BMJ 1994;308:1135-1139 (30 April)

Papers

Loss of employment and mortality

Joan K Morris, lecturer in medical statistics,a Derek G Cook, senior lecturer in epidemiology,a A Gerald Shaper, professor of clinical epidemiology Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE a

a Department of Public Health, Royal Free Hospital School of Medicine, London NW3 2PF

Correspondence to: Dr Cook.

Abstract

Objective: To assess effect of unemployment and early retirement on mortality in a group of middle aged British men.
Design: Prospective cohort study (British Regional Heart Study). Five years after initial screening, information on employment experience was obtained with a postal questionnaire.
Setting: One general practice in each of 24 towns in Britain.
Subjects: 6191 men aged 40-59 who had been continuously employed for at least five years before initial screening in 1978-80: 1779 experienced some unemployment or retired during the five years after screening, and 4412 remained continuously employed.
Main outcome measure: Mortality during 5.5 years after postal questionnaire.
Results: Men who experienced unemployment in the five years after initial screening were twice as likely to die during the following 5.5 years as men who remained continuously employed (relative risk 2.13 (95% confidence interval 1.71 to 2.65). After adjustment for socioeconomic variables (town and social class), health related behaviour (smoking, alcohol consumption, and body weight), and health indicators (recall of doctor diagnoses) that had been assessed at initial screening the relative risk was slightly reduced, to 1.95 (1.57 to 2.43). Even men who retired early for reasons other than illness and who appeared to be relatively advantaged and healthy had a significantly increased risk of mortality compared with men who remained continuously employed (relative risk 1.87 (1.35 to 2.60)). The increased risk of mortality from cancer was similar to that of mortality from cardiovascular disease (adjusted relative risk 2.07 and 2.13 respectively).
Conclusions: In this group of stably employed middle aged men loss of employment was associated with an increased risk of mortality even after adjustment for background variables, suggesting a causal effect. The effect was non-specific, however, with the increased mortality involving both cancer and cardiovascular disease.

Public health implications

  • Public health implications

  • Unemployed men are less healthy and have a higher mortality than employed men, but in many studies it is difficult to rule out selection on the basis of ill health and confounding with other background factors such as social class and health behaviours as explanations

  • We found that stably employed middle aged men who experienced loss of employment (unemployment or retirement) were twice as likely to die as continuously employed men in a 5.5 year follow up

  • Even men who lost employment for reasons unrelated to health were at raised risk of dying after adjustment for factors such as smoking, drinking, and social class, suggesting a causal effect

  • Mortality was raised for cancer as well as for cardiovascular disease, however, arguing against a causal effect

  • Society should consider the impact of loss of employment on all members of society when they stop working, not just those who are officially classified as unemployed


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to StumbleUpon StumbleUpon   Add to Technorati Technorati    What's this?

Relevant Articles

Unemployment and health
Danny Dorling
BMJ 2009 338: b829. [Extract] [Full Text]

Age at retirement and long term survival of an industrial population: prospective cohort study
Shan P Tsai, Judy K Wendt, Robin P Donnelly, Geert de Jong, and Farah S Ahmed
BMJ 2005 331: 995. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

