20-Year labor market histories of 66-year-old women and men: a nationwide retrospective cohort study from Sweden.

A health-promoting, supportive, and inclusive labor market is essential to sustainable working life. However, knowledge is warranted on working life patterns from midlife on. We aimed to map 20-year histories of labor market and healthcare use among women and men aged 66. A 20-year retrospective cohort study of 52 920 women and 51 823 men aged 66 in 2019 who lived in Sweden 2000-19, using microdata on type of economic activity, income, secondary healthcare use, and prescribed medications, linked from nationwide registers. Sequence and cluster analysis were performed on yearly dominant labor market states, separately for women and men. Women spent more time in "low-income" and "sickness absence/disability pension (SA/DP)" and less time in "high-income" states than men. Time spent in "unemployed," "no/minimal income," "social assistance" and "retired" states were similar in both sexes. Probabilities of transitioning from "SA/DP," "social assistance," and "retired" to other states were low (<.09). The largest sequence cluster in men (68%) was mostly characterized by sequences with "high-income" and in women by "low-" and "high-" income states (74%). Other clusters were represented by "unemployed" (14% of women, 17% of men), "no/minimal income" (10%, 11%), and "SA/DP" (3%, 3%) states. Most women and men were active in the labor market when aged 46-66, nevertheless, around 30% followed less active paths, dominated by long-term SA/DP, social assistance, or unemployment. Transitions from these states were unlikely. The most pronounced sex-difference in working life was time spent in "low"- and "high-income" states.