- 學位論文
職涯晚期失業對於台灣中老年人全死因死亡率與失能的影響
Effect of late-career unemployment on all-cause mortality and functional disability among the older adults in Taiwan
摘要
目的：主要是評估職涯晚期的失業是否增加中老年族群未來失能與死亡的風險。 方法：在這個長期追蹤的前瞻性研究中，數據資料是從臺灣地區中老年身心社會生活狀況長期追蹤調查 ( Taiwan Longitudinal Study in Aging )所取出。這項研究是從1996年至2007年，追蹤12年期間。參與者包括50至64歲男性716人，女性為327人。參與者依據他們在1996年工作情形區分為有工作組及失業組，其中失業組中再將50歲後的失業次數累計，依不同失業次數分組。最後用使用 Logistic Regression model 來評估職涯晚期失業及失業累積次數是否增加未來的失能與死亡的風險。 結果: 1996年參與者的平均年齡為56.3（IQR=7.0）歲，非失業組共871人，失業組172人。其中，非失業組和失業組在性別比例、年齡分布、教育程度、婚姻狀態、收入水平、自評健康狀況與各慢性疾病罹病比例都有顯著的差異。結論顯示，在調整了以上變項後，失業組相較於非失業組會提高未來死亡與失能的風險，且統計學上有意義。【OR 2.79 (1.74-4.47)；OR 2.33 (1.54-3.55)】。若把50歲後失業的次數累加，50歲後的累計失業次數愈多，會提高未來死亡與失能的風險，且統計學上有意義。【OR 1.93 (1.36-2.74)；OR 1.80 (1.31-2.48)】。 結論：職涯晚期失業會提高老年人未來的死亡率與失能比例，其中累計失業次數愈多者死亡率與失能比例愈高。政策制定者應訂定相關政策以避免個人職涯晚期工作有劇烈變動，同時雇主應視中高齡工作者為資產，定期追蹤中高齡族群的身心狀態，應用策略避免任何可能的失業產生。如此不僅可以降低老年人的死亡，同時也可避免他們在失能的狀況下度過晚年，減少社會照顧成本。
並列摘要
Objectives: To evaluate whether late-career unemployment is associated with increased all-cause mortality and functional disability among older adults in Taiwan. Method: In this long-term prospective cohort study, data were retrieved from the Taiwan Longitudinal Study on Aging. This study was initiated from 1996 until 2007. The complete data from 716 males and 327 females aged 50-66 years were retrieved. Parcipitants were categorized to 2 groups (Normally employed and unemployed) depending on their employment status during 1996. In the unemployed group, cumulative number of unemployment after age 50 was calculated. Logistic regression analysis was used to examine the association between late-career unemployment and cumulative number of late-career unemployment on all-cause mortality and functional disability. Results: The average age of the participants in 1996 was 56.3 (IQR=7.0) years. There were 871 participants in the normally employed group, while 172 participants in the unemployed group. After adjustment of gender, age, level of education, income, self-rated health and major comorbidities, late-career unemployment was associated with increased all-cause mortality [Odds ratio (OR) = 2.79; 95% confidence interval (CI) = 1.74–4.47] and functional disability [Odds ratio (OR) = 2.33; 95% confidence interval (CI) = 1.54-3.55]. For cumulative number of late-career unemployment, it was also associated with increased all-cause mortality [Odds ratio (OR) = 1.91; 95% confidence interval (CI) = 1.35–2.70] and functional disability [Odds ratio (HR) = 2.35; 95% confidence interval (CI) = 1.55–3.55]. Conclusion: Late-career unemployment and cumulative number of late-career unemployment are associated with increased all-cause mortality and functional disability. Older adults should be encouraged to have normal employment during their late career before retirement. Employers should routinely examine the fitness for work for older employees for preventing possible future unemployement.