Losing life and livelihood: A systematic review and meta-analysis of unemployment and all-cause mortality

Abstract

Unemployment rates in the United States remain near a 25-year high and global unemployment is rising. Previous studies have shown that unemployed persons have an increased risk of death, but the magnitude of the risk and moderating factors have not been explored. The study is a randomeffects meta-analysis and meta-regression designed to assess the association between unemployment and all-cause mortality among working-age persons. We extracted 235 mortality risk estimates from 42 studies, providing data on more than 20 million persons. The mean hazard ratio (HR) for mortality was 1.63 among HRs adjusted for age and additional covariates. The mean effect was higher for men than for women. Unemployment was associated with an increased mortality risk for those in their early and middle careers, but less for those in their late-career. The risk of death was highest during the first 10 years of follow up, but decreased subsequently. The mean HR was 24% lower among the subset of studies controlling for health-related behaviors. Public health initiatives could target unemployed persons for more aggressive cardiovascular screening and interventions aimed at reducing risk-taking behaviors. KeywordsUnemployment; All-cause Mortality; Meta-analysis; Meta-regression; Systematic Review; Psychosocial Stress; health behaviours According to the United States Department of Labor, the US unemployment rate was 9.6% in August 2010 (compared to 5.8% in July 2008), remaining near its highest level in 25 years (United States Department of Labor, 2010). As of July 2010, the unemployment rate was 7.1% in Canada, 5.3% in Australia, 4.9% in Japan, 9.6% in France, 7.3% in Germany, 8.5% in Italy, 4.4% (June 2010) in the Netherlands, 8.4% in Sweden, and 7.8% (May 2010) © 2011 Elsevier Ltd. All rights reserved.Contact information for corresponding author (David Roelfs): S-401 SBS Building Department of Sociology Stony Brook University Stony Brook, NY 11794-4356. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptSoc Sci Med. Author manuscript; available in PMC 2012 March 1. The London Times estimated that, as a result of the current economic crisis, the number of unemployed worldwide could climb further, from 179 million in 2007 to 230 million (Mortished, 2009). This recent rise makes understanding the health effects of unemployment particularly important.Over the last 4 decades the study of unemployment and its association with health and mortality has expanded significantly (see Hanisch, 1999 for an early comprehensive review on unemployment research). Wheth...

Unemployment is associated with lower cortisol awakening and blunted dehydroepiandrosterone responses

“…Unemployment is one source of chronic stress that has received comparatively little endocrinological research, particularly in recent years, despite the rising unemployment figures globally due to the latest economic crisis. Unemployment has been shown to be damaging to health, but has inconsistent associative patterns with health outcomes (McKee-Ryan et al 2005, Roelfs et al 2011, including cortisol (Claussen, 1994;Ockenfels et al, 1995). To date, evidence in this area has focussed largely on assessing overall cortisol, or diurnal rhythm differences only; with no assessment of the awakening response, which has been specifically related to a range of sources of chronic stress (Fries et al 2009).…”

L’impact du chômage sur la santé

“…L'ensemble de ces données indique clairement que les chômeurs ont un risque accru d'avoir des problèmes de santé par rapport aux non-chômeurs. Ainsi, une compilation des études prospectives réalisées jusqu'en 2009 montre que le chômage est associé à une surmortalité, toutes causes confondues, de 60 % après ajustement sur l'âge et les autres facteurs confondants [11] …”

“…L'ensemble de ces données indique clairement que les chômeurs ont un risque accru d'avoir des problèmes de santé par rapport aux non-chômeurs. Ainsi, une compilation des études prospectives réalisées jusqu'en 2009 montre que le chômage est associé à une surmortalité, toutes causes confondues, de 60 % après ajustement sur l'âge et les autres facteurs confondants [11]. Les causes de cette surmortalité semblent multiples : les données indiquant un taux de suicide plus élevé sont convaincantes [12], celles issues de la littéra-ture disponible jusqu'en 1997 [13] et des études publiées par la suite [14,15] [6,[16][17][18][19].…”

“…Ainsi, le genre semble avoir une influence puisque la surmortalité, toutes causes confondues, est plus forte chez les chômeurs que chez les chômeuses [11], bien que les récessions économiques dégradent plus fortement la santé des femmes que celle des hommes [31]. Une explication possible de cette apparente contradiction repose sur le fait que les mécanismes par lesquels le chômage détériore la santé pourraient partiellement différer entre les hommes et les femmes, et que ces différences pourraient varier selon le contexte social et culturel [32].…”

“…Une explication possible de cette apparente contradiction repose sur le fait que les mécanismes par lesquels le chômage détériore la santé pourraient partiellement différer entre les hommes et les femmes, et que ces différences pourraient varier selon le contexte social et culturel [32]. L'âge semble être un autre modulateur puisque l'augmentation de la mortalité, toutes causes confondues, est plus importante chez les chômeurs jeunes ou d'âge moyen, que chez ceux d'âge plus avancé, même si les raisons de ces différences ne sont pas clairement identifiées [11,33]. De même que le filet de protection sociale, dont le rôle modulateur est discuté ci-dessous, l'environnement familial serait aussi susceptible d'influencer la détérioration de l'état de santé des chômeurs en modulant la perte de revenu [34,35].…”