Spatial characteristics of non-communicable diseases and their associations to social conditions in a large urban cohort in Germany-Results from the Hamburg City Health Study.

BACKGROUND: Non-communicable diseases (NCDs) are responsible for many deaths. They are associated with several modifiable and metabolic risk factors and are therefore prone to significant regional variations on different scales. However, only few intra-urban studies examined spatial variation in NCDs and its association with social circumstances, especially in Germany. Thus, the present study aimed to identify associations of personal risk factors and local social conditions with NCDs in a large German city. METHODS: This study is based on a population-based cohort of the Hamburg City Health Study including 10,000 probands. Six NCDs were analyzed (chronic obstructive pulmonary disease [COPD], coronary heart disease [CHD], diabetes mellitus, heart failure, depression, and hypertension) in 68 city district clusters. As risk factors, we considered socio-demographic variables (age, sex, education) and risk behaviour variables (smoking, alcohol consumption). Logistic regression analyses identified associations between the district clusters and the prevalence rates for each NCD. Regional variation was detected by Gini coefficients and spatial cluster analyses. Local social condition indexes were correlated with prevalence rates of NCDs on city district level and hot-spot analyses were performed for significant high or low values. RESULTS: The analyses included 7,308 participants with a mean age of 63.1 years (51.5% female). The prevalence of hypertension (67.6%) was the highest. Risk factor associations were identified between smoking, alcohol consumption and education and the prevalence of NCDs (hypertension, diabetes, and COPD). Significant regional variations were detected and persisted after adjusting for personal risk factors. Correlations for prevalence rates with the local social conditions were significant for hypertension (r = 0.294, p < 0.02), diabetes (r = 0.259, p = 0.03), and COPD (r = 0.360, p < 0.01). CONCLUSIONS: The study shows that regional differences in NCD prevalence persist even after adjusting for personal risk factors. This highlights the central role of both personal socio-economic status and behaviors such as alcohol and tobacco consumption. It also highlights the importance of other potential regional factors (e.g. the environment) in shaping NCD prevalence. This knowledge helps policy- and decision-makers to develop intervention strategies.

[Association of oral health literacy and behaviour with physical oral health. What role can dental education play?] / Zusammenhang von Mundgesundheitskompetenz und -verhalten mit physischer Mundgesundheit. Welche Rolle kann die zahnmedizinische Ausbildung spielen?

BACKGROUND: Oral health is an essential component of a person's general health and well-being. It is influenced by many factors. These include individual aspects such as oral health literacy and oral health behaviour. The aim of this study was to investigate the association between oral health literacy and behaviour with physical oral health. METHODS: In this population-based cross-sectional study, data of 5510 subjects enrolled in the Hamburg City Health Study (HCHS) from 2016 to 2018 with a mean age of 62.1 years and 50.7% women were evaluated. Physical oral health was assessed using the 14-item Physical Oral Health Index (PhOX). A newly developed 10-item questionnaire based on the Oral Health Literacy Adult Questionnaire and the 5th German Oral Health Study were used to determine oral health literacy and behaviour. RESULTS: The sum score of the 10 questions related to oral health literacy and behaviour significantly correlated with the PhOX sum score (r = 0.23; p < 0.001). An increase of one point in the total score of oral health literacy and behaviour was associated with an increase in the PhOX sum score of 1.45 points on average. This association decreased only marginally after integrating potential confounders such as age and education. CONCLUSION: Higher oral health literacy and better oral health behaviour are associated with better physical oral health. Oral health literacy and behaviour should be important targets in dental education to efficiently and sustainably improve the oral health of the general population.

Characteristics of employment history and self-perceived barriers to healthcare access.

BACKGROUND: Research suggests that people in disadvantaged social positions are more likely to perceive barriers to accessing healthcare, especially to specialists and preventive services. In this study, we analyze if adversity during past employment histories (e.g. spells of unemployment) is linked to subsequent subjectively perceived barriers in healthcare access. Further, we investigate if the associations vary according to national healthcare access and quality indicators. METHODS: We use data from the Survey of Health, Ageing and Retirement in Europe with a study sample of 31 616 men and women aged 52-80 from 25 countries. Data include retrospective information on employment histories allowing us to derive characteristics of past careers, including the number of unemployment periods, main occupational position and pension contributions. Barriers to healthcare access are measured by self-perceived forgone care due to costs and unavailability of services. We apply multilevel Poisson regression for binary outcomes and test for cross-level interactions between career characteristics and national healthcare system characteristics. RESULTS: Career characteristics are linked to later self-perceived healthcare access barriers, consistently in the case of cost barriers and less consistently for unavailability of services. Associations are similar for men and women, and persist after controlling for current income, wealth and subjective health. We find no cross-level interactions between career characteristics and country-level healthcare access and quality indicators. CONCLUSION: Self-perceived barriers to healthcare access are linked to people's past working lives. More in-depth investigation is needed to identify the reasons for the lingering effects of characteristics of employment history on reduced healthcare access.

