Formal retirement and multidimensional health among middle-aged and older adults in China: a five-wave within-person analysis of the China Health and Retirement Longitudinal Study

Background Retirement may alter time use, social roles, physical activity and health, but the evidence is mixed, partly because studies differ in how retirement is defined and which outcomes and settings they examine. We examined within-person associations between formal retirement status and multidimensional health in China, distinguishing formal retirement from complete labour-force exit. Methods We analysed five waves of the China Health and Retirement Longitudinal Study (2011–2020). The panel comprised 25,698 respondents and 95,885 person-wave observations, including 5,002 respondents ever observed as formally retired and 1,774 with a directly observed retirement transition. Primary outcomes were limitations in activities of daily living (ADL), any physical activity and serial-seven performance; depressive symptoms, sleep duration and immediate word recall were secondary. Linear respondent and survey-wave fixed-effects models estimated within-person associations. Formal interaction tests assessed sex and education heterogeneity; event-time models, exploratory path analyses and sensitivity analyses were also conducted. Results Overall, formal retirement was associated with a 2.9-percentage-point higher probability of reporting any physical activity (β = 0.029, 95% CI 0.008 to 0.050; p = 0.006). Among women, it was associated with 0.098 fewer ADL limitations (95% CI − 0.176 to − 0.019; p = 0.015) and a 4.5-percentage-point higher probability of any physical activity (95% CI 0.016 to 0.073; p = 0.002). The serial-seven estimate was indistinguishable from zero overall (β = −0.040, 95% CI − 0.131 to 0.052; p = 0.395) and small among women (β = −0.135, 95% CI − 0.272 to 0.002; p = 0.054). Retirement-by-sex interactions were not significant; education heterogeneity was supported for ADL only (joint p = 0.041). An exploratory path analysis identified a small indirect association through physical activity for women's ADL (− 0.0095; bias-corrected 95% bootstrap CI − 0.0189 to − 0.0029). Conclusions Formal retirement in China was associated most consistently with higher physical-activity participation and fewer ADL limitations among women, whereas evidence for change in serial-seven performance was weak. Because subgroup and pathway findings were exploratory, and formal retirement does not necessarily mean paid work has ceased, retirement is best treated as a potential public-health intervention point rather than a uniform cause of benefit or harm.