Using 16 years of Health and Retirement Study data (1998–2014), this study examined how combined employment status and perceived job insecurity trajectories across late midlife were associated with domain-specific cognitive scores and cognitive impairment (MCI or dementia) in 2016 among U.S. adults aged 65+ (n=2418; women=1470, men=948), using gender-stratified sequence analysis.
Among women, early retirement and not-in-labor-force trajectories were linked to ~0.30–0.32 SD lower memory scores and nearly twice the odds of cognitive impairment (aOR=1.97 and 1.80, respectively) vs. secure employment; among men, inconsistent employment was associated with lower scores across multiple domains (global cognition β=−0.29 SD) and twice the odds of impairment (aOR=2.02). Persistently job-insecure but continuously employed participants showed no cognitive deficit relative to job-secure peers.
Employment status and job insecurity were self-reported, introducing potential misclassification. Health-related selection (early sub-clinical cognitive or physical decline driving labor force exit) cannot be fully excluded despite adjustment for baseline cognition and censoring weights. The HCAP sub-sample restriction reduced statistical power, yielding wide confidence intervals for some impairment estimates, and direct caregiving intensity data were unavailable to account for gendered caregiving as a confounder.
Clinicians should recognize employment discontinuity—early retirement, extended labor force absence, and frequent job transitions in midlife—as potential dementia risk markers, particularly in women. Patients with these histories may warrant early cognitive screening and referral to preventive interventions.
