Unemployment is associated with high cardiovascular event rate and increased all-cause mortality in middle-aged socially privileged individuals
- 437 Downloads
To assess prospectively the association between employment status and cardiovascular health outcomes in socially privileged individuals.
The incidence of fatal and non-fatal cardiovascular events and all-cause mortality rate were monitored during 12 years in a national sample of 5,852 French volunteers, aged 45–64 years, who were free of cardiovascular disease or other overt disease at baseline. The association between health outcomes and employment status was tested using Cox proportional modelling with adjustment for confounding factors.
Compared to randomly selected individuals, these volunteers were characterized by higher education level and socio-economic status and lower cardiovascular risk and mortality rate. A total of 242 cardiovascular events (3.5 events per 1,000 person-years) and 152 deaths from all causes (2.2 deaths per 1,000 person-years) occurred during follow-up. After adjustment for age and gender, both cardiovascular event risk [HR (95 % CI) 1.84 (1.15–2.83), p = 0.01] and all-cause mortality [2.79 (1.66–4.47), p = 0.0002] were increased in unemployed individuals compared to workers. These poor health outcomes were observed to the same extent after further adjustment for clinical, behavioural and socio-demographic characteristics of individuals at baseline [HR (95 % CI) 1.74 (1.07–2.72), p = 0.03 and 2.89 (1.70–4.69), p = 0.0002, respectively]. In contrast, neither cardiovascular event risk nor all-cause mortality was significantly increased in retired individuals compared to workers after adjustment for confounding factors.
These results support the existence of a link between unemployment and poor cardiovascular health and suggest that this link is not mediated by conventional risk factors in middle-aged socially privileged individuals.
KeywordsSocial status Cohort Cardiovascular event risk All-cause mortality Unemployment
This study was funded by the Association Robert Debré pour la Recherche Médicale, the Institut National pour la Santé et la Recherche Médicale, the Conservatoire National des Arts et Métiers, the Institut National de la Recherche Agronomique and the Université Paris 13.
Conflict of interest
The authors declare that they have no conflict of interest relevant to this research.
- Akil L, Ahmad HA (2011) Effects of socioeconomic factors on obesity rates in four southern states and Colorado. Ethn Dis 21:58–62Google Scholar
- Bertrais S, Preziosi P, Mennen L, Galan P, Hercberg S, Oppert JM (2004) Sociodemographic and geographic correlates of meeting current recommendations for physical activity in middle-aged French adults: the Supplementation en Vitamines et Mineraux Antioxydants (SUVIMAX) study. Am J Public Health 94:1560–1566CrossRefGoogle Scholar
- Conway DI, McKinney PA, McMahon AD, Ahrens W, Schmeisser N, Benhamou S, Bouchardy C, Macfarlane GJ, Macfarlane TV, Lagiou P, Minaki P, Bencko V, Holcatova I, Merletti F, Richiardi L, Kjaerheim K, Agudo A, Castellsague X, Talamini R, Barzan L, Canova C, Simonato L, Lowry RJ, Znaor A, Healy CM, McCartan BE, Marron M, Hashibe M, Brennan P (2010) Socioeconomic factors associated with risk of upper aerodigestive tract cancer in Europe. Eur J Cancer 46:588–598CrossRefGoogle Scholar
- Darmon N, Drewnowski A (2008) Does social class predict diet quality? Am J Clin Nutr 87:1107–1117Google Scholar
- Driscoll AK, Bernstein AB (2012) Health and access to care among employed and unemployed adults: United States, 2009–2010. NCHS Data Brief 83:1–8Google Scholar
- Hercberg S (2005) Table de composition SU.VI.MAX des alimentsGoogle Scholar
- Hercberg S, Preziosi P, Briancon S, Galan P, Triol I, Malvy D, Roussel AM, Favier A (1998) A primary prevention trial using nutritional doses of antioxidant vitamins and minerals in cardiovascular diseases and cancers in a general population: the SU.VI.MAX study—design, methods, and participant characteristics. SUpplementation en VItamines et Mineraux AntioXydants. Control Clin Trials 19:336–351CrossRefGoogle Scholar
- Janlert U (1997) Unemployment as a disease and diseases of the unemployed. Scand J Work Environ Health 23(Suppl 3):79–83Google Scholar
- Jin RL, Shah CP, Svoboda TJ (1995) The impact of unemployment on health: a review of the evidence. CMAJ 153:529–540Google Scholar
- Kendzor DE, Cofta-Woerpel LM, Mazas CA, Li Y, Vidrine JI, Reitzel LR, Costello TJ, Businelle MS, Ahluwalia JS, Cinciripini PM, Wetter DW (2008) Socioeconomic status, negative affect, and modifiable cancer risk factors in African-American smokers. Cancer Epidemiol Biomark Prev 17:2546–2554CrossRefGoogle Scholar
- Lanoe JL, Makdessi-Raynaud Y (2005) L’état de santé en France en 2003: santé perçue, morbidité déclarée et recours aux soins à travers l’enquête décennale santé. Etudes et Résultats 436:1–12Google Scholar
- Le Moullec N, Deheeger M, Preziosi P, Montero P, Valeix P, Rolland-Cachera MF, Potier de Courcy G, Cherouvrier F, Christides JP, Galan P, Hercberg S (1996) Validation du manuel-photos utilisé pour l’enquête alimentaire de l’étude SU.VI.MAX. Cah Nutr Diet 31:158–164Google Scholar
- Lynge E (1997) Unemployment and cancer: a literature review. IARC Sci Publ 138:343–351Google Scholar
- Morrell SL, Taylor RJ, Kerr CB (1998) Jobless. Unemployment and young people’s health. Med J Aust 168:236–240Google Scholar
- Yarnell J, Yu S, McCrum E, Arveiler D, Hass B, Dallongeville J, Montaye M, Amouyel P, Ferrieres J, Ruidavets JB, Evans A, Bingham A, Ducimetiere P (2005) Education, socioeconomic and lifestyle factors, and risk of coronary heart disease: the PRIME Study. Int J Epidemiol 34:268–275CrossRefGoogle Scholar