Abstract
BackgroundAs society is aging, retirement takes on increasing importance for individuals in the later life. This study aimed to describe mortality before and after retirement in the Japanese middle-aged/elderly with special attention to socioeconomic position and social relationships.MethodsWe conducted a 10-year follow-up study (the Komo-Ise cohort study) and assessed mortality according to socioeconomic positions (relative poverty and occupation) and social relationships (e.g., marital status, living alone, and social support) in workers and the retired. Relative poverty was defined as a household equivalent income of 12,700 US dollars (1.37 million Japanese Yen) or less in 2000. Stratified analyses were conducted according to sex in two groups of employment status: the workers and the retired. Adjusted hazard ratios (HRs) were calculated using the Cox proportional hazard model.ResultsWe included 5534 individuals. Of these, 3360 were men (working, 2499; retired, 861) and 2174 were women (working, 1306; retired, 868). We observed 610 deaths (475 in men and 135 in women) during the study period. Relative poverty was a significant risk factor for death (HR 1.52, 95% confidence interval [CI] 1.07–2.14) among retired men but not among working men (HR 1.20, 95% CI 0.79–1.83). Among workers, self-employed men showed a significantly higher hazard of death (HR 1.57, 95% CI 1.09–2.25) than white-collar employees. Retired men who lacked participation in social activities were more likely to die than those who did not (HR 1.44, 95% CI 1.06–1.94). All results, except marital status, indicated non-significant associations in women.ConclusionsRelative poverty and lack of social engagement may be related to high mortality risk in retired men. Further studies are needed to assess the health status among the middle-aged/elderly population around retirement.
Highlights
The increasing aging of the population has resulted in a rapid increase in fiscal burden for social security privileges; as such, several governments have responded to this increasing longevity by raising the age of eligibility for senior citizen benefits [1]
We aimed to describe mortality among Japanese middle-aged and elderly with a focus on its relationship with socioeconomic position and social relationships stratified by sex and retirement status
Study participants and design We used data from the Komo-Ise cohort study, which previously revealed that mortality and perceived health were associated with socioeconomic position and degree of social relationships among middle-aged and elderly community dwelling Japanese [13,14,15,16]
Summary
The increasing aging of the population has resulted in a rapid increase in fiscal burden for social security privileges; as such, several governments have responded to this increasing longevity by raising the age of eligibility for senior citizen benefits [1]. Previous studies have demonstrated an inverse relationship between socioeconomic position and mortality, with income and occupation serving as primary determinants of health [7,8,9]. Japan faces the concern about inequality in health under a hyper-aged society because the relative poverty rate of older people aged 65 years and over in 2012 was higher than the average in the Organization for Economic Cooperation and Development (OECD) (19.0% vs 12.5%) [1]. When considering the transition period between middle and old age, retirement can serve as a major contributor to changes in income and can affect lifestyle, social relationships, physical activity, social contact, and societal roles. This study aimed to describe mortality before and after retirement in the Japanese middle-aged/elderly with special attention to socioeconomic position and social relationships
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