Mid-life employment trajectories and subsequent memory function and rate of decline in rural South Africa, 2000-22

Aim To investigate mid-life employment trajectories in relation to later-life memory function and rate of decline in rural South Africa.Methods Data from the Agincourt Health and Socio-Demographic Surveillance System were linked to the 'Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa' (HAALSI) in rural Agincourt, South Africa (N = 3133). Employment was assessed every 4 years over 2000-12 as being employed (0, 1, 2 and >= 3 time points), being employed in a higher-skill occupation (0, 1, 2 and >= 3 time points) and dynamic employment trajectories identified using sequence analysis. Latent memory z-scores were assessed over 2014-22. Mixed-effects linear regression models were fitted to examine the associations of interest.Results Sustained mid-life employment from 2000-12 (beta = 0.052, 95% CI: -0.028 to 0.132, 1 vs 0 time points; beta = 0.163, 95% CI: 0.077 to 0.250, 2 vs 0 time points; beta = 0.212, 95% CI: 0.128 to 0.296, >= 3 vs 0 time points) and greater time spent in a higher-skill occupation (beta = 0.077, 95% CI: -0.020 to 0.175, 1 vs 0 time points; beta = 0.241, 95% CI: 0.070 to 0.412, 2 vs 0 time points; beta = 0.361, 95% CI: 0.201 to 0.520, >= 3 vs 0 time points) were associated with higher memory scores in 2014/15, but not subsequent rate of memory decline. Moving from a lower-skill to higher-skill occupation was associated with higher memory function, but a faster rate of decline over 2014-22.Conclusions Sustained mid-life employment, particularly in higher-skill occupations, may contribute to later-life memory function in this post-Apartheid South African setting.