Far-right political ideology and COVID-19 vaccine hesitancy: Multilevel analysis of 21 European countries.

BACKGROUND: Far-right political parties across the EU have downplayed the risk of COVID-19 and have expressed skepticism toward the safety of the COVID-19 vaccine. This may affect the risk perception of people who support far-right parties and may be associated with an elevated risk of vaccine hesitancy. We aimed to explore if voting far-right is associated with COVID-19 vaccine hesitancy and if the association varies by individual and country-level factors. METHODS: We used cross-sectional data from 28,057 individuals nested in 21 countries who participated in the tenth round of the European Social Survey (ESS). COVID-19 vaccine hesitancy was assessed by asking respondents whether they will get vaccinated against COVID-19. Voting behavior was measured by asking respondents which party they voted for in the last election. To test the association between far-right voting and COVID-19 hesitancy, we applied a series of multilevel regression models. We additionally ran models including interaction terms to test if the association differs by sociodemographic characteristics (e.g., institutional trust) or contextual factors (e.g., income inequality). RESULTS: We found that far-right voters were 2.7 times more likely to be COVID-19 vaccine hesitant compared to center voters (PR: 2.69, 95% CI: 1.46-4.94). The association persisted even after controlling for institutional trust and social participation (adjusted PR: 2.15, 95% CI: 1.35-3.42). None of the tested interaction terms were significant suggesting that the association between political ideology and COVID-19 vaccine hesitancy does not differ by sociodemographic characteristics or contextual factors. CONCLUSION: Voting for far-right parties is associated with COVID-19 vaccine hesitancy. The association is similar among European countries, regardless of how stringent the public health measures were and magnitude of income inequality in each country. Our findings call for a more in-depth investigation of why, how and under which conditions political ideology affects vaccination behavior.

Persistent symptoms and risk factors predicting prolonged time to symptom-free after SARS­CoV­2 infection: an analysis of the baseline examination of the German COVIDOM/NAPKON-POP cohort.

PURPOSE: We aimed to assess symptoms in patients after SARS-CoV-2 infection and to identify factors predicting prolonged time to symptom-free. METHODS: COVIDOM/NAPKON-POP is a population-based prospective cohort of adults whose first on-site visits were scheduled ≥ 6 months after a positive SARS-CoV-2 PCR test. Retrospective data including self-reported symptoms and time to symptom-free were collected during the survey before a site visit. In the survival analyses, being symptom-free served as the event and time to be symptom-free as the time variable. Data were visualized with Kaplan-Meier curves, differences were tested with log-rank tests. A stratified Cox proportional hazard model was used to estimate adjusted hazard ratios (aHRs) of predictors, with aHR < 1 indicating a longer time to symptom-free. RESULTS: Of 1175 symptomatic participants included in the present analysis, 636 (54.1%) reported persistent symptoms after 280 days (SD 68) post infection. 25% of participants were free from symptoms after 18 days [quartiles: 14, 21]. Factors associated with prolonged time to symptom-free were age 49-59 years compared to < 49 years (aHR 0.70, 95% CI 0.56-0.87), female sex (aHR 0.78, 95% CI 0.65-0.93), lower educational level (aHR 0.77, 95% CI 0.64-0.93), living with a partner (aHR 0.81, 95% CI 0.66-0.99), low resilience (aHR 0.65, 95% CI 0.47-0.90), steroid treatment (aHR 0.22, 95% CI 0.05-0.90) and no medication (aHR 0.74, 95% CI 0.62-0.89) during acute infection. CONCLUSION: In the studied population, COVID-19 symptoms had resolved in one-quarter of participants within 18 days, and in 34.5% within 28 days. Over half of the participants reported COVID-19-related symptoms 9 months after infection. Symptom persistence was predominantly determined by participant's characteristics that are difficult to modify.

Changes in work-related stressors before and during the COVID-19 pandemic: differences by gender and parental status.

