Do socioeconomic differences in mortality persist after retirement? 25 Year follow up of civil servants from the first Whitehall study

Abstract Objective : To assess the risk of death associated with work based and non-work based measures of socioeconomic status before and after retirement age. Design : Follow up study of mortality in relation to employment grade and car ownership over 25 years. Setting : The first Whitehall study. Subjects : 18 133 male civil servants aged 40–69 years who attended a screening examination between 1967 and 1970. Main outcome measure : Death. Results : Grade of employment was a strong predictor of mortality before retirement. For men dying at ages 40–64 the lowest employment grade had 3.12 times the mortality of the highest grade (95% confidence interval 2.4 to 4.1). After retirement the ability of grade to predict mortality declined (rate ratio 1.86; 1.6 to 2.2). A non-work based measure of socioeconomic status (car ownership) predicted mortality less well than employment grade before retirement but its ability to predict mortality declined less after retirement. Using a relative index of inequality that was sensitive to the distribution among socioeconomic groups showed employment grade and car ownership to have independent associations with mortality that were of equal magnitude after retirement. The absolute difference in death rates between the lowest and highest employment grades increased with age from 12.9 per 1000 person years at ages 40–64 to 38.3 per 1000 at ages 70–89. Conclusions : Socioeconomic differences in mortality persist beyond retirement age and in magnitude increase with age. Social differentials in mortality based on an occupational status measure seem to decrease to a greater degree after retirement than those based on a non-work measure. This suggests that alongside other socioeconomic factors work itself may play an important part in generating social inequalities in health in men of working age. Key messages Relative differences in mortality between low and high employment grades are less after retirement, suggesting the importance of work in generating inequalities in health A non-work based measure of socioeconomic status (after adjustment for employment grade) continues to predict relative differences in mortality after retirement Absolute differences in mortality between less and more advantaged groups increase at older ages