American Journal of Epidemiology Advance Access originally published online on August 11, 2008
American Journal of Epidemiology 2008 168(8):974-975; doi:10.1093/aje/kwn239
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LETTERS TO THE EDITOR |
RE: "AGE AT RETIREMENT AND MORTALITY IN A GENERAL POPULATION SAMPLE: THE GREEK EPIC STUDY"
Occupational Health Unit, Department of Public Health, Medical School, University of Patras, 26500 Rio, Patras, Greece
(e-mail: ecalexop{at}upatras.gr)
In a recent Journal article, Bamia et al. (1) proposed that early retirement may be a risk factor for all-cause and cardiovascular mortality in apparently healthy persons. Since several studies have shown a markedly higher mortality rate among disability pensioners, it is of specific interest to address the same contemporary issue among healthy retirees. However, several of the authors’ points deserve further comment.
Until recently in Greece, early, nondisabled retirees included men at age 58 years who completed 35 years of work and those who work in hazardous occupations (a moot list of approximately 150 "heavy and unhealthy jobs") at ages 55 or 53 years for full or partial retirement, respectively. For mothers with dependent children and for specific services (police, fire brigade, and military), there were opportunities for earlier retirement even below the age of 50 years. On the basis of these pension entitlement schemes, the authors’ (1) choice of the specific cutoff points to assign retirement as early or normal/late may not be the most appropriate for the stratified analysis and for checking effect modification. I suppose that most male retirees in the first age group (54 subjects already retired at age 54 years) were workers in hazardous jobs biased to exit employment or disability pensioners who suffered from diseases, other than the excluded ones, such as mental, neurologic, orthopedic, and respiratory disorders. Retirees who were sick or were exposed to harmful conditions were at higher risk of mortality. This finding may have been reflected in the results because the death rate in this first group of male retirees was 6.6 times higher than that for the respective group of employees (the rate was 1.2 and 1.5 in the 2 other groups). On the contrary, women may include a fair proportion of healthy retirees in the first group. This variation of apportionment ratio across strata, combined with the possibility of severe inaccuracy in cause of death on death certificates, could have biased the results regarding both all-cause and cause-specific mortality (2). Although the results were adjusted for a number of potential confounders, factors with a well-known influence on morbidity and disability, such as socioeconomic status or occupational factors, were not addressed in this study (3). To some extent, adjustment for education could have minimized the confounding, but it will not address potential confounding due to strenuous working conditions.
A strong healthy-worker effect or misclassification is possible given that at least a 10-fold larger proportion of elders (aged >64 years) who continue to work belonged in the elementary educational level category. Finally, the statement that retirees and employees have the same access to health care in Greece is questionable, since the health care system is characterized by inequitable coverage and access to health services and the majority of retirees are of low economic status (4, 5). Two of 3 retirees receive up to 600 Euro (US $950) per month, and 860,000 farmers are forced to survive with a monthly pension of 360 Euro, a pourboire according to a former minister (5).
Early retirement constitutes a major policy challenge especially in Greece, with the highest proportion of pensioners in the European Union and a rapidly aging population (6). In addition to financial incentives and measures to increase job opportunities, a satisfactory work environment is expected to have significant effects on the retirement behavior of older workers, healthy and disabled ones, which could be utilized by the state and employers as an invaluable investment to tackle early retirement. Paid employment may impart health advantages, but this presumes worksite preventive measures and promotion of health (7–9), worker awareness of potential job-related hazards (10), and inspection and enforcement of compliance with health and safety regulations (11).
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ACKNOWLEDGMENTS |
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Conflict of interest: none declared.
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References |
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 TOP References |
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- Bamia C, Trichopoulou A, Trichopoulos D. Age at retirement and mortality in a general population sample: the Greek EPIC study. Am J Epidemiol (2008) 167(5):561–569.
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[Abstract/Free Full Text] - Elovainio M, Forma P, Kivimaki M, et al. Job demands and job control as correlates of early retirement thoughts in Finnish social and health care employees. Work Stress (2005) 19:84–92.[CrossRef][Web of Science]
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  C. Bamia, A. Trichopoulou, and D. Trichopoulos THE AUTHORS REPLY Am. J. Epidemiol., October 15, 2008; 168(8): 975 - 975. [Full Text] [PDF]
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