PURPOSE: The COVID-19 pandemic changed people's working conditions worldwide and research suggests increases in work stressors. However, it is not known to what extent these changes differ by gender or parental status. In the present study, we investigate trends in work stressors and whether these differ by gender and parental status. METHODS: We used cross-sectional time series data of the European Working Conditions Survey of 2015 and Living, Working and COVID-19 survey of spring 2020 to examine trends in work stressors by gender and parental status. Work stressors were working in leisure time, lack of psychological detachment and work-life conflict. We applied three-way multilevel regressions reporting prevalence ratios and reported predicted probabilities and average marginal effects to show trends and differences in changes in work stressors. RESULTS: Our multilevel regression results showed elevated prevalence ratios during the pandemic for working leisure time (PR: 1.43, 95% CI 1.34-1.53), psychological detachment (PR: 1.70, 95% CI 1.45-1.99) and work-life conflict (PR: 1.29, 95% CI 1.17-1.43) compared to before the pandemic. Except for working in leisure time, the increase was more significant among women and mothers. The proportion of work-life conflict in 2020 was 20.7% (95% CI 18.7-22.9) for men and 25.8% (95% CI 24.0-27.6) for women, equalling a difference of 5.1% (p < 0.001). CONCLUSIONS: There is evidence that work stressors increased disproportionately for women and mothers. This needs to be monitored and addressed to prevent widening gender inequalities in the quality of work.

My home-my castle? Self-reported anxiety varies in relation to the subjective evaluation of home environment.

Introduction: Although people spend most of the day in their home environment, the focus of research in environmental psychology to date has been on factors outside the home. However, it stands to reason that indoor quality likewise has an impact on psychological well-being. Therefore, the present study addresses the question of whether the subjective evaluation of home environmental parameters are related to self-reported anxiety and whether they can additionally explain variance beyond the usual sociodemographic and general lifestyle variables. Methods: Data from the Hamburg City Health Study (first 10,000 participants) was analyzed. A subsample of N = 8,886 with available GAD-7 anxiety data was selected, and hierarchical regression models were computed, with demographic data entered first, followed by variables concerning lifestyle/habits and finally variables of the subjective evaluation of home environment. Results: Using the integrated model, we were able to explain about 13% of the variance in self-reported anxiety scores. This included both the demographic, lifestyle, and subjective evaluation of home environment variables. Protection from disturbing night lights, a greater sense of security, less disturbing noises, brighter accommodations, and a satisfactory window view explained almost 6% of the variance and was significantly associated with lower anxiety scores. Conclusion: The home as a place of refuge plays an increasingly important role as home office hours rise. It is therefore crucial to identify domestic factors contributing to people's mental well-being. The subjective evaluation of one's home environment has proven influential over and above modifiable lifestyle variables.

Striving for Health Equity: The Importance of Social Determinants of Health and Ethical Considerations in Pandemic Preparedness Planning.

Since the WHO's "Influenza Pandemic Preparedness Plan" in 1999, pandemic preparedness plans at the international and national level have been constantly adapted with the common goal to respond early to outbreaks, identify risks, and outline promising interventions for pandemic containment. Two years into the COVID-19 pandemic, public health experts have started to reflect on the extent to which previous preparations have been helpful as well as on the gaps in pandemic preparedness planning. In the present commentary, we advocate for the inclusion of social and ethical factors in future pandemic planning-factors that have been insufficiently considered so far, although social determinants of infection risk and infectious disease severity contribute to aggravated social inequalities in health.

Economic change and population health: lessons learnt from an umbrella review on the Great Recession.

OBJECTIVES: Worldwide, the COVID-19 pandemic triggered the sharpest economic downturn since the Great Recession. To prepare for future crises and to preserve public health, we conduct an overview of systematic reviews to examine the evidence on the effect of the Great Recession on population health. METHODS: We searched PubMed and Scopus for systematic reviews and/or meta-analyses focusing specifically on the impact of the Great Recession on population health (eg, mental health). Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines were followed throughout this review and critical appraisal of included systematic reviews was performed using Assessing the Methodological Quality of Systematic Reviews. RESULTS: Twenty-one studies were identified and consistently showed that the Great Recession was most risky to health, the more a country's economy was affected and the longer strict austerity policies were in place. Consequently, a deterioration of health was highest in countries that had implemented strict austerity measures (eg, Greece), but not in countries that rejected austerity measures (eg, Germany). Moreover, the impact of the Great Recession fell disproportionately on the most vulnerable groups such as people in unemployment, at risk of unemployment and those living in poverty. CONCLUSIONS: The experiences of the last economic crisis show that it is possible to limit the consequences for health. Prioritising mental healthcare and prevention, foregoing austerity measures in the healthcare system and protecting vulnerable groups are the most important lessons learnt. Moreover, given the further aggravating social inequalities, a health in all policies approach, based on a comprehensive Health Impact Assessment, is advised.

