Association between ultra-processed foods and recurrence of depressive symptoms: the Whitehall II cohort study.

OBJECTIVES: To examine the association between high intakes of ultra-processed foods (UPF) and recurrence of depressive symptoms (DepS) in a Western non-Mediterranean country and its contribution to the overall diet-depression relationship. METHODS: Analyses were carried out on British participants from the Whitehall II cohort. Present analyses were restricted to white participants N = 4554 (74% men, mean age = 61; SD = 5.9). UPF consumption was estimated from a 127-item food frequency questionnaire using the NOVA classification, and cumulative average of UPF intakes (g/day) over 11 years of exposure (1991/1994-2002/2004) was computed. Recurrent DepS after measurement of UPF was defined as having two or more episodes of DepS (the Center for Epidemiologic Studies Depression Scale (CES-D) score ≥ 16 or antidepressants use) during four phases of follow-up (2002/2004-2015/2016). RESULTS: Over the follow-up, 588 (12.9%) cases of recurrent DepS were observed. After adjusting for socio-demographic factors, health behaviours and health status, participants in top quintile of UPF intakes [mean 33% of total daily intakes in grams] had 31% higher odds of recurrent DepS (odds ratio 1.31; 95% CI 1.04-1.64) compared to participants in the four lowest quintiles of UPF [mean 18.1% of total daily intakes in grams]. Additional analyses showed that associations between adherence to several diet quality measures and recurrent DepS were partially attenuated (17-27%) by UPF intakes. CONCLUSION: In this British population, high intakes of ultra-processed foods were associated with increased odds of recurrent depressive symptoms and contributed to the overall diet quality-depressive symptoms association.

Trends in Associations Between Sickness Absence Before the Age of 65 and Being in Paid Work After the Age of 65: Prospective Study of Three Total Population Cohorts.

The increasing workforce participation at higher ages may impact social insurance systems, however, this has hardly been studied at all. We studied associations between sociodemographic factors and prior sickness absence and disability pension, with having paid work and sickness absence after age 65, and if such associations changed over time. We used longitudinal register data regarding three cohorts of all residents in Sweden who turned 65 in 2000, 2005, or 2010 (N = 50,000, 68,000, and 99,000, respectively). Although employment rates when aged 66-71 increased between the cohorts, associations of sociodemographic factors with paid work and sickness absence, when aged 66-71 did not. Both sickness absence and disability pension when aged 60-64 were negatively associated with working past 65. Sickness absence when aged 60-64 was positively associated and disability pension was negatively associated with sickness absence after 65. Possibilities to remain in paid work with different health conditions need to be strengthened to avoid inequalities when raising the retirement age.

Paid work increased from 2000 to 2010, sickness absence increased marginallyAssociations of sociodemographic factors with paid work did not change over timePrior sickness absence and disability pension correlate with paid work after age 65Sickness absence before age 65 correlates with sickness absence after 65Disability pension before age 65 correlates with less sickness absence after 65.

Association of sleep with cognitive function during retirement transition: the Whitehall II study.

STUDY OBJECTIVES: Sleep duration and difficulties have been shown to associate with cognitive function. This study examined how changes in sleep and in cognitive function are associated during retirement transition. METHODS: The study population consisted of 2980 Whitehall II study participants, who retired during the follow-up, whose sleep was queried, and cognitive function measured (inductive reasoning and verbal memory) before and after retirement (follow-up 16 years). Using the last information on sleep before and the first after retirement, participants were categorized into constantly without (59%), increasing (13%), decreasing (11%), and constantly with (18%) sleep difficulties; and constantly short (26%), increasing (19%), decreasing (8.5%), and constantly mid-range (47%) sleep duration. Change in cognitive function during retirement transition was examined by sleep change groups using linear regression analyses with generalized estimating equations. RESULTS: More pronounced decline in inductive reasoning during retirement transition was observed among participants with increasing sleep difficulties (-1.96, 95% CI -2.52 to -1.41) compared to those constantly without sleep difficulties (-1.25, 95% CI -1.52 to -0.98) and constantly with sleep difficulties (-1.26, 95% CI -1.75 to -0.92). Decreasing sleep difficulties (-0.64, 95% CI -0.86 to -0.43) were associated with a more pronounced decline in verbal memory when compared to constantly without sleep difficulties (-0.42, 95% CI -0.52 to -0.32) in post-retirement period. No statistically significant differences across sleep duration groups in cognitive function were observed. CONCLUSIONS: Increasing and decreasing sleep difficulties may be associated with accelerated decline in cognitive function during retirement transition and post-retirement.

