Workforce Participation and Mortality Risk Among Chinese Older Adults: A Nationwide Population-Based Prospective Study

Objectives: This study examines the association between workforce participation and mortality among Chinese older adults. Methods: 6,138 participants aged 60 and older from the 2011 to 2018 China Health and Retirement Longitudinal Study were studied and 79.5% of the sample were rural Hukou. Cox proportional hazard models were used to estimate hazard ratios (HRs) for the associations of work status, work types, and changes in work status with all-cause mortality. Cox models with penalized splines were performed to explore the doseresponse relationship for hours worked per week and mortality. Results: 37,235.3 person-years observed 1,165 deaths (19.0%). Working reduced the mortality risk in older adults by 41% compared with those who did not work (HR: 0.59, 95% confidence interval: 0.50-0.69). This effect was consistent across subgroups. The mortality risk was lowest among self-employed older adults, followed by nonagricultural employment and then agricultural work, with adjusted HRs of (0.38, 0.21-0.70), (0.58, 0.36-0.93), and (0.61, 0.51-0.72), respectively. The mortality risk decreased with increasing hours of work per week and appeared to reach a threshold of about 45 hr of work per week. Compared with the older adults who continuously did not work, those who started and kept working had 28% (0.72, 0.53-0.97) and 48% (0.52, 0.41-0.65) lower mortality risks, respectively. When older adults transitioned from working to not working, the mortality risk would no longer be significantly different from that of older adults who were continuously not working (0.86, 0.65-1.12, p = 0.3). Discussion: Workforce participation was associated with survival benefits among older adults in China.