Pan, Yuwei; (2024) Effects of labour market characteristics on general health status and cardiometabolic diseases in ageing population: evidence from China Health and Retirement Longitudinal Study (CHARLS). Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: China is experiencing a profound social transformation. Rapid industrialisation, urbanisation, and population ageing have introduced new challenges to the labour market and public health of the country. However, research on the health impact of labour-market characteristics in China remains scarce. Aims: This PhD research investigated the associations of labour-market characteristics (characteristics measuring psychosocial work environments such as employment status, and characteristics reflecting objective indicators such as salaries) with self-rated health (SRH), all-cause mortality, and cardiometabolic diseases (CMDs) during this period of rapid changes in China. Methods: Data from China Health and Retirement Longitudinal Study (CHARLS) (2011-2018, baseline n=17,708 participants aged 45 years or over) were analysed using the following methods: (1) Cohen’s kappa statistic was applied to assess the reliability of SRH scales; (2) Multivariable logistic regression models were estimated to investigate the association between labour-market characteristics and SRH; (3) Cox proportional hazards models were estimated to investigate the predictive validity of SRH scales, and the associations of employment status with all-cause mortality, and cardiometabolic mono- and multi-morbidity; (4) Multilevel growth curve models were estimated to investigate age trajectories of metabolic syndrome (MetS) factors in different employment groups. Results: There was moderate to substantial test-retest reliability of SRH in Chinese adults. In age-sex adjusted models, poor SRH was associated with unpaid family business, working for less (1-39 h/week) or extremely long hours (≥60 h/week), working in private sectors, earning a lower income, being without any employer-provided insurance, not being in a supervisory position, and being without any formal-form labour contract. Compared to non-agricultural employees, non-agricultural self-employed workers had a higher risk of cardiometabolic multi-morbidity, and retired workers had higher risks of death and cardiometabolic mono- and multi-morbidity. Age trajectories of MetS factors varied across employment groups, with gender differences observed. Implications: This research provides new insights into the impact of unfavourable labour-market characteristics on general and cardiometabolic health of middle-aged and older Chinese workers. It provides policymakers with evidence to improve working conditions, reduce disease morbidity and mortality, and eventually alleviate the burden of diseases.

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