Does it matter how we measure the health of older people in places for associations with labour market outcomes? A cross-sectional study.

BACKGROUND: Inequalities between different areas in the United Kingdom (UK) according to health and employment outcomes are well-documented. Yet it is unclear which health indicator is most closely linked to labour market outcomes, and whether associations are restricted to the older population. METHODS: We used the Office for National Statistics (ONS) Longitudinal Study (LS) to analyse which measures of health-in-a-place were cross-sectionally associated with three employment outcomes in 2011: not being in paid work, working hours (part-time, full-time), and economic inactivity (unemployed, retired, sick/disabled, other). Seven health indicators from local-authority census and vital records data were chosen to represent the older working age population (self-rated health 50-74y, long-term illness 50-74y, Age-specific mortality rate 50-74y, avoidable mortality, life expectancy at birth and 65 years, disability-free life expectancy at 50 years, and healthy life expectancy at 50 years). An additional two health indicators (life expectancy at birth and infant mortality rate) were included as test indicators to determine if associations were limited to the health of older people in a place. These nine health indicators were then linked with the LS sample aged 16-74y with data on employment outcomes and pertinent demographic and individual health information. Interactions by gender and age category (16-49y vs. 50-74y) were also tested. FINDINGS: For all health-in-a-place measures, LS members aged 16-74 who resided in the tertile of local authorities with the 'unhealthiest' older population, had higher odds of not being in paid work, including all four types of economic inactivity. The strongest associations were seen for the health-in-a-place measures that were self-reported, long-term illness (Odds Ratio 1.60 [95% Confidence Intervals 1.52, 1.67]) and self-rated health (1.60 [1.52, 1.68]). Within each measure, associations were slightly stronger for men than women and for the 16-49y versus 50-74y LS sample. In models adjusted for individual self-rated health and gender and age category interactions, health-in-a-place gradients were apparent across all economic inactivity's. However, these same gradients were only apparent for women in part-time work and men in full-time work. CONCLUSION: Improving health of older populations may lead to wider economic benefits for all.

Workplace interventions for cardiovascular diseases: protocol of a systematic review and meta-analysis.

INTRODUCTION: Cardiovascular diseases (CVDs) are the number one cause of death globally, impacting on public and private sectors. Current traditional interventions to prevent CVDs are mainly provided in healthcare centres and even when they are effective, they are not enough to reduce the rising prevalence; therefore, additional strategies are needed. Evidence suggests that health interventions in the workplace supply numerous benefits improving cardiovascular risk factor profiles in individuals. Hence, the aim of this systematic review and meta-analysis is to collate the evidence from randomised controlled trials, cluster randomised trials and quasi-experimental studies of workplace interventions to determine their effectiveness in terms of improving cardiovascular risk factors and preventing CVDs. METHODS AND ANALYSIS: EMBASE, PsycINFO, PubMed, the Cochrane Central Register of Controlled Trials, LILACS, Scopus, Web of Science, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and ProQuest Dissertations & Theses Global will be searched to include articles on workplace interventions in adults for CVDs events, cardiometabolic risk factors or behavioural risk factors. The study selection, data extraction, risk of bias and the assessment of the quality of the body of evidence will be conducted by two reviewers working in parallel and disagreements will be resolved by consensus or consultations with a third reviewer. Data synthesis will be done by meta-analysis using random-effects models when possible, otherwise the vote counting method will be applied. Statistical heterogeneity will be assessed by a χ2 test and I2 statistics. The quality of the body of evidence for each outcome will be assessed by applying the Grading of Recommendations, Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION: Ethical approval is not required for this systematic review protocol. The results of the systematic review will be published in a peer-reviewed journal and will be publicly available. PROSPERO REGISTRATION NUMBER: CRD42021276161.

