain approach.

BACKGROUND: Markov models are a key tool for calculating expected time spent in a state, such as active life expectancy and disabled life expectancy. In reality, individuals often enter and exit states recurrently, but standard analytical approaches are not able to describe this dynamic. We develop an analytical matrix approach to calculating the expected number and length of episodes spent in a state. METHODS: The approach we propose is based on Markov chains with rewards. It allows us to identify the number of entries into a state and to calculate the average length of episodes as total time in a state divided by the number of entries. For sampling variance estimation, we employ the block bootstrap. Two case studies that are based on published literature illustrate how our methods can provide new insights into disability dynamics. RESULTS: The first application uses a classic textbook example on prednisone treatment and liver functioning among liver cirrhosis patients. We replicate well-known results of no association between treatment and survival or recovery. Our analysis of the episodes of normal liver functioning delivers the new insight that the treatment reduced the likelihood of relapse and extended episodes of normal liver functioning. The second application assesses frailty and disability among elderly people. We replicate the prior finding that frail individuals have longer life expectancy in disability. As a novel finding, we document that frail individuals experience three times as many episodes of disability that were on average twice as long as the episodes of nonfrail individuals. CONCLUSIONS: We provide a simple analytical approach for calculating the number and length of episodes in Markov chain models. The results allow a description of the transition dynamics that goes beyond the results that can be obtained using standard tools for Markov chains. Empirical applications using published data illustrate how the new method is helpful in unraveling the dynamics of the modeled process.

Cohort Trends in Working Life Expectancies at Age 50 in the United States: A Register-Based Study Using Social Security Administration Data.

OBJECTIVES: Little is known about the length of working life, even though it is a key indicator for policy-makers. In this paper, we study how the length of working life at age 50 has developed in the United States from a cohort perspective. METHODS: We use a large longitudinal sample of U.S. Social Security register data that covers close to 1.7 million individuals of the cohorts born from 1920 to 1965. For all of these cohorts, we study the employment trajectories and working life expectancy (WLE) at age 50 by gender and nativity (native-born/foreign-born). For the cohorts with employment trajectories that are only incompletely observed, we borrow information from older cohorts to predict their WLE. RESULTS: The length of working life has been increasing for the native-born males and females, and the younger cohorts worked longer than the older cohorts. However, WLE might soon peak, and then stall. The gap in WLE between the native-born and the foreign-born has increased over time, although latter group might be able to catch up in the coming years. DISCUSSION: Our findings show that studying employment from a cohort perspective reveals crucial information about patterns of working life. The future development of the length of working life should be a major concern for policy-makers.

Trends in gender differences in health at working ages among West and East Germans.

Before 1990, Germany was divided for more than 40 years. While divided, significant mortality disparities between the populations of East and West Germany emerged. In the years following reunification, East German mortality improved considerably, eventually converging with West German levels. In this study, we explore changes in the gender differences in health at ages 20-59 across the eastern and western regions of Germany using data from the German Socio-Economic Panel (SOEP) for the 1990-2013 period. We apply random-effects linear regressions to the SOEP data to identify trends in health, measured as self-assessed health satisfaction, after German reunification. The findings indicate that women were substantially less satisfied with their health than men in both West and East Germany, but that the gender gap was larger in East Germany than in West Germany. Furthermore, the results show that respondents' satisfaction with their health decreased over time, and that the decline was steeper among men - and particularly among East German men - than among women. Thus, the initial male advantage in health in East and West Germany in the years immediately after reunification diminished over time, and even reversed to become a female advantage in East Germany. One interpretation of this finding is that stress-inducing post-reunification changes in the political and social landscape of East Germany had lasting damaging consequences for men's health. Ongoing risky health behaviors and high levels of economic insecurity due to unemployment could have had long-lasting effects on the health of the working-aged population. A partial explanation for our finding that health declined more sharply among East German men than among their female counterparts could be that women have better compensatory mechanisms than men for dealing with psychosocial stress.

Estimating men's fertility from vital registration data with missing values.

Comparative perspectives on men's fertility are still rare, in part because vital registration data are often missing paternal age information for a substantial number of births. We compare two imputation approaches that attempt to estimate men's age-specific fertility rates and related measures for data in which paternal age information is missing for a non-negligible number of cases. Taking births with paternal age information as a reference, the first approach uses the unconditional paternal age distribution, while the second approach considers the paternal age distribution conditional on the maternal age. To assess the performance of these two methods, we conduct simulations that mimic vital registration data for Sweden, the United States, Spain, and Estonia. In these simulations, we vary the overall proportion and the age selectivity of missing values. We find that the conditional approach outperforms the unconditional approach in the majority of simulations and therefore should be generally preferred.

The Length of Working Life in Spain: Levels, Recent Trends, and the Impact of the Financial Crisis.

While there has been considerable debate about extending the length of working life, relatively little is known about this issue. We use data from the Spanish Continuous Working Life Sample for 2004-2013 to calculate period working life tables, which in turn allows us to assess the impact of the financial crisis on working life expectancy in Spain. Before the recession hit, working life expectancy in Spain was around 38 years for males and 33 years for females. The recession had a tremendous impact on the Spanish labor market, but the effects differed considerably by gender and occupational category. Men working in skilled non-manual jobs were less affected, while men working in unskilled manual jobs lost close to 14 years of working life expectancy. Women were less affected than men. With working life expectancy decreasing, the average proportion of lifetime spent in unemployment and outside the labor market increased markedly, whereas the average number of years spent in retirement changed only a little. When we decompose losses in working life expectancy by age group, we find that economic fluctuations affect both older and younger workers. This result suggests that policies that focus on retirement ages only are incomplete. We also compare our findings to the results obtained by Sullivans method, which is based on prevalence rates rather than the incidence-based working life table approach. We find that the use of Sullivans approach does not accurately reflect the levels of and the trends in working life expectancy.

Working Life Expectancy at Age 50 in the United States and the Impact of the Great Recession.

A key concern about population aging is the decline in the size of the economically active population. Working longer is a potential remedy. However, little is known about the length of working life and how it relates to macroeconomic conditions. We use the U.S. Health and Retirement Study for 1992-2011 and multistate life tables to analyze working life expectancy at age 50 and study the impact of the Great Recession in 2007-2009. Despite declines of one to two years following the recession, in 2008-2011, American men aged 50 still spent 13 years, or two-fifths of their remaining life, working; American women of the same age spent 11 years, or one-third of their remaining life, in employment. Although educational differences in working life expectancy have been stable since the mid-1990s, racial differences started changing after the onset of the Great Recession. Our results show that although Americans generally work longer than people in other countries, considerable subpopulation heterogeneity exists. We also find that the time trends are fluctuating, which may prove troublesome as the population ages. Policies targeting the weakest performing groups may be needed to increase the total population trends.