PONE-D-25-21578Multidimensional health patterns and labor market participation among older workers:

Evidence from a European six-year follow-up studyPLOS ONE

Dear Dr. Baumann,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

I have received two reports from respected reviewers. Reviewer #2 suggests a minor revision, while Reviewer #1 recommends a major revision. Overall, I agree with the comments provided by both reviewers, and I believe it is necessary to address their suggestions thoroughly.

Therefore, I have classified your submission as requiring a major revision and invite you to revise and resubmit your manuscript accordingly.

Please ensure that your revised submission includes a detailed response to each reviewer comment (particularly, for Reviwer#1).

==============================

Please submit your revised manuscript by Aug 22 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Edgar Demetrio Tovar-García

Academic Editor

PLOS ONE

Journal Requirements:

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Thank you for stating in your Funding Statement:

[This work was supported by the Swiss National Science Foundation (SNSF) (grant number 179696: IB, VG; https://data.snf.ch/grants/grant/179696); the ZHAW Schwerpunkt Angewandte Gerontologie [Research focus “Applied Gerontology”: RG; https://www.zhaw.ch/de/forschung/departementsuebergreifende-kooperationen/angewandte-gerontologie]; Forte (grant numbers 2016-07206: JF; and 2021-00999: DF; https://forte.se/en/about-forte/our-mission/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.].

Please provide an amended statement that declares *all* the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now.  Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement.

Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors address an interesting and socially relevant topic. They argue that health is a multidimensional construct and advocate for using a multidimensional health measure to examine the role of health in labor market participation at older working ages. Their approach represents a small but significant contribution to the field of health, employment and retirement research.

The authors analyzed data from 5,006 older workers participating in the Survey of Health, Ageing and Retirement in Europe (SHARE), they performed a latent transition analysis based on four health indicators - chronic conditions, activity limitations, self-rated health, and depressive symptoms - to identify multidimensional health profiles (MHPs). In the second step, the examined the relationship between these MHPs and labor force participation six years later. Four distinct patterns were identified. The authors conclude that using health as a multidimensional construct allows to better understand the social implications of poor health.

In addition to the research idea, I also appreciate the choice of dataset for this investigation. However, there are several major—primarily conceptual—issues with the paper that, in my view, must be addressed before it can be considered for publication.

Methodology

The manuscript would gain from more clarity in the choice of the methodological approach and its description.

- Multidimensional construct: What is the author’s reasoning behind the indicators chosen for the mc? The fact that Boehme has chosen this? Why is this model superior to others?

- Why using overlapping health concepts in the model?

- Why using dichotomous health indicators if linear indicators can also be used in latent group modelling?

- From my point of view the methodology latent transition analysis needs to be explained more in detail. How does one have to understand the clusters if the numbers of participants in each cluster differ by wave? How do you estimate belonging to a cluster? On which basis (wave 5 or 6? or a transition measure) did the authors calculate the distribution of the outcomes?

- What does it mean for analyses and findings to use an initial sample with an age range from 50 to 60 years and following these for eight years, with the older reaching/passing statutory retirement age and the younger still being far away from it?

Measurement of health

If concepts of health are in the focus of the paper, a detailed description, presentation and discussion of each health indicator chosen should be given.

- What is known about each measure? What are the underlying health concepts of each measure used? What is known about stability over time, predictivity, validity? How were the measures operationalized – and why? Distributions in the sample.

- For example: is the term “depressive symptoms” justified if the underlying question is whether the respondent has “felt sad or depressed in the month before the interview”. Doesn’t the high proportion of participants shifting from Cluster 3 (wave 5) to Cluster 1 (wave 6) indicate that the question reflects a temporary condition, possibly linked to a specific event or living situation?

- The understanding of “self-perceived health” seems too limited in the manuscript. Why should it be an indicator for mental health? (p5) Several authors have reasoned about what this highly predictive indicator stands for. I recommend reading Jylhä 2009 “What is self-rated health and why does it predict mortality? Towards a unified conceptual model”.

- Number of chronic diseases: 1 vs 2+. Why this dichotomization? Which disease groups are included?

Further measures

- Measuring household income: Why not use "household net equivalized income," which more accurately reflects social status than total household income alone? This should be possible with SHARE data.

- Measuring change of weekly working hours. The finding is very surprising that on average, the workers have reduced their weekly working hours by >> 10 hours over 6 years. Which participants were included in the calculation: also those that had stopped working for full? In that case the overall mean is not useful for analysis. Or: was it due to some specific countries with special regulations allowing for such a substantial reduction of working time prior to retirement? This however, would raise the question of heterogeneity between countries.

Cultural heterogeneity

- One important factor that may explain many of the findings in the manuscript is the strong country-level influence on the topics of (work,) health, employment, and retirement. These areas are highly context-dependent, shaped by national welfare systems, retirement regulations, social norms, and cultural perceptions of health. From my perspective, it is crucial for a study of this kind to discuss the potential implications of analyzing pooled data from 14 European countries as well as Israel. What does this heterogeneity mean for the findings? How are participants from different countries distributed across the identified clusters? Are there clusters predominantly composed of individuals from specific countries and vice versa? Were any sensitivity analyses conducted based on welfare state regimes or country groupings?

Overall

The authors acknowledge that their concept of "multidimensionality is still somewhat crude." I appreciate this critical reflection and would encourage the authors to reconsider their methodological approach. From my point of view not much is gained by specifically applying this approach, however, there are more differentiated ways of clustering health conditions in populations. Overall: did the approach applied really contribute to the central aim stated in the introduction: “These facts raise our principal question of what factors influence whether older workers with adverse health conditions exit or remain in the labor force.”?

Reviewer #2: This manuscript addresses an important and timely topic: the identification of Multidimensional Health Profiles (MHP) among older workers and their association with employment status and working time reduction. The study uses high-quality longitudinal data from the SHARE survey and applies Latent Transition Analysis (LTA), which is an appropriate and advanced method to capture temporal health profile dynamics.

The findings offer valuable insights into the complex interplay between health and employment in later life, with clear implications for policy and active ageing strategies. The manuscript is clearly written and logically structured.

However, there are some areas that could be improved to enhance clarity and impact.

-Conceptual clarity

The definition of “Multidimensional Health Profile (MHP)” should be introduced more explicitly earlier in the introduction, before stating the hypotheses.

The formulation of hypotheses could be streamlined for better readability.

-Methodology

Although LTA is well applied, the rationale for choosing this method over alternatives should be made clearer.

The manuscript could benefit from a more critical discussion of the SHARE sample design, particularly regarding rotation and attrition across waves.

-Discussion and implications

The discussion could be strengthened by elaborating on the practical implications of the identified health profiles for policies on active ageing, employment support, and reducing inequalities.

It would also be valuable to comment on the potential cross-national variability and whether institutional differences may limit generalizability.

-Limitations

A more detailed reflection on sample attrition and its potential influence on MHP stability would be beneficial.

The authors could acknowledge the reliance on self-reported health measures as a possible limitation.

Recommendation: Accept with minor revisions

This is a strong and relevant contribution to research on health and employment among older adults. The suggestions above are meant to improve clarity and robustness, but they do not challenge the study's overall validity. With minor revisions, the manuscript will be ready for publication.

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

Reviewer #2: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step.

Multidimensional health patterns and labor market participation among older workers:

Evidence from a European six-year follow-up study

PONE-D-25-21578R1

Dear Dr. Baumann,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager®  and clicking the ‘Update My Information' link at the top of the page. For questions related to billing, please contact billing support .

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Edgar Demetrio Tovar-García

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewer #1:

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy .

Reviewer #1: No

**********