Cardiometabolic disease burden and first health-related cessation of work among middle-aged Chinese adults: a longitudinal competing-exit study.

OBJECTIVES

To examine whether a time-updated count of physician-diagnosed cardiometabolic conditions is associated with first survey-reported health-related cessation of work among adults in China.

METHODS

We analyzed 4,404 participants aged 45-60 years working and neither formally retired nor reporting baseline health-related work disruption in the China Health and Retirement Longitudinal Study. Across three intervals from 2011 to 2018, the exposure was the lagged, time-updated count of physician-diagnosed hypertension, diabetes, heart disease, stroke, and kidney disease. The outcome was first health-related work exit, with retirement, other exit, and death as competing states. The primary association was estimated with discrete-time cause-specific pooled logistic regression, participant-clustered standard errors, and 50 longitudinal imputations.

RESULTS

The cohort contributed 10,852 observed person-periods and 346 health-related work exits. Each additional diagnosed cardiometabolic condition was associated with higher odds of health-related work exit after adjustment for interval, age, sex, education, work type, smoking, alcohol, and body mass index (odds ratio 1.73, 95% confidence interval 1.51-1.97). Estimates were similar across clustering, weighting, and other sensitivity analyses. By Wave 4, standardized cumulative incidence was 6.4%, 10.5%, and 16.6% for condition counts 0, 1, and 2.

CONCLUSIONS

A higher count of physician-diagnosed cardiometabolic conditions was prospectively associated with first survey-reported health-related cessation of work, although residual confounding by unmeasured socioeconomic and job-demand factors cannot be excluded. Replication with adjudicated employment outcomes and cross-cohort validation is needed before policy or causal interpretation.