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Background: Declines in cognitive and physical function in later adulthood can have an impact whether or not individuals remain in the workforce, although the relationship is complex and often bidirectional. Little is also known about how this relationship differs in rural versus urban populations. We capitalized on longitudinal data in an urbanizing population to estimate the differential impact of urbanization level with cognitive and physical function on remaining in the work force. Methods: We used longitudinal data from 5,228 adults in the China Health and Nutrition Survey aged 58+ to assess the association between cognitive and physical function at the 2015 survey with whether older adults remained in the work force, based on self-report of either formal or informal work, in 2018. We defined cognitive function using a global cognitive score based on a subset of the modified Telephone Interview for Cognitive Status (TICS) and physical function using limitations as measured by instrumental activities of daily living (IADLs). Given differences in demographics of working status in urban (urban areas or small towns) versus rural villages, we included an interaction term for cognitive function by urban versus rural village residence. In minimally adjusted models, we controlled for age and gender and in fully adjusted models we additionally adjusted for birth cohort, education, region, marital status, and income. Results: In 2018, 48% of adults lived in rural villages and 41% were currently working. In rural villages, we found individuals with any (versus no) physical limitations in 2015 in were more likely to be working in 2018: Any IADL limitations versus no limitations: (OR=0.47 [95% confidence interval (CI) of 0.34-0.65). However, in urban areas, individuals with any (versus no) physical limitations in 2015 were more likely to be working in 2018: Any IADL limitations versus no limitations: OR=2.44 (1.18,5.03). We found no evidence of differential association between cognitive function and subsequent working status in the total sample or by rural village residence in the minimally or fully adjusted models. Conclusion: Physical (but not cognitive) function at baseline impacts future occupational status differently for those in rural versus urban areas which could reflect differences in the types of work being done as well as differences in the availability of economic resources between rural versus urban areas.
Howard et al. (Tue,) studied this question.