No abstract

Workplace downsizing and closure have been considered natural experiments that strengthen causal inference when assessing the association between unemployment and health. Selection into unemployment plays a lesser role among those exposed to severe workplace downsizing. This study compared mortality for individuals unemployed from stable, downsized, and closed workplaces with a reference group unexposed to unemployment. We examined nationally representative register data of residents of Finland aged 25–63 years in 1990–2009 (n = 275,738). Compared with the control group, the hazard ratio for substance use–related mortality among men unemployed from stable workplaces was 2.43 (95% confidence interval (CI): 2.22, 2.67), from downsized workplaces 1.85 (CI: 1.65, 2.08), and from closed workplaces 2.16 (CI: 1.84, 2.53). Among women, the corresponding estimates were 3.01 (CI: 2.42, 3.74), 2.39 (CI: 1.75, 3.27), and 1.47 (CI: 1.09, 1.99). Unemployment from stable workplaces was associated with mortality from psychiatric and self-harm–related conditions. However, mortality due to ischemic heart disease and other somatic diseases decreased for those unemployed following closure. The results indicate that selection mechanisms partially explain the excess mortality among the unemployed. However, substance-use outcomes among men and women, and fatal accidents and violence among men, might be causally associated with unemployment.

Poor mental health among the unemployed – the long-term unemployed in particular – is established, but these associations may be driven by confounding from unobserved, time-invariant characteristics such as past experiences and personality. Using longitudinal register data on 2,720,431 residents aged 30–60, we assess how current unemployment and unemployment history predict visits to specialized care due to psychiatric conditions and self-harm in Finland in 2008–2018. We estimate linear ordinary least squares and fixed effects models. Prior to adjusting for time-invariant characteristics, current unemployment was associated with poor mental health and the risk increased with longer unemployment histories. Accounting for all time-invariant characteristics with the fixed effects models, these associations attenuated by approximately 70%, yet current unemployment was still associated with a 0.51 (95% confidence interval: 0.48, 0.53) percentage-point increase in the probability of poor mental health among men and women. Longer unemployment histories increased the probability among men in their 30’s but not among older men or among women. The results indicate that selection by stable characteristics may explain a major part of the worse mental health among the unemployed and especially the long-term unemployed. However, even when controlling for this selection, current unemployment remains associated with mental health.

Aims To assess the importance of health selection in the association between unemployment and alcohol‐related mortality by comparing mortalities of those unemployed from workplaces experiencing different levels of downsizing. The more severe the downsizing, the less dependent unemployment would be on personal characteristics and the weaker the role of health selection. Design We estimated hazards models of unemployment on alcohol‐related diseases and poisonings and external causes with alcohol as a contributing cause over follow‐ups of 0–5, 6–10 and 11–20 years and at different levels of downsizing (stable, downsized or closed). Setting Finland, 1990 to 2009. Participants A register‐based random sample of employees aged 25–63 in privately owned workplaces (n = 275 738). Measurements The outcome was alcohol‐related death and the exposure was unemployment. We adjusted for age, sex, year, education, marital status, health status, workplace tenure, industry, region and unemployment rate. Findings Alcohol‐disease mortality was elevated among the unemployed throughout the follow‐up, regardless of the level of downsizing. At 11–20 years after baseline, those unemployed from stable workplaces had a 2.46 hazard ratio (HR) (95% confidence interval [CI] = 2.14–2.82), those from downsized workplaces 1.94 (95% CI = 1.64–2.30) and those from closed workplaces 2.13 (95% CI = 1.75–2.59), when compared with the controls. Alcohol‐related external‐cause mortality at 0–5 years follow‐up was only associated with unemployment from stable workplaces (HR = 1.39, 95% CI = 1.22–1.58), but over time, an association emerged among those unemployed following downsizing and closure. At 11–20‐year follow‐up, the HR following downsizing was 1.83 (CI 95% = 1.37–2.45) and 1.54 (95% CI = 1.03–2.28) following closure. Conclusions There is some indication that alcohol‐related ill‐health may lead to unemployment in Finland. However, the persistent long‐term association between unemployment and alcohol‐related mortality even after workplace closure may imply a causal relation.

Background Successful transitions from unemployment to employment are an important concern, yet little is known about health-related selection into employment. We assessed the association of various physical and psychiatric conditions with finding employment, and employment stability. Methods Using total population register data, we followed Finnish residents aged 30–60 with an unemployment spell during 2009–2018 (n = 814,085) for two years from the onset of unemployment. We predicted any, stable, and unstable employment by health status using Cox proportional hazards models. The data on specialized health care and prescription reimbursement were used to identify any alcohol-related conditions and poisonings, psychiatric conditions and self-harm, injuries, and physical conditions. We further separated physical conditions into cancer, diabetes, heart disease, and neurological conditions, and psychiatric conditions into depression, anxiety disorders and substance use disorders. Results The likelihood of any employment was lower among those who had any of the assessed health conditions. It was lowest among those with alcohol-related or psychiatric conditions with an age-adjusted hazard ratio of 0.45 (95% confidence interval 0.44, 0.46) among men and 0.39 (0.38, 0.41) among women for alcohol-related and 0.64 (0.63, 0.65) and 0.66 (0.65, 0.67) for psychiatric conditions, respectively. These results were not driven by differences in socioeconomic characteristics or comorbidities. All the included conditions were detrimental to both stable and unstable employment, however alcohol-related and psychiatric conditions were more harmful for stable than for unstable employment. Conclusions The prospects of the unemployed finding employment are reduced by poor health, particularly alcohol-related and psychiatric conditions. These two conditions may also lead to unstable career trajectories. The selection process contributes to the health differentials between employed and unemployed people. Unemployed people with health problems may therefore need additional support to improve their chances of employment.