(Un-) healthy ageing: Geographic inequalities in disability-free life expectancy in England and Wales.

Health expectancies are an indicator of healthy ageing that reflect quantity and quality of life. Using limiting long term illness and mortality prevalence, we calculate disability-free life expectancy for small areas in England and Wales between 1991 and 2011 for males and females aged 50-74, the life stage when people may be changing their occupation from main career to retirement or alternative work activities. We find that inequalities in disability-free life expectancy are deeply entrenched, including former coalfield and ex-industrial areas and that areas of persistent (dis-) advantage, worsening or improving deprivation have health change in line with deprivation change. A mixed health picture for rural and coastal areas requires further investigation as do the demographic processes which underpin these area level health differences.

Work Exposures and Development of Cardiovascular Diseases: A Systematic Review.

INTRODUCTION: Cardiovascular diseases (CVDs) are the number one cause of death, and there is evidence that work exposures could be associated with their development. This study aimed to systematically review observational studies of adults exposed to job strain, effort-reward imbalance, long working hours, job insecurity, shift work, and occupational noise, and assess the association of those work exposures with CVDs. METHODS: The Navigation Guide framework was applied. The population were adults of working age (18-65), and cohort and case-control studies were included. The work exposures were job strain, effort-reward imbalance, long working hours, job insecurity, shift work, and occupational noise. The outcomes were cerebrovascular diseases, ischaemic heart disease, and hypertensive diseases. The selection, data extraction, risk of bias assessment, and quality assessment were carried out by two reviewers independently and disagreements were solved by a third reviewer or by consensus. The synthesis of the results was done by applying the 'vote counting based on direction' method, and the results were summarized in an effect direction plot. The strength of the evidence for every risk factor and CVD was defined by consensus. RESULTS: A total of 17 643 papers were initially identified in the literature search, but after applying the filters by title and abstract, and full text, 86 studies were finally included. From the included studies, sufficient evidence was found of the harmfulness of job strain for cerebrovascular disease and ischemic heart disease. Furthermore, there was sufficient evidence of the harmfulness of shift work for ischemic heart disease. Evidence of no relationship was found between long working hours and shift work with ischaemic heart disease and hypertensive disease, respectively. The other associations of work exposures and CVDs had limited or inadequate evidence of harmfulness. CONCLUSIONS: In this comprehensive review, there was sufficient evidence of a harmful relationship between job strain, shift work, and CVDs. For the other work exposures, more high-quality studies are needed. In order to improve current prevention strategies for CVDs, the findings of this review imply that job strain and shift work are work exposures that constitute additional risk factors that could be approached as targets for worksite interventions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020179972.

Measuring the health of people in places: A scoping review of OECD member countries.

A scoping review was performed to identify how Organisation for Economic Co-operation and Development (OECD) countries measure overall health for sub-national geographies within each country. Sixty publications were selected from MEDLINE, Scopus and Google Scholar, plus information extracted from 37 of 38 OECD countries statistical agency and/or public health institute websites that were available in English. Data sources varied by categorisation into national statistical agency mortality (n = 7) or population-level survey morbidity (n = 5) health indicators. Region was the most common geographic scale (e.g., eight indicators for 26 countries), slightly fewer indicators for urban areas (max countries per most frequent indicator = 24), followed by municipality (range of 1-14 countries per indicator). Other geographies, particularly those at smaller granularity, were infrequently available across health indicators and countries. Wider availability of health indicators at smaller, and non-administrative, geographies is needed to explore the best way to measure comparative population health in local areas.

