Background: high job strain increases the risk of health decline, but little is known about the specific consequences and long-term effects of job strain on old age health.

Objectives: purpose was to investigate whether physical and mental job strain in midlife was associated with hospital care use in old age.

Methods: study population included 5,625 Finnish public sector employees aged 44–58 years who worked in blue- and white-collar professions in 1981. The number of in-patient hospital care days was collected from the Finnish Hospital Discharge Register for the 28-year follow-up period.

Results: rates of hospital care days per 1,000 person-years for men were 7.78 (95% confidence interval [CI] 7.71–7.84) for low, 9.68 (95% CI 9.50–9.74) for intermediate and 12.56 (95% CI 12.47–12.66) for high physical job strain in midlife. The corresponding rates for women were 6.63 (95% CI 6.57–6.68), 7.91 (95% CI 7.87–7.95) and 10.35 (95% CI 10.25–10.42), respectively. Rates were parallel but lower for mental job strain. Reporting high physical job strain in midlife increased the risk of hospital care in old age compared with those who reported low job strain, fully adjusted incidence rate ratio 1.17 (95% CI 1.00–1.38) for men and 1.42 (95% CI 1.25–1.61) for women. These associations were robust in analyses confined to hospital care that took place after the employees had turned 65 years.

Conclusion: exposure to high mental and, particularly, high physical job strain in midlife may set employees on a higher healthcare use trajectory which persists into old age.