Country- and individual-level factors associated with healthy working life expectancy: A multinational longitudinal study

Background To address labor force shortages associated with population aging, many countries have proposed raising the retirement age. As health is an important determinant of employment outcomes among older workers, it is important in this context to understand the individual- and country-level factors associated with healthy working life expectancy (HWLE), defined as the average number of years individuals can expect to remain healthy and employed from age 50. Methods and findings This is a multinational prospective cohort study, leveraging data from six health and retirement cohorts. The study included 79,833 men and 95,485 women aged ≥50 years from 28 countries. Individual-level factors included demographics, socioeconomic status, lifestyle factors, and chronic diseases. Country-level factors comprised economic (GDP per capita, health expenditure, tax revenue, Gini index, ease of doing business), employment (flexible working Arrangements, labor force participation, equal workforce opportunities, hiring and firing practices) and governance (effectiveness, corruption control, political stability) metrics sourced from the World Bank. HWLE was estimated using discrete-time Markov multi-state models. Among the total participants, at age 50, the total life expectancy (TLE) was 33.59 years (95% CI [33.49, 33.69]), of which 10.98 years (95% CI [10.87, 11.08]) were HWLE. HWLE among women(9.82 years, 95% CI [9.68, 9.97]) was shorter than HWLE among men(12.36 years, 95% CI [12.22, 12.50]). Marriage, higher education, and healthy lifestyles were associated with longer HWLE, while chronic diseases reduced HWLE, with stroke showing the greatest reduction of 5.49 years (95% CI [4.94,6.04]). At the country level, higher health expenditures, GDP per capita, and tax revenue were associated with longer HWLE. Greater governance effectiveness, corruption control, and ease of doing business were associated with longer HWLE, whereas higher Gini index and political instability were associated with shorter HWLE. Higher levels of flexible working arrangements, labor force participation, equal workforce opportunities, and more favorable hiring and firing practices were consistently associated with longer HWLE and nHWLE and shorter nHnWLE. The main limitations were differences in follow-up periods across cohorts, relatively small samples in some countries, and incomplete global coverage, which may limit cross-country comparability and generalizability. Conclusions In this multinational cohort, the findings revealed the associations of individual- and country-level factors with healthy working lives, underscoring the necessity for measures aimed at extending healthy working lives to align with country-specific social, economic and employment contexts. Besides, interventions targeting individual modifiable risk factors should be warranted through life-course.