Heterogeneity in the association between youth unemployment and mental health later in life: a quantile regression analysis of longitudinal data from English schoolchildren.

OBJECTIVES: An association between youth unemployment and poorer mental health later in life has been found in several countries. Little is known about whether this association is consistent across individuals or differs in strength. We adopt a quantile regression approach to explore heterogeneity in the association between youth unemployment and later mental health along the mental health distribution. DESIGN: Prospective longitudinal cohort of secondary schoolchildren in England followed from age 13/14 in 2004 to age 25 in 2015. SETTING: England, UK. PARTICIPANTS: 7707 participants interviewed at age 25.Primary and secondary outcome measures12-Item General Health Questionnaire (GHQ) Likert score, a measure of minor psychiatric morbidity. RESULTS: Youth unemployment was related to worse mental health at age 25. The association was several times stronger at deciles of GHQ representing the poorest levels of mental health. This association was only partly attenuated when adjusting for confounding variables and for current employment status. In fully adjusted models not including current employment status, marginal effects at the 50th percentile were 0.73 (95% CI -0.05 to 1.54, b=0.11) points, while marginal effects at the 90th percentile were 3.76 (95% CI 1.82 to 5.83; b=0.58) points. The results were robust to different combinations of control variables. CONCLUSIONS: There is heterogeneity in the longitudinal association between youth unemployment and mental health, with associations more pronounced at higher levels of psychological ill health. Youth unemployment may signal clinically relevant future psychological problems among some individuals.

How robust is the association between youth unemployment and later mental health? An analysis of longitudinal data from English schoolchildren.

BACKGROUND: Several studies show that youth unemployment is associated with worse mental health later in life. However, existing studies report results for only one model, or a few models, and use regression adjustment to support causal claims. We use two novel methods to address these gaps in the literature. METHODS: We use data from Next Steps, a cohort study of English schoolchildren who entered the labour market in the aftermath of the 2008-2009 global financial crisis, and measure mental health using the 12-item General Health Questionnaire (GHQ-12) at age 25. We use specification curve analysis and a negative control outcome design (a form of placebo test) to test whether associations between youth unemployment and later GHQ-12 scores are sensitive to model specification or are likely to be confounded by unobserved factors. RESULTS: We find that the association between unemployment and later GHQ-12 is qualitatively similar across 99.96% of the 120 000 models we run. Statistically significant associations with two placebo outcomes, height and patience, are not present when regression adjustments are made. CONCLUSIONS: There is clear evidence that youth unemployment is related to later mental health, and some evidence that this cannot be easily explained by unobserved confounding.

Behavioural risk factors and healthy life expectancy: evidence from two longitudinal studies of ageing in England and the US.

We examined whether the co-occurrence of four behavioural risk factors (alcohol consumption, smoking, physical inactivity and obesity) is associated with disability-free and chronic disease-free life expectancy similarly in two longitudinal studies of ageing in England and the United States. Data were from 17,351 individuals aged 50+ from the US Health and Retirement Study (HRS) and, 10,388 from the English Longitudinal Study of Ageing (ELSA), from 2002 to 2013. Disability-free life expectancy was estimated using repeat measures of limitations with instrumental activities and activities of daily living and, chronic disease-free life expectancy was based on chronic health conditions. Multistate life table models were used to estimate sex-specific health expectancy at the ages of 50, 60 and 70. In both countries and at all ages, there was a clear gradient towards shorter health expectancy with increasing number of behavioural risk factors. Compared to people with 2+ behavioural risk factors, in both countries, those with no behavioural risk factors could expect to live up to 11 years longer without disability and, up to 12 years longer without chronic conditions. Individual and co-occurring behavioural risk factors were strongly associated with shorter healthy life expectancy in both countries, attesting to the robustness of the contribution of lifestyle factors on health expectancy.

