Abstract 020: Heartbreaking Careers in Old Age: Retirement Sequences as a Non-Traditional Risk Factor for Cardiovascular Diseases

Abstract

Background: Traditional factors leave substantial risk for incident cardiovascular disease (CVD) unexplained. Recent literature addressing this limitation identifies non-traditional risk factors, such as depression and clinical biomarkers. This study explored retirement sequences as a new non-traditional risk factor for CVD among older Americans. Methods: Heart disease and stroke incidence were measured for 7,880 Health and Retirement Study participants age 70 and over. Non-parametric survival curves and time-discrete survival models were used to compare the succeeding incidence of CVD across the retirement sequences that individuals followed between ages 60-61 and 70-71. We employed six holistic types of retirement sequences: (i) early for individuals who completely retired at or before age 62; (ii) complete for the conventional normative model of retirement by which people who are working in full-time jobs completely retire at the legally established age; (iii) ambiguous for people out of the labor force who shifted into retirement; (iv) partial for subjects with full-time jobs that claimed partial pension benefits in their early 60s; (v) compact for individuals moving from part-time positions into partial retirement; and (vi) late for individuals with full-time employments until their late 60s. These sequences were measured as longitudinal pathways of labor-force statuses and transitions measured in two-year intervals between the ages 60-61 to 70-71 years. Models were fitted for the whole sample, as well as males and females separately, adjusting for the probability of dying before CVD onset, sociodemographics, traditional risk factors, and clinical characteristics. Results: Out of all participants, 78.1% (6154/7880) reported at least one adverse cardiovascular event after age 70. Individuals following retirement sequences characterized by a progression from full-time jobs to either early retirement (heart disease, HR 3.07 CI95% 2.89-3.26 p<.001; stroke, HR:2.75 CI95% 2.53-2.96 p<.001) or retirement at the state pension age (heart disease, HR:3.73 CI95% 3.52-3.93 p<.001; stroke, HR:2.30 CI95% 2.07-2.54 p<.001), as well as people out of the labor force who move into retirement (heart disease, HR:2.36 CI95% 2.12-2.60 p<.001; stroke, HR:2.72 CI95% 2.44-3.01 p<.001) experienced a higher risk for heart disease and stroke relative to individuals who kept on working past the retirement age. However, the effects are stronger for heart disease among women and stroke among men. Conclusions: Retirement sequences may indeed be regarded as a non-traditional risk factor for CVD in aging populations. Keywords: Retirement-Heart disease-Stroke-Work