The impact of cumulative years of biomechanical and psychosocial exposures on competing exit routes from paid employment among older workers in Norway: A life course perspective.

OBJECTIVE: This study aimed to examine associations between cumulative years of biomechanical and psychosocial job exposures and premature labor market exit among older workers within a competing risks framework. METHODS: Using linked registry data and gender-specific job-exposure matrices, we constructed measures of cumulative years of biomechanical and psychosocial job exposures over the 30 years preceding baseline. A cohort of Norwegian workers (N=339 227) was followed from age 50 for up to 17 years, until statutory retirement age of 67 years. Fine & Gray competing risk models estimated subdistribution hazard ratios (SHR) for health-related exit, early retirement, and unemployment, stratified by gender. RESULTS: Several exposures were positively associated with the cumulative incidence of specific exit routes. Among men, the highest SHR per additional year of exposure were observed for standing/walking for health-related exit [SHR 1.013, 95% confidence interval (CI) 1.011-1.015], low decision authority for early retirement (SHR 1.008, 95% CI 1.006-1.008), and forward bending for unemployment (SHR 1.009, 95% CI 1.005-1.013). Among women, the highest SHR were observed for standing/walking for health-related exit (SHR 1.012, 95% CI 1.010-1.015), conflicting work methods for early retirement (SHR 1.017, 95% CI 1.014-1.019), and monotonous work for unemployment (SHR 1.034, 95% CI 1.027-1.041). Several biomechanical and psychosocial exposures showed inverse associations, which could be attributable to the higher cumulative incidence of competing exit routes in the Fine & Gray framework. CONCLUSION: Within a competing-risks framework, cumulative years of biomechanical and psychosocial exposures were associated with distinct labor market exit patterns among older workers, highlighting the importance of incorporating work histories and competing routes into intervention design.