Changes in Emotional Vitality as a Predictor of Levels and Change in Allostatic Load: Longitudinal Results From the Whitehall II Cohort Study.

OBJECTIVE: Increasing evidence has shown an association between reduced psychological well-being and long-term morbidity. However, longitudinal studies addressing potential biobehavioral mechanisms, such as physiological function, are lacking. The aim of this study is to examine the association between changes in emotional vitality on levels and changes in allostatic load (AL), a measure of multisystem physiological dysregulation, as well as its composite risk markers. METHODS: Participants comprised 5919 British civil servants from phases 3, 5, and 7 of the Whitehall II study. Psychological well-being was operationalized as emotional vitality. AL was measured using nine biomarkers of the cardiovascular, metabolic, and immune system. Linear mixed-effect models were used to determine the association between changes in emotional vitality between phases 3 and 5 and subsequent levels and change in AL from phases 5 to 7. Generalized linear models were used to address the association between changes in emotional vitality and individual risk markers. RESULTS: Increase in emotional vitality was associated with a lower mean level of AL, whereas the AL slope was not markedly affected. Among the included risk markers, only interleukin-6 was weakly associated with changes in emotional vitality, with a 7% reduced risk of high levels of interleukin-6 per one-unit increase in emotional vitality. CONCLUSION: This study found that an increase in emotional vitality was associated with subsequent lower levels, but not rate of change, of AL over time. Further research is needed to address the relationship between trajectories of psychological well-being and physiological dysregulation.

Socioeconomic Inequalities in Disability-free Life Expectancy in Older People from England and the United States: A Cross-national Population-Based Study.

BACKGROUND: We examined socioeconomic inequalities in disability-free life expectancy in older men and women from England and the United States and explored whether people in England can expect to live longer and healthier lives than those in the United States. METHODS: We used harmonized data from the Gateway to Global Aging Data on 14,803 individuals aged 50+ from the U.S. Health and Retirement Study (HRS) and 10,754 from the English Longitudinal Study of Ageing (ELSA). Disability was measured in terms of impaired activities and instrumental activities of daily living. We used discrete-time multistate life table models to estimate total life expectancy and life expectancy free of disability. RESULTS: Socioeconomic inequalities in disability-free life expectancy were of a similar magnitude (in absolute terms) in England and the United States. The socioeconomic disadvantage in disability-free life expectancy was largest for wealth, in both countries: people in the poorest group could expect to live seven to nine fewer years without disability than those in the richest group at the age of 50. CONCLUSIONS: Inequalities in healthy life expectancy exist in both countries and are of similar magnitude. In both countries, efforts in reducing health inequalities should target people from disadvantaged socioeconomic groups.

Diet quality as a predictor of cardiometabolic disease-free life expectancy: the Whitehall II cohort study.

BACKGROUND: Poor diet quality has been linked to increased risk of many chronic diseases and premature mortality. Less research has considered dietary habits in relation to disease-free life expectancy. OBJECTIVES: Our objective was to investigate the association of diet quality with cardiometabolic disease-free life expectancy between ages 50 and 85 y. METHODS: Diet quality of 8041 participants of the Whitehall II cohort study was assessed with the Alternative Healthy Eating Index 2010 (AHEI-2010) in 1991-1994, 1997-1999, and 2002-2004. The measurement of diet quality closest to age 50 for each participant was used. We utilized repeat measures of cardiometabolic disease (coronary heart disease, stroke, and type 2 diabetes) from the first observation when participants were aged ≥50 y. Multistate life table models with covariates age, gender, occupational position, smoking, physical activity, and alcohol consumption were used to estimate total and sex-specific cardiometabolic disease-free life expectancy from age 50 to 85 y for each AHEI-2010 quintile, where the lowest quintile represents unhealthiest dietary habits and the highest quintile the healthiest habits. RESULTS: The number of cardiometabolic disease-free life-years after age 50 was 23.9 y (95% CI: 23.0, 24.9 y) for participants with the healthiest diet, that is, a higher score on the AHEI-2010, and 21.4 y (95% CI: 20.6, 22.3 y) for participants with the unhealthiest diet. The association between diet quality and cardiometabolic disease-free life expectancy followed a dose-response pattern and was observed in subgroups of participants of different occupational position, BMI, physical activity level, and smoking habit, as well as when participants without cardiometabolic disease at baseline were excluded from analyses. CONCLUSIONS: Healthier dietary habits are associated with cardiometabolic disease-free life expectancy between ages 50 and 85.

