To Work or Not to Work? The Effect of Higher Pension Age on Cardiovascular Health

• DOI: http://doi.org/10.1111/irel.12257
• Author: Chiara Ardito,Roberto Leombruni,Angelo d’Errico,David Blane
• Date: 01 July 2020
• Published date: 01 July 2020

To Work or Not to Work? The Effect of Higher

Pension Age on Cardiovascular Health

CHIARA ARDITO , ROBERTO LEOMBRUNI, DAVID BLANE

and ANGELO D’ERRICO

This study investigates the effect of pension age on hospitalization for cardiovas-

cular diseases using administrative social security and hospital discharge records

in Italy. The endogeneity of the retirement decision is addressed using an instru-

mental variable strategy exploiting the exogenous variation in pension age deter-

mined by quarter of birth. Results indicate a detrimental effect of higher pension

age only for retirees who, before retirement, were suffering worse health and were

employed in lower quality and more physically demanding jobs. Among them, a

1-year delay in pension claiming increases the risk of hospitalization for cardio-

vascular diseases by approximately 2.6 percentage points.

Introduction

During the last half century, average life expectancy at birth has increased

steadily in developed economies, raising concerns about future pension sys-

tems sustainability. The dominant policy response to this demographic change

has focused on raising statutory pension age and restricting access to early

JEL codes: I10, I14, J26, C36, J14.

*The authors’affiliations are, respectively, University of Torino, Torino, Italy. E-mail: chiara.ardito@uni-

to.it; University of Torino, Torino, Italy. E-mail: roberto.leombruni@unito.it; Imperial College London and

University College London, London, United Kingdom. E-mail: d.blane@imperial.ac.uk; Epidemiology Unit

ASL TO3 Piedmont Region, Grugliasco, Italy. E-mail: angelo.derrico@epi.piemonte.it. The authors are

grateful to Massimiliano Bratti, Kerwin Charles, Peter Eibich, Bernardo Fanfani, Michele Mosca, Lia Pacelli,

Alessandro Pezzoli, Chiara Pronzato, Enrico Rettore, Amanda Sacker, Elena Strippoli, and the participants

in the seminars and conferences at Tuscany Quality of Life, WAHE 2016, EALE 2016, IUSSP-Max Plack

Instititute, Collegio Carlo Alberto, Society for Longitudinal and Life Course Studies for their help and sug-

gestions. All errors remain their own. Part of the research was carried out while Chiara Ardito was visiting

ESRC International Centre for Life Course Studies in Society and Health—ICLS at University College Lon-

don, which she thanks for their hospitality. The financial support received from "Tuscany: a Global Labora-

tory for Quality of Life," promoted by Tuscany Region, Toscana Promozione and E.di C.s.p.a.-Polo

Lionello Bonfanti (Prot. 2014/3014/8.4.1/30, D. n.135 del 28/04/2014 and D. n. 325 del 15/12/2014), “The

PopArt Network. New Synthetic Data on Socio-Economic Histories New Knowledge Base on Social Poli-

cies, Work and Health in Times of Recession,”promoted by Universit

a di Torino and Compagnia di San

Paolo is gratefully acknowledged.

INDUSTRIAL RELATIONS, DOI: 10.1111/irel.12257. Vol. 59, No. 3 (July 2020). ©2020 Regents of the

Universit y of Calif ornia. Published by Wiley Periodicals, Inc., 350 Main Street, Malden, MA 02148, USA,

and 9600 Garsington Road, Oxford, OX4 2DQ, UK.

399

retirement as ways to extend working life and collect more payroll taxes, while

reducing pension expenditures. Though the financial implications of these mea-

sures are deemed positive (Gruber and Wise 2007), they might also have unin-

tended negative effects on individuals’health. The concern is that an increase

in statutory pension age may affect health or accelerate the age-related health

decline by protracting the exposure to work-related stress, occupational strain,

and adverse labor-market events (Ardito and d’Errico 2018).

