Across the globe, more people are spending more time in retirement than ever before. So staying healthy in later life is critical. Yet political debates on ageing tend to ignore a growing body of research on how retirement can affect our health. Baowen Xue and colleagues from the Department of Epidemiology and Public Health at UCL looked at links between retirement and cardio-vascular disease – and found unexplained differences between Europe and the US.
Is retirement good for your heart, or bad for it? The question is an important one because cardio-vascular disease (CVD) is the biggest cause of death globally and costs health services a huge amount of money.
Some studies have shown retired people have a higher risk of being diagnosed with CVD than those who are still working. But until now the evidence has been unclear.
We set out to review evidence from across the world, so that we could help to build a more accurate picture of whether, and how, retirement might affect our cardio-vascular health. As CVD is linked to our lifestyle, diet and other behaviour, there are lots of ways in which changes that take place in retirement might have an effect – both negative or positive.
We looked for longitudinal studies that could help answer our questions, and found 82 which measured risk factors for CVD and 14 which looked at actual incidence of CVD. The second set of 14 papers provided the answer to our first question – does retirement affect our cardio-vascular health?
The answer revealed a major difference between the USA and Europe. Studies conducted in the US showed no significant effect, good or bad, on retirees’ cardio-vascular health. In Europe, meanwhile – with the exception of France – studies consistently showed a link between retirement and an increase in CVD.
Data from the British Regional Heart Study, for instance, showed that healthy men who retired before the age of 60 were more likely than others to die from circulatory disease within five and a half years. Fatal and non-fatal CVD was also more common among retirees in Denmark, Greece, Italy and the Netherlands.
Why might this be? Could there be cultural or lifestyle differences between Europe and the US which might cause this difference? We took a systematic look at the risk factors.
First, we looked at weight gain. If Americans were less likely to put on weight after retirement compared to Europeans, that might help to explain the difference. But when we looked at this, we found that body mass index (BMI) actually increased after retirement in the USA – and also Japan -but did not change in England, Denmark, France, Germany, Switzerland or Korea. While those who do physically demanding jobs are likely to put on weight after they retire, most people aren’t.
Could it be that retired people generally do less exercise – another risk factor – in Europe? The studies suggest that’s not the reason. While many retirees did more physical activities, they also spent more time sitting still – so the effect was a balanced one. For instance, a retiree might play more golf, but also watch more television.
Do retired people perhaps smoke more, we asked? Again, there were contradictory results but 12 out of 14 studies either showed no effect or showed retirement led to people smoking less.
Perhaps retired people in Europe drink more, then? Again, this couldn’t be identified as the reason. Studies in Australia, the UK, Japan and the USA suggested there was no association between retirement and alcohol consumption.
Diet is another possible cause of CVD, but again, there was no clear pattern of between retirement and diet emerged from reviewed studies.
So the picture isn’t straightforward, and we don’t have answers as to why retirement might put Europeans at risk but not Americans. What we can say, though, is that none of the studies we looked at found any beneficial effects of retirement on CVD.
Apart from a decrease in smoking, there wasn’t evidence of any general ‘relief’ effect of retirement on people’s cardio-vascular health – so the supposition that working could be bad for our health and therefore retirement better for it doesn’t necessarily hold true.
However, studies that showed retirement brought negative health effects should be interpreted with caution. Many assessed the health effects of retirement by comparing retired people with employed people – and we know people who stay in the labour market are generally healthier than retirees. We do know people who have CVD, diabetes or hypertension are more likely to retire.
What our review has done is to reveal the complex nature of the underlying mechanism through which retirement might impact on the risk factors for CVD. Different people react differently to retirement, depending on their life experiences and the cultural and policy environments in which they live. So there isn’t one global solution to any of this – each country needs to plan its citizens’ retirement according to their individual needs.
The impact of retirement on cardiovascular disease and its risk factors: A systematic review of longitudinal studies, by Baowen Xue, Jenny Head and Anne McMunn, is published by The Gerontologist.