The Impact of Retirement on Cardiovascular Disease and Its Risk Factors: A Systematic Review of Longitudinal Studies.

BACKGROUND AND OBJECTIVES: People are now spending longer in retirement than ever before and retirement has been found to influence health. This study systematically reviewed the impact of retirement on cardiovascular disease (CVD) and its risk factors (metabolic risk factors, blood biomarkers, physical activity, smoking, drinking, and diet). RESEARCH DESIGN AND METHODS: Longitudinal studies published in Medline, Embase, Social Science Citation Index, PsycINFO, and Social Policy and Practice were searched. No language restrictions were applied if there was an English abstract. Eighty-two longitudinal studies were included after critical appraisals. RESULTS: Studies in the United States often found no significant effect of retirement on CVD, while studies in European countries, except France, showed a detrimental effect of retirement on CVD. Results from the United States and several European countries consistently show that retirement increase adiposity measures among those retired from physically demanding jobs. For diabetes and hypertension, five out of nine studies suggest no effect of retirement. Retirement has been repeatedly linked to increasing leisure-time physical activity but may reduce work- and transport-related physical activity in turn. Most studies showed that retirement either decreased smoking or had no effect on smoking. The evidence did not show a clear conclusion on drinking. Only a few studies have assessed the impact on diet and blood biomarkers. DISCUSSION AND IMPLICATIONS: Effect of retirement varies according to the health outcomes studied and country of the study population. Policy concerning extending the retirement age needs to focus on ensuring they are suited to the individual.

Mental Health Before and After Retirement-Assessing the Relevance of Psychosocial Working Conditions: The Whitehall II Prospective Study of British Civil Servants.

OBJECTIVES: Retirement could be a stressor or a relief. We stratify according to previous psychosocial working conditions to identify short-term and long-term changes in mental health. METHOD: Using data from the Whitehall II study on British civil servants who retired during follow-up (n = 4,751), we observe mental health (General Health Questionnaire [GHQ] score) on average 8.2 times per participant, spanning up 37 years. We differentiate short-term (0-3 years) and long-term (4+ years) changes in mental health according to retirement and investigate whether trajectories differ by psychosocial job demands, work social support, decision authority, and skill discretion. RESULTS: Each year, mental health slightly improved before retirement (-0.070; 95% CI [-0.080, -0.059]; higher values on the GHQ score are indicative of worse mental health), and retirees experienced a steep short-term improvement in mental health after retirement (-0.253; 95% CI [-0.302, -0.205]), but no further significant long-term changes (0.017; 95% CI [-0.001, 0.035]). Changes in mental health were more explicit when retiring from poorer working conditions; this is higher psychosocial job demands, lower decision authority, or lower work social support. DISCUSSION: Retirement was generally beneficial for health. The association between retirement and mental health was dependent on the context individuals retire from.

Work-Family Conflict and Work Exit in Later Career Stage.

