Does unemployment cause long-term mortality? Selection and causation after the 1992–96 deep Swedish recession

Abstract

Background: Mass unemployment in Europe is endemic, especially among the young. Does it cause mortality? Methods: We analyzed long-term effects of unemployment occurring during the deep Swedish recession 1992–96. Mortality from all and selected causes was examined in the 6-year period after the recession among those employed in 1990 (3.4 million). Direct health selection was analyzed as risk of unemployment by prior medical history based on all hospitalizations 1981–91. Unemployment effects on mortality were estimated with and without adjustment for prior social characteristics and for prior medical history. Results: A prior circulatory disease history did not predict unemployment; a history of alcohol-related disease or suicide attempts did, in men and women. Unemployment predicted excess male, but not female, mortality from circulatory disease, both ischemic heart disease and stroke, and from all causes combined, after full adjustment. Adjustment for prior social characteristics reduced estimates considerably; additional adjustment for prior medical history did not. Mortality from external and alcohol-related causes was raised in men and women experiencing unemployment, after adjustment for social characteristics and medical history. For the youngest birth cohorts fully adjusted alcohol mortality HRs were substantial (male HR = 4.44; female HR = 5.73). The effect of unemployment on mortality was not uniform across the population; men, those with a low education, low income, unmarried or in urban employment were more vulnerable. Conclusions: Direct selection by medical history explains a modest fraction of any increased mortality risk following unemployment. Mass unemployment imposes long-term mortality risk on a sizeable segment of the population.

Changes in directly alcohol-attributable mortality during the great recession by employment status in Spain: a population cohort of 22 million people

“…However, the predominance of flows between employment categories towards non-employment during the crisis may also have contributed to the unfavourable change. Our findings are consistent with previous studies indicating a positive association during the crisis between unemployment and alcohol-related mortality,12 20 21 25 or problem drinking14 22–24 and with a Spanish study indicating an increased frequency of alcohol-related disorders in primary healthcare during 2006–2010, and a stronger positive association between such disorders and unemployment in 2010 13. However, another Spanish study showed no heterogeneous changes in heavy or binge drinking prevalence by employment status during the crisis 15.…”

“…A higher sensitivity of DAA mortality to cyclical variation in economic conditions at younger ages is plausible, given the greater financial insecurity of young people 4. Finally, among employees, our study suggests more favourable crisis effects on the outcome in married than unmarried people, which is also consistent with previous studies 14 25 26…”

“…These people probably made risky investments during economic expansion (with strongly increasing housing prices), and during the crisis were not able to find a job or sell their home (due to its reduced market value). Although some studies elsewhere have found more unfavourable crisis effects on alcohol-related problems or heavy or binge drinking in less-educated people,14 18 25 26 other studies have found particularly unfavourable effects on such alcohol outcomes in subgroups with high household income 14 16. A positive association has also been observed between housing troubles (difficulties in paying rent/mortgage, lost housing) and alcohol-related problems,24 27 but not always 41.…”

“…Depending on differences in the predominant mediator mechanism, vulnerability of different sociodemographic groups, crisis features and context, the effects of recession on alcohol-related problems may be heterogeneous 2 6 10 16 18. Thus, some evidence suggests that adverse effects are greater in men13 14 19 or people who are unemployed,12–14 20–25 less educated,13 14 18 25 26 unmarried14 25 26 or experiencing housing instability or rent/mortgage payment difficulties 24 27. We aimed to assess the impact of the post-2008 economic crisis on directly alcohol-attributable (DAA) mortality according to employment status and other sociodemographic factors, testing the hypotheses of especially unfavourable impacts on non-employed or socioeconomically disadvantaged people.…”

Unemployment, intragenerational social mobility and mortality in Finland: heterogeneity by age and economic context

“…But for whom are these consequences most apparent? While men may be more disadvantaged in terms of increased mortality risk following unemployment,3 we find that patterns related to social mobility portray a different image. Older women are at the greatest disadvantage; they have high odds of mortality if downwardly mobile, but reap none of the benefits of upward mobility.…”