Publication Date

2014-04-30

Availability

Embargoed

Embargo Period

2016-04-30

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Public Health Sciences (Medicine)

Date of Defense

2014-03-24

First Committee Member

David J. Lee

Second Committee Member

Lora E. Fleming

Third Committee Member

Guillermo Prado

Fourth Committee Member

Peter Muennig

Fifth Committee Member

Sharon L. Christ

Abstract

The proportion of adults aged 65 years and over in the U.S. population is rapidly increasing due to increasing longevity, as well as decreasing fertility rates. As a result, adults aged 65+ constitute the fastest growing group among workers, and this trend is projected to continue as the baby boomer generation enters retirement age. The positive effects of employment at older age on health has been suggested by previous research, however no comprehensive examination of health status of older workers has been conducted. In addition, the effect of employment at older age on such important health outcomes as health-related qualityof life (HRQL), healthcare use, and healthcare utilization has not been well examined. Finally, the effect of occupation on health outcomes of older workers has been virtually ignored. This study fills this important gap in literature using nationally-representative data and complex statistical modeling techniques, such as structural equation modeling. Using the data from the 1997-2011 National Health Interview Survey (NHIS) and the 2000-2009 Medical Expenditure Panel Survey (MEPS), we found that older workers are generally healththier than the non-workers, with those in more physically demanding occupations (farm, service, and blue collar workers) reporting the best health. Workers in these occupations reported the fewest number of functional limitations and prior diagnoses of chronic illness, and had the highest mental health and overall HRQL scores. They were however just as likely as the white collar workers to rate their health as good or better, and had the same physical HRQL scores. Only service workers had lower healthcare expenditures than other working older adults, which could be explained by poorer healthcare access in this occupation. Unemployment at older age was however among the strongest predictors of increased healthcare costs, poorest HRQL, and poor health outcomes on all other measures. In agreement with previous literature, we find a strong association between later life employment and improved health outcomes. Our results suggest a certain degree of healthy worker effect (e.g. in lower number of chronic health conditions in workers), as well as beneficial effect of employment on health at older age (e.g. improved mental HRQL scores among workers in physical occupations in the absence of differences between workers on physical HRQL scores). We discuss the implications of the results and provide suggestions for potential policy measures aimed at improvement of older adult work opportunities.

Keywords

older workers; national health interview survey; medical expenditure panel survey; health-related quality of life; health status; healthcare expenditures

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