Adverse employment histories and allostatic load: associations over the working life.

BACKGROUND: Most studies on the health impact of occupational stress use single-point measures of stress at work. This study analyses the associations of properties of entire employment trajectories over an extended time period with a composite score of allostatic load (AL). METHODS: Data come from the French CONSTANCES cohort, with information on adverse employment histories between ages 25 and 45 and a composite score of AL (based on 10 biomarkers, range 0-10) among people aged 45 or older (47 680 women and 45 035 men). Data were collected by questionnaires (including retrospective employment histories) or by health examinations (including blood-based biomarkers). We distinguish six career characteristics: number of temporary jobs, number of job changes, number of unemployment periods, years out of work, mode occupational position and lack of job promotion. RESULTS: For both men and women, results of negative binomial regressions indicate that adverse employment histories are related to higher levels of AL, particularly histories that are characterised by a continued disadvantaged occupational position, repeated periods of unemployment or years out of work. Findings are adjusted for partnership, age and education, and respondents with a health-related career interruption or early retirement are excluded. CONCLUSIONS: Our study highlights physiological responses as a mechanism through which chronic stress during working life is linked to poor health and calls for intervention efforts among more disadvantaged groups at early stages of labour market participation.

Adverse employment histories, work stress and self-reported depression in the French CONSTANCES study.

BACKGROUND: Job instability and disadvantaged work were shown to be associated with poor mental health, but few studies analyzed these conditions in a life course perspective. In this study, adverse employment histories are retrospectively assessed and linked to self-reported depression. Furthermore, indirect effects of later stressful psychosocial work in terms of effort-reward imbalance are investigated. METHODS: With data from the French CONSTANCES cohort study of 13 716 male and 12 767 female employees aged 45 and older, we identify adverse employment histories between age 25 and 45, focussing on job discontinuity, job instability and cumulative disadvantage. Direct effects of these conditions on self-reported depression over a period of up to 5 years are analyzed, using discrete-time logistic regression. Indirect effects of stressful work at baseline are examined. RESULTS: Moderately elevated odds ratios of self-reported depression are observed among participants with discontinued employment histories (number of unemployment periods; years out of work for men). Effort-reward imbalance at work is consistently related to elevated risk of self-reported depression and explains parts of the association between discontinuous employment and depression. CONCLUSIONS: Applying a life course perspective to occupational health research extends current knowledge. Specifically, adverse employment histories in terms of recurrent job discontinuity are related to the risk of self-reported depression. This association is partly explained by exposure to a stressful psychosocial work environment. These results can instruct labour market policies and the development of targeted worksite interventions that address disadvantage throughout entire employment trajectories.

The role of pension contributions in explaining inequalities in depressive symptoms. Results from SHARE.

Aims: Research has established solid evidence that socioeconomic position impacts health. It is, however, still debated to what extent characteristics of entire employment histories are associated with health inequalities later on. This study investigates associations between contributing to pension schemes throughout entire employment histories and depressive symptoms in older men and women. Methods: We use retrospective life history data from the Survey of Health, Ageing and Retirement in Europe (SHARE), collected in 2008-2009 from retired men and women. Data include detailed information on previous employment histories (between age 25 and 60 years) that allows us to measure labour market involvements and pension contributions during past working lives. In addition, we measure elevated depressive symptoms using EURO-D. Results: We observe that employed work without contributing to pension schemes is associated with elevated depressive symptoms for women, even when taking the current household income into consideration. For men (but not for women), self-employed work without pension contributions is linked to elevated depressive symptoms. Conclusions: Our results indicate that studies linking previous employment participation to health after labour market exit should not only consider whether a person worked, but also whether he or she contributed to a pension scheme. In addition, our study points to interesting gender differences, where pension contributions matter most for women in employed work and for men in self-employed work.

Adverse Employment Histories, Later Health Functioning and National Labor Market Policies: European Findings Based on Life-History Data From SHARE and ELSA.

