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Effect of retirement on major chronic conditions and fatigue: French GAZEL occupational cohort study

BMJ 2010; 341 doi: (Published 24 November 2010) Cite this as: BMJ 2010;341:c6149
  1. Hugo Westerlund, associate professor of psychology12,
  2. Jussi Vahtera, professor of public health34,
  3. Jane E Ferrie, senior research fellow2,
  4. Archana Singh-Manoux, research director25,
  5. Jaana Pentti, statistician3,
  6. Maria Melchior, senior researcher5,
  7. Constanze Leineweber, researcher1,
  8. Markus Jokela, senior research fellow2,
  9. Johannes Siegrist, professor of medical sociology6,
  10. Marcel Goldberg, professor of epidemiology5,
  11. Marie Zins, senior researcher5,
  12. Mika Kivimäki, professor of social epidemiology23
  1. 1Stress Research Institute, Stockholm University, SE-106 91 Stockholm, Sweden
  2. 2Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
  3. 3Finnish Institute of Occupational Health, FI-00250 Helsinki, Finland
  4. 4Department of Public Health, University of Turku and Turku University Hospital, FI-20520 Turku, Finland
  5. 5INSERM, U1018, Villejuif, F-94807, France; Université Versailles Saint Quentin en Yvelines, France
  6. 6Institut für Medizinische Soziologie, Heinrich Heine-Universität Düsseldorf, D-40001 Düsseldorf, Germany
  1. Correspondence to: H Westerlund hugo.westerlund{at}
  • Accepted 8 September 2010


Objectives To determine, using longitudinal analyses, if retirement is followed by a change in the risk of incident chronic diseases, depressive symptoms, and fatigue.

Design Prospective study with repeat measures from 7 years before to 7 years after retirement.

Setting Large French occupational cohort (the GAZEL study), 1989-2007.

Participants 11 246 men and 2858 women.

Main outcome measures Respiratory disease, diabetes, coronary heart disease and stroke, mental fatigue, and physical fatigue, measured annually by self report over the 15 year observation period; depressive symptoms measured at four time points.

Results The average number of repeat measurements per participant was 12.1. Repeated measures logistic regression with generalised estimating equations showed that the cumulative prevalence of self reported respiratory disease, diabetes, and coronary heart disease and stroke increased with age, with no break in the trend around retirement. In contrast, retirement was associated with a substantial decrease in the prevalence of both mental fatigue (odds ratio for fatigue one year after versus one year before retirement 0.19, 95% confidence interval 0.18 to 0.21) and physical fatigue (0.27, 0.26 to 0.30). A major decrease was also observed in depressive symptoms (0.60, 0.53 to 0.67). The decrease in fatigue around retirement was more pronounced among people with a chronic disease before retirement.

Conclusions Longitudinal modelling of repeat data showed that retirement did not change the risk of major chronic diseases but was associated with a substantial reduction in mental and physical fatigue and depressive symptoms, particularly among people with chronic diseases.


  • We thank EDF-GDF, especially the Service Général de Médecine de Contrôle, and the “Caisse centrale d’action sociale du personnel des industries électrique et gazière.” We also wish to acknowledge the Cohorts Team at Inserm Unit 1018 responsible for management of the GAZEL database and Stockholm Stress Centre for providing the basis for our international collaboration.

  • Contributors: HW, MK, and JV designed the original hypothesis. MG and MZ are the principal investigators of the Gazel Cohort Study and prepared the data. HW did all the analyses in close dialogue with MK and JV. MK and JV contributed equally to the study. JP provided statistical advice. HW wrote the first draft of the report. All authors interpreted the results, revised the text, and approved the final draft of the report. All authors had full access to all of the data in the study. HW is the guarantor.

  • Funding: HW and CL are supported by the Swedish Council for Working Life and Social Research (FAS, grants #2004-2021, #2007-1143, and #2009-1758), JV and MK are supported by the Academy of Finland (grants #124271, #124322, #129262, and #132944), MK is additionally supported by a BUPA Foundation UK specialist research grant and the National Institutes of Health/National Heart, Lung, and Blood Institute (NIH) (R01HL036310-20A2). MK and AS-M are supported by the National Institute on Aging, NIH (R01AG013196; R01AG034454); AS-M is also supported by a EUYRI award from the European Science Foundation. This work was additionally supported by a grant from the ESRC Research Seminar Series Competition 2007/8 (RES-451-26- 0491). The GAZEL Cohort Study was funded by EDF-GDF and INSERM and received grants from the “Cohortes Santé TGIR Program,” Agence nationale de la recherché (ANR), and Agence française de sécurité sanitaire de l’environnement et du travail (AFSSET). The study sponsors did not contribute to the study design and had no role in the conduct of the study, data collection, data management, data analysis, or interpretation of the data, nor in the preparation, review, or approval of the manuscript.

  • Competing interests: All authors have completed the Unified Competing Interest form at (available on request from the corresponding author) and declare that (1) regarding the submitted work HW and CL have support from the Swedish Council for Working Life and Social Research (FAS); JV and MK have support from the Academy of Finland; MK has additional support from the BUPA Foundation, UK; MK and AS-M also have support from the National Institutes of Health (NIH), USA; AS-M has additional support from the European Science Foundation (ESF); JF and all other authors except JS have additional support from ESRC, UK; MG and MZ have additional support from the Institut de recherche en santé publique (INSERM) and Caisse centrale d’action sociale, France; and JS had support from Agence nationale de la recherché (ANR), France; (2) none of the authors have any relationships with any company or organisation that might have an interest in the submitted work in the previous 3 years; (3) their spouses, partners, or children have no financial relationships that may be relevant to the submitted work; and (4) the authors have no non-financial interests that may be relevant to the submitted work.”

  • Ethical approval: The GAZEL study received approval from the national commission overseeing ethical data collection in France (“Commission Nationale de L’Informatique et Libertés”), GAZEL #105 728-Avis du 26 avril 1988. In addition, we also had the approval of the Ethics Evaluation Committee of INSERM (the French Institute of Medical Research and Health), opinion number 01-017, 20 May 2009.

  • Data sharing: The statistical script is available from the corresponding author at hugo.westerlund{at}; the dataset can be requested from the principal investigators of the GAZEL study at Marie.Zins{at}

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