In this article, we focus on the effect of pension age on cardiovascular dis-

eases, a group of diseases whose correlation with working conditions has been

widely documented, which represent the leading cause of death worldwide

(WHO 2018). Surprisingly, the relationship between cardiovascular diseases

and age at retirement is an understudied topic. As has emerged by a recent

systematic review of the literature on the effect of retirement on cardiovascular

diseases and its risk factors (Xue et al. 2019), only two out of the eighty-two

reviewed articles employed a causal design to study the impact of retirement

on diagnosis of cardiovascular diseases (hereafter: CVD), while the effect of

age at retirement on CVD has never been investigated. Most previous studies

indeed looked at retirement rather than retirement age. This is an important

aspect on which research should shed light as, arguably, retirement age is

more policy relevant, because it allows a more direct evaluation of the health

effects of policies that increase the retirement age. Also, some papers, such as

Eibich (2015), show that there is some heterogeneity in the effects of retire-

ment on health depending on the age at retirement. Focusing on CVD out-

comes is particularly relevant when assessing the implications of work-life

extension, because many physical and psychosocial work-related factors have

been found to be associated with the development of cardiovascular diseases.

In particular, exposures to high physical demands (shifting loads, repetitive

movements, maintaining standing, and/or awkward postures), low autonomy

about how to perform the tasks (e.g., pace of work, breaks), and job insecurity

are known to play a role in the activation or acceleration of stress pathogenic

mechanisms such as increase in blood pressure and to trigger unhealthy behav-

iors such as smoking and sleep disturbances—all of which are well-established

risk factors for cardiovascular diseases (Brunner 1997; Marmot et al. 1997;

Pollitt, Rose, and Kaufman 2005; Siegrist 1996). Exposures to adverse labor-

market events, such as experiencing involuntary job loss, or lack of social sup-

port from colleagues and supervisors worsen mental health (Maclean et al.

2015; Mandal and Roe 2008), which has been found to be a cause of CVD

(Kubzansky and Kawachi 2000; Rozanski, Blumenthal, and Kaplan 1999). As

widely documented by life course epidemiology, these continued physical and

psychological exposures seem to accumulate and interact throughout the

400 / CHIARA ARDITO,ROBERTO LEOMBRUNI,DAVID BLANE,AND ANGELO D’ERRICO

working life, leading to impaired future health (Blane 2006; Blane et al. 2013;

Marmot et al. 1997).

In this article we contribute to the existing literature by filling these knowl-

edge gaps. We assess the impact of pension age on hospitalization for CVD in

Italy adopting an innovative instrumental variable approach to tackle the issue

of endogeneity, exploiting the variability in pension age induced by month of

birth within any birth cohort. The use of longitudinal administrative social

security and hospitalization discharge records allows observing very precisely

both the outcome and the retirement transition, reducing measurement errors

and self-reporting biases typical of subjective measures. Our results show that

a 1-year delay in pension claiming has a differential effect on hospitalization

for CVD at 68–70 years across the subpopulations of retirees. We find that

claiming pension at an older age exerts a detrimental effect only on those retir-

ees who were employed in low quality and more physically demanding jobs

and among those with poorer health by approximately 2.6 percentage points.

Instead, among higher skilled and paid workers as well as those with better

health, no significant effect of pension age on future CVD can be detected.

The rest of the article is organized as follows. The next section provides a

review of the previous literature. We then briefly present the institutional set-

ting of the pension system in Italy. We then describe the sample of analysis

and discuss potential health endogeneity issues and the empirical strategy. The

results are then outlined and their robustness tested, followed by a discussion

of the findings and a conclusion.

The Health Effects of Retirement

Retirement is a major life course transition, according to both psychological

and sociological theories. Previous contributions, however, have provided con-

flicting theoretical predictions on the health effect of retirement. According to

some theories, retirement is a major stressful life transition, carrying negative

consequences on health because it entails a loss of benefits intrinsically associ-

ated with work, such as social contacts, financial security, a social identity, and a

time structure (Lazarus and DeLongis 1983). Retirement could be detrimental

also according to the role theory, which predicts a negative influence of retire-

ment on health because retired individuals experience a disruption in their social

identity with the disappearance of their work role (George 1993). In contrast,

other theories predict no change in health or an improvement in health caused by

retirement. For example, the activity theory (Lemon, Bengtson, and Peterson

1972), points out that retired people have more time to spend with family and

friends, engaging in leisure, training, or physical activities, all of which are likely

Effect of Pension Age on Cardiovascular Health / 401