Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
J Gerontol B Psychol Sci Soc Sci. 2024 Oct 1;79(10). doi: 10.1093/geronb/gbae131.
Multimorbidity, known as multiple chronic conditions (MCC), is the coexistence of two or more chronic health conditions (CHC). The near-retirement-age population with MCC is more likely to experience discontinued labor force participation (LFP). Our objective was to evaluate the impact of MCC on LFP among adults aged 50-64 and to explore heterogeneous effects between self-employed and non-self-employed workers.
We constructed our sample using the Health and Retirement Study (HRS) from 1996 to 2018. We adopted an individual fixed-effect (F.E.) model and propensity score matching (PSM) to measure the impact of MCC on the probability of being employed and changes in annual work hours.
50.5% of respondents have MCC. Individuals with MCC exhibit a predicted probability of being employed that is 9.3 percentage points (p < .01, 95% confidence interval [95% CI]: -0.109, -0.078) lower than those without MCC. Compared with non-CHC, MCC significantly reduced annual working hours by 6.1% (p < .01, 95% CI: -0.091, -0.036) in the F.E. model and by 4.9% (p < .01, 95% CI: -0.064, -0.033) in PSM estimation. The effect is more pronounced for the self-employed with MCC, who have 13.0% (p < .05, 95% CI: -0.233, -0.026) fewer annual work hours than non-CHC based on the FE model and 13.4% (p < .01, 95% CI: -0.197, -0.070) in PSM estimation.
MCC significantly reduces LFP compared with non-MCC. MCC has a heterogeneous impact across occupational types. It is important to support the near-retirement-age working population with multimorbidity through effective clinical interventions and workplace wellness policies to help manage health conditions and remain active in the labor market.
多种并存疾病（multimorbidity），又称多种慢性疾病（multiple chronic conditions，MCC），是指同时存在两种或以上的慢性健康状况。患有 MCC 的即将退休人群更有可能停止劳动力参与。本研究旨在评估 MCC 对 50-64 岁成年人劳动力参与的影响，并探讨自雇和非自雇工人之间的异质性影响。
我们使用 1996 年至 2018 年期间的健康与退休研究（Health and Retirement Study，HRS）构建了样本。我们采用个体固定效应（fixed-effect，FE）模型和倾向评分匹配（propensity score matching，PSM）来衡量 MCC 对就业概率和年工作时间变化的影响。
50.5%的受访者患有 MCC。与无 MCC 者相比，MCC 个体的就业预测概率低 9.3 个百分点（p<0.01，95%置信区间 [95%CI]：-0.109，-0.078）。与非 CHC 相比，MCC 在用 FE 模型时显著减少了 6.1%的年工作时间（p<0.01，95%CI：-0.091，-0.036），在 PSM 估计中减少了 4.9%（p<0.01，95%CI：-0.064，-0.033）。对于患有 MCC 的自雇人士来说，这种影响更为明显，他们的年工作时间比非 CHC 少 13.0%（p<0.05，95%CI：-0.233，-0.026），根据 FE 模型，他们的年工作时间比非 CHC 少 13.4%（p<0.01，95%CI：-0.197，-0.070）。
与非 MCC 相比，MCC 显著降低了劳动力参与率。MCC 对不同职业类型的影响存在异质性。通过有效的临床干预和工作场所健康政策，支持患有多种并存疾病的即将退休工作人群，帮助他们管理健康状况并保持劳动力市场的活跃性，这一点很重要。
