A life course study of quality of life at older ages in a French occupational cohort

Abstract

Background and aims. This thesis took a life course approach to examining inequalities in quality of life in early old age using the French occupational cohort GAZEL. The cohort combines company administrative records with information from annual questionnaires for 20 625 electricity and gas industry employees. The thesis aimed to examine whether current circumstances, retirement routes, mid-life working conditions or occupational grade were associated with subjective quality of life, measured with CASP-19, in retired participants. Results. Cross-sectional and change analyses using multiple regression demonstrated that social support, financial adequacy and, above all, mental and physical health were strongly associated with quality of life. There was a graded relationship between occupational grade in mid-life and quality of life following labour market exit, a relationship which was largely accounted for by health and financial circumstances in retirement. After adjusting for occupational grade and social class, exposures to physical hazards and ergonomic strain were associated with lower quality of life following retirement; accumulated exposures to carcinogens were not. Pathways from working conditions to poorer quality of life via physical and mental health accounted for the associations between earlier strenuous and dangerous working conditions and quality of life following retirement. Retiring tended to improve subjective quality of life, particularly if it was from difficult psychosocial working conditions. Retiring in ill health was associated with worse quality of life; this retirement route was more likely for individuals who had poor working conditions. Continuing professional activities after retirement was associated with better quality of life, a retirement route more likely for individuals working in higher grades. Conclusions. The thesis demonstrated small but persistent life course influences of employment characteristics upon quality of life which appeared to be mediated via current determinants of quality of life.