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Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis

BMJ 2013; 347 doi: (Published 08 August 2013) Cite this as: BMJ 2013;347:f4746

Re: Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis

The meta-analysis by Virtanen et al1 provides the highest level evidence of a modest link between job insecurity and the risk of ischaemic heart disease (IHD). Unemployment is well known to be associated with higher morbidity and mortality, but relatively few studies have examined measures of health in employees who are at risk of unemployment2, notable ones having been reviewed in the meta-analysis.

At an earlier time of off-shoring of jobs from Britain in the 1980s a small study of factory workers threatened with and subsequently made redundant (129 subjects and 99 controls) showed a significant increase in general practitioner consultations, episodes of illness and referrals to hospital outpatient departments3. The changes occurred two years before actual job-loss, i.e. the point at which workers learned that their job was in jeopardy.

The search strategy for the meta-analysis1 included studies on the basis of incident IHD. An earlier cohort study among Swedish shipyard workers did not meet the inclusion criteria for the meta-analysis because there were no recorded cases of incident IHD. Like studies included in the meta-analysis this study demonstrated that serum cholesterol concentration was elevated among men who were threatened with redundancy4. Serum cholesterol concentrations increased more (mean 0.25 (SD 0.68) mmol/l v 0.08 (0.66) mmol/l) in the shipyard workers than in the controls. A positive correlation was found between change in cholesterol concentration and change in blood pressure, indicating that the overall risk profile had worsened among men with increased serum cholesterol concentrations4.

The meta-analysis would in any case be important, but is more so now because we are living in “VUCA times”, that is to say the world is: Volatile, Uncertain, Complex and Ambiguous. While the acronym VUCA was first used by the US military after 9/11 it is now used commonly in the business world. Job insecurity is likely to be around for many years to come associated with a slow and uneven recovery from recession; and thereafter will happen at least cyclically as it has for many decades. Health professionals and governments need to be aware of the health consequences of job uncertainty in order to take effective steps to mitigate the risks and provide adequate resources.

1 Virtanen M, Nyberg ST, Batty GD, Jokela M, Heikkilä K, Fransson EI, et al. Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis. BMJ 2013;347:f4746.

2 Nicholson PJ. Unemployment is an occupational hazard. Occup Med, 1994; 44: 7-8.

3 Beale N & Nethercott S. Job-loss and health – the influence of age and previous morbidity. J R Coll Gen Pract, 1986; 36: 261-4.

4 Mattiasson I, Lindgärde F, Nilsson JA & Theorell T. Threat of unemployment and cardiovascular risk factors: longitudinal study of quality of sleep and serum cholesterol concentrations in men threatened with redundancy. BMJ, 1990; 301: 461–466.

Competing interests: No competing interests

12 August 2013
Paul J Nicholson OBE
Occupational physician
Chair, BMA Occupational Medicine Committee
BMA House, Tavistock Square, London WC1H 9JP