OBJECTIVES: We investigate associations between adverse employment histories over an extended time period and health functioning in later life, and explore whether national labor market policies moderate the association. METHODS: We use harmonized life-history data from the Gateway to Global Aging Data on two European studies (SHARE and ELSA) linked to health beyond age 50 (men = 11,621; women = 10,999). Adverse employment histories consist of precarious, discontinued, and disadvantaged careers between age 25 and 50, and we use depressive symptoms, grip strength, and verbal memory as outcomes. RESULTS: Adverse employment histories between age 25 and 50 are associated with poor health functioning later in life, particularly repeated periods of unemployment, involuntary job losses, weak labor market ties, and disadvantaged occupational positions. Associations remain consistent after adjusting for age, partnership history, education and employment situation, and after excluding those with poor health prior to or during working life. We find no variations of the associations by national labor market policies. DISCUSSION: Our study calls for increased intervention efforts to improve working conditions at early career stages. Despite the importance in shaping employment histories, the role of national policies in modifying the impact of employment on health is less clear.

Cumulative disadvantage during employment careers - The link between employment histories and stressful working conditions.

Accumulated evidence on health-adverse effects of stressful psychosocial and physical work environments is considered a major breakthrough in recent social epidemiological research. However, research on adverse health effects of repeated exposure over time is lacking. In this contribution we analyse associations of characteristics of adverse employment histories with stressful psychosocial and physical current working conditions. We use data from the French CONSTANCES study and restrict the sample to employed men and women aged 45-60 (n = 23652). Current working conditions are assessed by effort-reward imbalance as well as stressful physical working tasks and positions. Previous employment histories (between age 25 and 45) are retrospectively assessed and measured by indicators of precarious, discontinuous and disadvantaged working careers. We found consistent associations of precarious, discontinuous or disadvantaged careers with strenuous physical working conditions and with low occupational rewards. However, low effort rather than high effort was associated with adverse employment histories. Therefore, associations with the effort-reward ratio turned out to be inconsistent. By extending the scope of analysis beyond single time-point measures, we identified three types of adverse employment histories among employees between age 25 and 45 in a stress-theoretical framework, and we demonstrated their associations with employees' current adversity at work between the age of 45-60.

Intragenerational social mobility and depressive symptoms. Results from the French CONSTANCES cohort study.

BACKGROUND: To further explain the association between low socioeconomic position and increased risk of poor health, research started to consider life course conditions, including previous occupational positions and patterns of social mobility in the analysis. We describe patterns of intragenerational social mobility and investigate their associations with depressive symptoms. METHODS: We use data from the French CONSTANCES study, a population-based cohort and restrict the sample to people aged 45 to 60. Based on detailed retrospective data with annual information on respondents' occupational position, we assess the modal social class for two time periods - early adulthood (age 25-34) and mid-adulthood (age 35-44). Depressive symptoms are measured by the Centre for Epidemiologic Studies Depression Scale (CES-D), using sex-specific cut-points. RESULTS: Our study reveals that most respondents remained in stable working careers, but these careers were less frequent amongst participants with lower socioeconomic positions compared with higher ones. In contrast to several earlier findings we observe no independent associations of intragenerational social mobility processes and health once the social positions of origin and destination are considered. However, our findings confirm a social gradient in the prevalence of depressive symptoms for stable working careers. CONCLUSIONS: Our findings underline the importance of integrating data into analysis on starting and ending points of social mobility processes within entire histories of labor market participation.

Adverse employment histories and health functioning: the CONSTANCES study.

BACKGROUND: With changing employment histories in European labour markets, occupational health research needs to be supplemented by an approach that integrates adverse characteristics of entire employment histories, in terms of precarious, discontinued and disadvantaged employment careers. We analyse associations of adverse employment histories and six measures of health functioning, including affective, physical and cognitive functioning. METHODS: We use baseline data from the CONSTANCES study with detailed retrospective data on previous employment histories that are linked to current health functioning among people aged 45-60 years (men = 15 134; women = 16 584). The following career characteristics are assessed (all referring to careers between ages 25 and 45 years): number of jobs with temporary contracts, number of job changes, number of unemployment periods, years out of work, mode occupational position and lack of job promotion. The measures of health functioning range from depressive symptoms, standing balance, walking speed, lung function, to verbal memory and semantic fluency. RESULTS: For both men and women, multilevel regressions (participant nested in health-examination centre) revealed that adverse employment histories are associated with poor health functioning later on, in particular persistent disadvantage in terms of low occupational position, repeated periods of unemployment and weak labour-market ties (years out of work). Findings remain consistent after excluding respondents who had a health-related career interruption or already retired before age 45 years and, additionally, after adjusting for age, partnership and education. CONCLUSION: Findings call for increased intervention efforts among more disadvantaged groups of the labour market at early-career stages.

