Educational inequalities in major depressive disorder prevalence, timing and duration among adults over the life course: a microsimulation analysis based on the Lifelines Cohort Study.

BACKGROUND: Educational inequalities in major depressive disorder (MDD) pose a major challenge. Tackling this issue requires evidence on the long-term impact of intervening on modifiable factors, for example lifestyle and psychosocial factors. For this reason, we aimed to simulate the development of educational inequalities in MDD across the life course, and to estimate the potential impact of intervening on modifiable factors. METHODS: We used data from the prospective Dutch Lifelines Cohort Study to estimate the required input for a continuous-time microsimulation. The microsimulation allowed us to project the development of educational inequalities in MDD between ages 18 and 65, and to assess the potential benefit of intervening on quality of social contacts, health literacy and smoking. RESULTS: On average, an additional 19.1% of individuals with low education will ever experience MDD between ages 18 and 65 compared with those with high education. Additionally, individuals with low education generally will develop MDD 0.9 years earlier and spend 1.2 years more with MDD, than individuals with high education. Improving the quality of social contacts in individuals with low education produced the largest effect; it would reduce the inequalities in the prevalence, onset and duration of MDD by an average of 18.4%, 18.3% and 28.6%, respectively. CONCLUSIONS: Intervening on modifiable factors, particularly quality of social contacts, in individuals with low education could help reduce the estimated educational inequalities in MDD over the life course.

Educational inequalities in metabolic syndrome prevalence, timing, and duration amongst adults over the life course: a microsimulation analysis based on the lifelines cohort study.

BACKGROUND: Educational inequalities in metabolic syndrome (MetS) are a growing public health concern. Intervening on modifiable factors may help reduce these inequalities, but there is a need for evidence on the long-term impact of intervening on these factors. Thus, we simulate the development of educational inequalities in MetS across the life course and assess the impact of intervening on the modifiable factors that contribute to these inequalities. METHODS: We used data from the prospective multigenerational Dutch Lifelines Cohort Study to estimate the required input for a continuous-time microsimulation. The microsimulation projects the development of educational inequalities in MetS between ages 18 and 65, and assesses the potential benefit of intervening on smoking, alcohol use, diet quality, and health literacy. FINDINGS: The likelihood of ever experiencing MetS between ages 18 and 65 varies from 32.5% among high educated women to 71.5% among low educated men. On average, 27.6% more individuals with low education will ever experience MetS between ages 18 and 65 compared to those with high education. Additionally, individuals with low education generally will develop MetS 2.3 years earlier, and will spend an extra 2.6 years with MetS, compared to individuals with high education. Changes to smoking behaviours in individuals with low education produced the largest effect; it would reduce inequalities in prevalence, timing and duration by an average of 7.5%, 9.5%, and 6.9%, respectively. CONCLUSIONS: Interventions targeting the modifiable factors included in this study, especially smoking, could help reduce the estimated educational inequalities in MetS over the life course.

Experts' assessments of migration scenarios between the Middle East & North Africa and Europe.

We describe data collected among 138 migration experts about the repercussions of scenarios of social change on migration between the Middle East & North Africa and Europe, during the period 2021-2030. Scenarios include changes in the cultural, demographic, economic, and political determinants of migration in sending and receiving countries. Assessments focus on the change in the number of family, work, and return migrants, the number of refugees, and the likelihood of achieving safe, orderly, and regular migration. Experts were at the moment of the survey active in European research centers or European (supra-) national governmental or civil society organizations. The survey features a factorial design, which allows for identifying a causal relationship between the experts' assessments and the scenarios of social change. Our data may be used to estimate projection models of future migration flows, map out what experts consider as critical migration issues for the region, and identify areas of agreement or disagreement between them. As such, our dataset may illuminate decision-making regarding migration policies in Europe and beyond.

Microsimulation of Household and Marital Transitions Leading to Childlessness Among Dutch Women Born Between 1971 and 2000.

After reaching historically low levels among the women born in the early 1940s, childlessness has been increasing in most Western countries among women born in the 1950s and 1960s. This increase took place as patterns of transition to adulthood have become increasingly late, protracted, and complex. Yet, it is precisely those women who enter a first relationship late, spend more time as single, and experience union instability who more often remain childless. This suggests that levels of childlessness will continue to increase as younger cohorts complete their childbearing histories. In this study, we use microsimulation to project the household and union formation histories of cohorts of Dutch women born between 1971 and 2000. Results suggest that childlessness will actually decrease among cohorts born between 1971 and 1983 and then increase among those born between 1984 and 2000. The decrease occurs as pathways of household and union formation become later, more protracted, and more complex, but also as cohabiting women start to exhibit a higher propensity to become mothers. The increase, on the other hand, occurs as pathways become somewhat less protracted and complex, but also as the propensity of cohabiting women to become mothers returns to previous levels and as age at leaving the parental home strongly rises. Childlessness levels appear to increasingly depend on the childbearing decisions of cohabiting couples and on age at leaving the parental home.

