Intended for healthcare professionals


Loss of employment and mortality

BMJ 1994; 308 doi: (Published 30 April 1994) Cite this as: BMJ 1994;308:1135
  1. Joan K Morris, lecturer in medical statisticsa,
  2. Derek G Cook, senior lecturer in epidemiologya,
  3. A Gerald Shaper, professor of clinical epidemiologya
  1. a Department of Public Health, Royal Free Hospital School of Medicine, London NW3 2PF
  2. Department of Public Health Sciences, St George's Hospital Medical School, London SW17 0RE
  1. Correspondence to: Dr Cook.
  • Accepted 7 March 1994


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.


    • Accepted 7 March 1994
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