BMJ 1999;319:600-605 ( 4 September )

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Predictors and consequences of unemployment among construction workers: prospective cohort study

Päivi Leino-Arjas, senior researcher, a Juha Liira, senior consultant, b Pertti Mutanen, statistician, a Antti Malmivaara, assistant chief medical officer, c Esko Matikainen, chief medical officer. d

a Department of Epidemiology and Biostatistics, Finnish Institute of Occupational Health, FIN-00250 Helsinki, b Work Ability Centre, Finnish Institute of Occupational Health, c Department of Occupational Medicine, Finnish Institute of Occupational Health, d Local Government Pensions Institution Finland, Albertinkatu 34, FIN-00100, Helsinki

Correspondence to: P Leino-Arjas plei{at}occuphealth.fi

Objective: To study predictors and consequences of unemployment.
Design: Prospective cohort study.
Setting: 11 construction companies in southern Finland.
Participants: 586 male employees, aged 40-59 years at baseline in 1991 and not retired during a 4 year follow up.
Main outcome measures: Long term unemployment, stress symptoms, disease, alcohol consumption, exercise activity, and body mass index.
Results: In a multiple logistic regression model, long term unemployment (>24 months v =<24 months) was predicted by age 50-54 years v 40-44 years (odds ratio 2.0, 95% confidence interval 1.1 to 3.7), =<3 years' employment in the present job (3.1, 1.9 to 5.1), previous unemployment (2.1, 1.2 to 3.8), being single (1.8, 1.1 to 3.1), current smoking (2.6, 1.4 to 4.7), high alcohol consumption (2.1, 1.1 to 4.3), body mass index <23 kg/m2 v 23-29 kg/m2 (2.4, 1.3 to 4.4), frequent stress symptoms (2.0, 1.2 to 3.2), mental disorders (7.8, 1.5 to 40.0), and skin diseases (2.0, 1.0 to 3.9). Workers who were unemployed long term reported increased stress (2.1, 1.2 to 3.5) but fewer incident diseases (0.6, 0.4 to 0.9), decreased alcohol consumption (2.9, 1.6 to 5.2), increased exercise (1.9, 1.2 to 3.0), and increased body mass index (2.3, 1.3 to 4.0) compared with the rest of the cohort.
Conclusions: The workers' perceptions of work did not predict unemployment. Health based selection to long term unemployment was shown. Smoking and high alcohol consumption predated unemployment, but favourable lifestyle changes were observed among the unemployed workers. Stress predicted unemployment, which further increased the stress.


Key messages

  • Among middle aged construction workers, long term unemployment was predicted by an unstable occupational history, health problems, smoking, high alcohol consumption, low body mass index, and being single

  • Stress predicted long term unemployment, which further increased the level of stress

  • Men unemployed long term reported increased exercise and decreased alcohol consumption, but increased body mass index, and fewer incident diseases than the rest of the cohort

  • Changes in personal economic situation with unemployment mediated the effect of unemployment on stress but not on alcohol consumption




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