Changes in healthy and unhealthy working-life expectancy over the period 2002-17: a population-based study in people aged 51-65 years in 14 OECD countries.

BACKGROUND: In response to population ageing, most countries within the Organisation for Economic Co-operation and Development (OECD) are planning increases to their pension age. To ensure the effectiveness of such measures, scholars have advocated for continued monitoring of healthy working-life expectancy. However, estimates are limited to a few countries during limited periods of time. Our study aims to estimate healthy and unhealthy working-life expectancy in 14 OECD countries at three points in time between 2002 and 2017. METHODS: In this population-based study, we used cross-sectional data from nationally representative surveys on ageing that were representative of the population aged 51-65 years in England, the USA, and 11 European countries plus Israel. European countries, except for England, and Israel were divided into two groups according to their score on the Active Ageing Index (AAI). We estimated healthy and unhealthy working-life expectancy, defined as the number of years spent working in good or in poor health. Poor health was defined as the presence of at least one chronic disease. Sullivan's method was used to estimate expectancies. FINDINGS: Among men, healthy working-life expectancy increased in low-AAI countries (4·15 in 2002, 95% CI 4·01-4·30; vs 4·73 in 2017, 4·58-4·87; p<0·0001), but decreased in the USA (3·68 in 2002, 3·47-3·89; vs 3·21 in 2017, 3·03-3·38; p<0·0001). Among women, healthy working-life expectancy increased in England (3·55 in 2002, 3·39-3·71; vs 4·47 in 2017, 4·14-4·81; p<0·0001), high-AAI countries (4·16 in 2002, 4·02-4·30; vs 4·80 in 2017, 4·65-4·96; p<0·0001), and low-AAI countries (2·41 in 2002, 2·30-2·52; vs 4·00 in 2017, 3·88-4·12; p<0·0001). Unhealthy working life expectancy increased among men and women in all countries. In all countries, the greatest number of years spent unhealthy and working was among men and women with hypertension or arthritis. INTERPRETATION: Across countries, increases in the total number of years spent working were systematically accompanied by increases in the number of years spent working with a chronic disease. The burden of chronic diseases will probably continue to increase among older workers as countries plan to further increase their pension ages, but prevention of hypertension and arthritis could mitigate this trend. FUNDING: Netherlands Interdisciplinary Demographic Institute (NIDI-KNAW) and University of Groningen.

A systematic review of causes of recent increases in ages of labor market exit in OECD countries.

Ages of labor market exit have increased steadily since the late 1990s in OECD countries, but with continuing population aging, there are calls for further stimulation of labor force participation at older ages. Social scientists have extensively studied causes of variation in retirement timing between individuals and across countries, but have paid less attention to causes of variation over time. This study systematically reviews evidence of causes of increases in ages of labor market exit over the past 30 years in OECD countries. Two goals are pursued: first, to provide an overview of the retirement domains that have been subject to investigation; second to compare studies with respect to the magnitude of change in retirement behavior that they attributed to different causes, in different contexts. Nineteen studies were reviewed. Available evidence articulates itself around four domains: inter-cohort changes in labor force participation of women (3 studies), educational attainment (3 studies) and lifetime wealth (1 study), and changes to social security systems (16 studies). Determinants in all domains explain a significant amount of past increases in ages of labor market exit, though figures attributable to similar determinants vary between studies and across countries. Evidence suggests that further postponement of labor market exit may depend on further increases to normal retirement ages and more limited access to early retirement programs, but also on further increases in educational attainment and the continued integration of women in the labor market. However, a large share of the past increases in ages of labor market exit remains unexplained; therefore, other factors such as those related to work and organizational characteristics deserve further research.

Work Ability Trajectories and Retirement Pathways: A Longitudinal Analysis of Older American Workers.

OBJECTIVE: To determine whether older workers who follow different work ability (WA) trajectories tend to follow different retirement pathways. METHODS: Nationally representative data on Americans born between 1943 and 1948. Latent class growth modeling to estimate trajectories of work ability between ages 53-54 and 65-66. Multinomial log-linear models to assess the association between WA trajectories and retirement pathways. RESULTS: Three WA trajectories were identified: high (74%), declining (17%), and low (9%). Low WA leads more often to an early-gradual retirement. Declining WA leads to both early-gradual and early-crisp retirements. CONCLUSIONS: Workers with low and declining WA are more at risk of unemployment, disability, and inactivity prior to retirement; workers with declining WA are also likely to make a direct transition to early retirement. Future changes to social security should consider inter-individual variation over time in WA.