Abstract
Objective
This prospective cohort study investigates the relationship between the onset of disability and employment status.
Methods
We investigated 3,741 community-dwelling adults aged 70 or older, who participated in a population-based cohort study in Japan. Their onset of disability was monitored monthly using the long-term care insurance certification registration system, for five years from baseline. Based on an employment status questionnaire, we categorized participants into three groups: (1) employee, (2) self-employed, and (3) not working. Covariates included demographic information, medical history, number of medications, educational level, living alone, social group engagement, smoking status, walking speed, instrumental activities of daily living, global cognitive function, and depressive symptoms. Missing values were managed using multiple imputation. Cox proportional hazard models were used to calculate hazard ratios (HRs) with 95% confidence intervals (CIs) for incident disability risk by employment status.
Results
The disability incidence rates were 15.3/1,000 (95% CIs: 10.7–22.0) person-years among employees, and 33.0/1000 (95% CIs: 24.4–44.6) and 39.6/1000 (95% CIs: 36.5–43.0) person-years among self-employed and non-working participants, respectively. The adjusted HRs for the onset of disability among non-working and self-employed participants were 1.69 (95% CIs: 1.16–2.46, p = 0.007) and 1.63 (95% CIs: 1.01–2.62, p = 0.044) compared with employees, respectively. Similar results were found among men. Among women, disability onset was not associated with employment status.
Conclusions
Older adults’ risk of disability onset differed according to their employment status. Older employees had a lower risk of disability onset than those not working or self-employed.
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Data availability
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- LTCI:
-
Long-term care insurance
- BADL:
-
Basic activities of daily living
- NCGG-SGS:
-
National Center for Geriatric and Gerontology-Study of Geriatric Syndromes
- MMSE:
-
Mini-mental state examination
- IADL:
-
Instrumental activities of daily living
- GDS-15:
-
Geriatric depression scale-15
- HR:
-
Hazard ratio
- CI:
-
Confidence interval
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Acknowledgements
The authors thank the Midori Ward of Nagoya Office for their assistance with participant recruitment. We also thank the healthcare staff for their assistance with the assessments. We thank Editage (www.editage.com) for their assistance with English language editing.
Funding
This work was supported by the Research Institute of Science and Technology for Society (RISTEX), from the Japan Science and Technology Agency (JST), the Health Labor Sciences Research Grants from the Japanese Ministry of Health, Labor, and Welfare [Grant number H24-tyoujyu-ippan-004], the Research Project on Health and Welfare Promotion for the Elderly, the Research Funding for Longevity Sciences from the National Center for Geriatrics and Gerontology [Grant number 24–18 and 25–26], and the Sasakawa Scientific Research Grant from The Japan Science Society [Grant number 2023–6011]. The funders were not involved in the design, methods, subject recruitment, data collection, analysis, or preparation of the manuscript paper.
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KF: contributed to the conceptualization, methodology, formal analysis, and writing—original draft. HS: contributed to the supervision, conceptualization, methodology, funding acquisition, and writing—review & editing. SL: contributed to the supervision, data curation, and writing—review & editing. OK: contributed to the data curation, methodology, and writing—review & editing. KM: contributed to the data curation, methodology, and writing—review & editing. KH: contributed to the data curation, methodology, and writing—review & editing. KT: contributed to the writing—review & editing. MM: contributed to the writing—review & editing. RY: contributed to the writing—review & editing. CN: contributed to the writing—review & editing. YM: contributed to the writing—review & editing.
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This study was performed in accordance with the Declaration of Helsinki. We obtained written informed consent from all the participants. The study design was approved by the Ethics Committee of the National Center for Geriatrics and Gerontology (approval number: 1440–3).
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Fujii, K., Lee, S., Katayama, O. et al. Difference in employment status and onset of disability among Japanese community-dwelling older adults: a prospective cohort study. Int Arch Occup Environ Health 96, 1225–1234 (2023). https://doi.org/10.1007/s00420-023-02000-8
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DOI: https://doi.org/10.1007/s00420-023-02000-8