Is effort-reward imbalance at work associated with different domains of health functioning? Baseline results from the French CONSTANCES study.

PURPOSE: Despite its importance a comprehensive assessment of health functioning has rarely been included in epidemiological investigations of work-related health outcomes. In this study, we analyzed associations of a health-adverse psychosocial work environment with a comprehensive set of subjective and objective measures of health functioning that cover the three domains of affective, cognitive, and physical functioning. METHODS: Baseline data from the French CONSTANCES cohort study were used with a sample of 24,327 employed men and women aged 45-60. Psychosocial work environment was measured by the short version of the effort-reward imbalance (ERI) questionnaire. Measures of health functioning were depressive symptoms, semantic fluency, verbal memory, walking speed, standing balance and lung function. RESULTS: First, we replicated main psychometric properties of the ERI questionnaire in the French cohort. Second, ERI scales revealed consistent associations with depressive symptoms, but less consistent links to cognitive and physical function. Among men, we observed an association of stressful work with reduced lung function. CONCLUSIONS: This study demonstrated consistent associations of stressful work in terms of effort-reward imbalance with affective functioning in a large sample of male and female employees. Relationships with physical functioning were less consistent and restricted to men, and cognitive functioning was only marginally associated with stressful work. We also established the psychometric properties of the French short version of the ERI questionnaire, thus offering a tool for guiding and harmonizing further research in this field.

Age differences in the association between stressful work and sickness absence among full-time employed workers: evidence from the German socio-economic panel.

PURPOSE: We aim to extend current knowledge on associations between stressful work and sickness absence, first, by studying associations between ERI and sickness absence among full-time employees from various occupations, and second, by investigating if associations vary by age. METHODS: We use data from four waves of the German socio-economic panel (GSOEP), collected among men and women between 2006 and 2012, with 9418 observations. Stressful work is measured with a short form of the ERI questionnaire. We investigate an imbalance between effort and reward (ER ratio) as well as the two main components ("high effort" and "low reward"). Sickness absence is measured by self-reported number of sickness days (assessed the following year). After descriptive analyses, we estimate a series of multivariable regressions, including tests for interactions between age and work stress. RESULTS: Each of the three indicators of stressful work is related to higher number of sickness days, with except of "high effort" in case of men. Findings remain significant after adjusting for social position (income, education and occupational class) and health. In addition, for both men and women, associations were slightly higher among older workers, though interactions did not reach statistical significance. CONCLUSION: Our findings support that stressful work is linked to sickness absence across a wide spectrum of jobs with varying incomes and educational levels, and also that associations are slightly more pronounced among older workers.

Late Life Employment Histories and Their Association With Work and Family Formation During Adulthood: A Sequence Analysis Based on ELSA.

Objectives: To extend research on workforce participation beyond age 50 by describing entire employment histories in later life and testing their links to prior life course conditions. Methods: We use data from the English Longitudinal Study of Ageing, with retrospective information on employment histories between age 50 and 70 for 1,103 men and 1,195 women (n = 2,298). We apply sequence analysis and group respondents into eight clusters with similar histories. Using multinomial regressions, we then test their links to labor market participation, partnership, and parenthood histories during early (age 20-34) and mid-adulthood (age 35-49). Results: Three clusters include histories dominated by full-time employees but with varying age of retirement (before, at, and after age 60). One cluster is dominated by self-employment with comparatively later retirement. Remaining clusters include part-time work (retirement around age 60 or no retirement), continuous domestic work (mostly women), or other forms of nonemployment. Those who had strong attachments to the labor market during adulthood are more likely to have histories of full-time work up until and beyond age 60, especially men. Parenthood in early adulthood is related to later retirement (for men only). Continued domestic work was not linked to parenthood. Partnered women tend to work part-time or do domestic work. The findings remain consistent after adjusting for birth cohort, childhood adversity, life course health, and occupational position. Discussion: Policies aimed at increasing the proportion of older workers not only need to address later stages of the life course but also early and mid-adulthood.