OBJECTIVES: This study investigated relationships between work-family conflict and routes of later-life work exit. METHODS: We used a cohort of British civil servants (5,157 men; 2,027 women) who participated in the Whitehall II study. Work interference with family (WIF) and family interference with work (FIW) were measured up to three times over 10 years. Cause-specific Cox models were used to assess the influence of WIF/FIW on particular routes ("retirement," "health-related exit," "unemployment," or "homemaker/other") of work exit in later career stage and all routes combined. RESULTS: WIF was not associated with any route of work exit in men or women, after adjusting for confounders. For perceived higher FIW, men were less likely to exit work through retirement, homemaker/other, or all routes combined. This was not attenuated by adding family factors or working conditions. Women with higher FIW were more likely to exit through the homemaker route. This was no longer significant after adjusting for family factors. Neither FIW nor WIF was associated with health-related exit or unemployment. DISCUSSION: FIW makes women more likely to become a homemaker at later career stage but reduces the risk of leaving work for men, which may reinforce gender inequality in work participation.

Long working hours and change in body weight: analysis of individual-participant data from 19 cohort studies.

OBJECTIVE: To examine the relation between long working hours and change in body mass index (BMI). METHODS: We performed random effects meta-analyses using individual-participant data from 19 cohort studies from Europe, US and Australia (n = 122,078), with a mean of 4.4-year follow-up. Working hours were measured at baseline and categorised as part time (<35 h/week), standard weekly hours (35-40 h, reference), 41-48 h, 49-54 h and ≥55 h/week (long working hours). There were four outcomes at follow-up: (1) overweight/obesity (BMI ≥ 25 kg/m2) or (2) overweight (BMI 25-29.9 kg/m2) among participants without overweight/obesity at baseline; (3) obesity (BMI ≥ 30 kg/m2) among participants with overweight at baseline, and (4) weight loss among participants with obesity at baseline. RESULTS: Of the 61,143 participants without overweight/obesity at baseline, 20.2% had overweight/obesity at follow-up. Compared with standard weekly working hours, the age-, sex- and socioeconomic status-adjusted relative risk (RR) of overweight/obesity was 0.95 (95% CI 0.90-1.00) for part-time work, 1.07 (1.02-1.12) for 41-48 weekly working hours, 1.09 (1.03-1.16) for 49-54 h and 1.17 (1.08-1.27) for long working hours (P for trend <0.0001). The findings were similar after multivariable adjustment and in subgroup analyses. Long working hours were associated with an excess risk of shift from normal weight to overweight rather than from overweight to obesity. Long working hours were not associated with weight loss among participants with obesity. CONCLUSIONS: This analysis of large individual-participant data suggests a small excess risk of overweight among the healthy-weight people who work long hours.

Inequalities in time from stopping paid work to death: findings from the ONS Longitudinal Study, 2001-2011.

BACKGROUND: UK state pension eligibility ages are linked to average life expectancy, which ignores wide socioeconomic disparities in both healthy and overall life expectancy. OBJECTIVES: Investigate whether there are occupational social class differences in the amount of time older adults live after they stop work, and how much of these differences are due to health. METHODS: Participants were 76 485 members of the Office for National Statistics Longitudinal Study (LS), who were 50-75 years at the 2001 census and had stopped work by the 2011 census. Over 10 years of follow-up, we used censored linear regression to estimate mean differences in years between stopping work and death by occupational social class. RESULTS: After adjustment for age, both social class and health were independent predictors of postwork duration (mean difference (95% CI): unskilled class vs professional: 2.7 years (2.4 to 3.1); not good vs good health: 2.4 years (1.9 to 2.9)), with LS members in the three manual classes experiencing ~1 additional year of postwork duration than professional workers (interaction p values all <0.001). Further adjustment for gender and educational qualifications was reduced but did not eliminate social class and postwork duration associations. We estimate the difference in postwork years between professional classes in good health and unskilled workers not in good health as 5.1 years for women (21.0 vs 26.1) and 5.5 years for men (19.5 vs 25.0). CONCLUSIONS: Lower social class groups are negatively affected by uniform state pension ages, because they are more likely to stop work at younger ages due to health reasons.