  • Schuring, M, Burdorf, A, Voorham, A J, der Weduwe, K, Mackenbach, J P (2009). Effectiveness of a health promotion programme for long-term unemployed subjects with health problems: a randomised controlled trial. J. Epidemiol. Community Health 63: 893-899 [Abstract] [Full text]  
  • Naper, S. O. (2009). All-cause and cause-specific mortality of social assistance recipients in Norway: A register-based follow-up study. Scand J Public Health 37: 820-825 [Abstract]  
  • Perlman, F., Bobak, M. (2009). Assessing the Contribution of Unstable Employment to Mortality in Posttransition Russia: Prospective Individual-Level Analyses From the Russian Longitudinal Monitoring Survey. AJPH 99: 1818-1825 [Abstract] [Full text]  
  • Walsh, D., Taulbut, M., Hanlon, P. (2009). The aftershock of deindustrialization--trends in mortality in Scotland and other parts of post-industrial Europe. Eur J Public Health 0: ckp063v1-ckp063 [Abstract] [Full text]  
  • Dorling, D. (2009). Unemployment and health. BMJ 338: b829-b829 [Full text]  
  • Zagozdzon, P., Zaborski, L., Ejsmont, J. (2009). Survival and cause-specific mortality among unemployed individuals in Poland during economic transition. J Public Health (Oxf) 31: 138-146 [Abstract] [Full text]  
  • Bambra, C, Eikemo, T A (2009). Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self-reported health in 23 European countries. J. Epidemiol. Community Health 63: 92-98 [Abstract] [Full text]  
  • Bamia, C., Trichopoulou, A., Trichopoulos, D. (2008). THE AUTHORS REPLY. Am J Epidemiol 168: 975-975 [Full text]  
  • Bamia, C., Trichopoulou, A., Trichopoulos, D. (2008). Age at Retirement and Mortality in a General Population Sample: The Greek EPIC Study. Am J Epidemiol 167: 561-569 [Abstract] [Full text]  
  • Schuring, M., Burdorf, L., Kunst, A., Mackenbach, J. (2007). The effects of ill health on entering and maintaining paid employment: evidence in European countries. J. Epidemiol. Community Health 61: 597-604 [Abstract] [Full text]  
  • Martikainen, P., Maki, N., Jantti, M. (2007). The Effects of Unemployment on Mortality following Workplace Downsizing and Workplace Closure: A Register-based Follow-up Study of Finnish Men and Women during Economic Boom and Recession. Am J Epidemiol 165: 1070-1075 [Abstract] [Full text]  
  • Christensen, U., Schmidt, L., Kriegbaum, M., Hougaard, C. O., Holstein, B. E. (2006). Coping with unemployment: Does educational attainment make any difference?. Scand J Public Health 34: 363-370 [Abstract]  
  • Dray-Spira, R., Persoz, A., Boufassa, F., Gueguen, A., Lert, F., Allegre, T., Goujard, C., Meyer, L., The Primo Cohort Study Group, (2006). Employment loss following HIV infection in the era of highly active antiretroviral therapies. Eur J Public Health 16: 89-95 [Abstract] [Full text]  
  • Ruhm, C. J (2005). Commentary: Mortality increases during economic upturns. Int J Epidemiol 34: 1206-1211 [Full text]  
  • Tsai, S. P, Wendt, J. K, Donnelly, R. P, de Jong, G., Ahmed, F. S (2005). Age at retirement and long term survival of an industrial population: prospective cohort study. BMJ 331: 995- [Abstract] [Full text]  
  • Li, Q., Wen, M. (2005). The Immediate and Lingering Effects of Armed Conflict on Adult Mortality: A Time-Series Cross-National Analysis. Journal of Peace Research 42: 471-492 [Abstract]  
  • Thurston, R. C., Kubzansky, L. D., Kawachi, I., Berkman, L. F. (2005). Is the Association between Socioeconomic Position and Coronary Heart Disease Stronger in Women than in Men?. Am J Epidemiol 162: 57-65 [Abstract] [Full text]  
  • Voss, M., Nylen, L., Floderus, B., Diderichsen, F., Terry, P. D. (2004). Unemployment and Early Cause-Specific Mortality: A Study Based on the Swedish Twin Registry. AJPH 94: 2155-2161 [Abstract] [Full text]  
  • Bartley, M, Sacker, A, Clarke, P (2004). Employment status, employment conditions, and limiting illness: prospective evidence from the British household panel survey 1991-2001. J. Epidemiol. Community Health 58: 501-506 [Abstract] [Full text]  
  • Kivimaki, M., Vahtera, J., Virtanen, M., Elovainio, M., Pentti, J., Ferrie, J. E. (2003). Temporary Employment and Risk of Overall and Cause-specific Mortality. Am J Epidemiol 158: 663-668 [Abstract] [Full text]  
  • Theorell, T, Oxenstierna, G, Westerlund, H, Ferrie, J, Hagberg, J, Alfredsson, L (2003). Downsizing of staff is associated with lowered medically certified sick leave in female employees. Occup. Environ. Med. 60: e9-9 [Abstract] [Full text]  
  • Keefe, V., Reid, P., Ormsby, C., Robson, B., Purdie, G., Baxter, J., Incorporated, N. K. I. (2002). Serious health events following involuntary job loss in New Zealand meat processing workers. Int J Epidemiol 31: 1155-1161 [Abstract] [Full text]  
  • Martinez-Sanchez, E., Regidor, E. (2002). Self-rated Health by Educational Level in Persons with and without Health Problems. J Health Psychol 7: 459-468 [Abstract]  
  • Quaade, T., Engholm, G., Johansen, A. M. T., Moller, H. (2002). Mortality in relation to early retirement in Denmark: a population-based study. Scand J Public Health 30: 216-222 [Abstract]  
  • Martikainen, P., Makela, P., Koskinen, S., Valkonen, T. (2001). Income differences in mortality: a register-based follow-up study of three million men and women. Int J Epidemiol 30: 1397-1405 [Abstract] [Full text]  
  • Lavis, J. N., Farrant, M. S. R., Stoddart, G. L. (2001). Barriers to employment-related healthy public policy in Canada. HEALTH PROMOT INT 16: 9-20 [Abstract] [Full text]  
  • Koskela, R.-S., Mutanen, P., Sorsa, J.-A., Klockars, M. (2000). Factors Predictive of Ischemic Heart Disease Mortality in Foundry Workers Exposed to Carbon Monoxide. Am J Epidemiol 152: 628-632 [Abstract] [Full text]  
  • Sokejima, S., Kagamimori, S. (1998). Working hours as a risk factor for acute myocardial infarction in Japan: case-control study. BMJ 317: 775-780 [Abstract] [Full text]  
  • Ferrie, J. E. (1997). Labour Market Status, Insecurity and Health. J Health Psychol 2: 373-397 [Abstract]  
  • Walker, A.R.P. (1996). Some thoughts on the influence of attitude on health and ageing. The Journal of the Royal Society for the Promotion of Health 116: 283-286 [Abstract]  
  • Trichopoulos, D. (1996). ANY QUESTIONS. BMJ 312: 632-632 [Full text]  
  • Mark, L., Simondan, G., Kondacs, A. (1996). Cardiovascular risk differences among employed and unemployed village people in Hungary. Scand J Public Health 24: 77-78  
  • Carroll, D., Smith, G. D., Bennett, P. (1996). Some Observations on Health and Socio economic Status. J Health Psychol 1: 23-39 [Abstract]  
  • Ferrie, J. E, Shipley, M. J, Marmot, M G, Stansfeld, S., Smith, G. D. (1995). Health effects of anticipation of job change and non-employment: longitudinal data from the Whitehall II study. BMJ 311: 1264-1269 [Abstract] [Full text]  
  • Manton, K. G., Vaupel, J. W. (1995). Survival after the Age of 80 in the United States, Sweden, France, England, and Japan. NEJM 333: 1232-1235 [Abstract] [Full text]  
  • Wilkinson, R. G (1994). Divided we fall. BMJ 308: 1113-1114 [Full text]  
Access jobs at BMJ Careers
Whats new online at Student BMJ