Advertisement

Unemployment is associated with high cardiovascular event rate and increased all-cause mortality in middle-aged socially privileged individuals

  • Pierre MenetonEmail author
  • Emmanuelle Kesse-Guyot
  • Caroline Méjean
  • Léopold Fezeu
  • Pilar Galan
  • Serge Hercberg
  • Joël Ménard
Original Article

Abstract

Purpose

To assess prospectively the association between employment status and cardiovascular health outcomes in socially privileged individuals.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Social status Cohort Cardiovascular event risk All-cause mortality Unemployment 

Notes

Acknowledgments

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.

References

  1. Akil L, Ahmad HA (2011) Effects of socioeconomic factors on obesity rates in four southern states and Colorado. Ethn Dis 21:58–62Google Scholar
  2. Astell-Burt T, Feng X (2013) Health and the 2008 economic recession: evidence from the United Kingdom. PLoS One 8:e56674CrossRefGoogle Scholar
  3. Bambra C, Eikemo TA (2009) Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self-reported health in 23 European countries. J Epidemiol Community Health 63:92–98CrossRefGoogle Scholar
  4. Bartley M, Owen C (1996) Relation between socioeconomic status, employment, and health during economic change, 1973–93. BMJ 313:445–449CrossRefGoogle Scholar
  5. Berard E, Bongard V, Arveiler D, Amouyel P, Wagner A, Dallongeville J, Haas B, Cottel D, Ruidavets JB, Ferrieres J (2011) Ten-year risk of all-cause mortality: assessment of a risk prediction algorithm in a French general population. Eur J Epidemiol 26:359–368CrossRefGoogle Scholar
  6. 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
  7. Bockerman P, Ilmakunnas P (2009) Unemployment and self-assessed health: evidence from panel data. Health Econ 18:161–179CrossRefGoogle Scholar
  8. Bolton KL, Rodriguez E (2009) Smoking, drinking and body weight after re-employment: does unemployment experience and compensation make a difference? BMC Public Health 9:77CrossRefGoogle Scholar
  9. Claussen B (1993) A clinical follow up of unemployed. I: lifestyle, diagnoses, treatment and re-employment. Scand J Prim Health Care 11:211–218CrossRefGoogle Scholar
  10. 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
  11. Darmon N, Drewnowski A (2008) Does social class predict diet quality? Am J Clin Nutr 87:1107–1117Google Scholar
  12. 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
  13. Dupre ME, George LK, Liu G, Peterson ED (2012) The cumulative effect of unemployment on risks for acute myocardial infarction. Arch Intern Med 172:1731–1737CrossRefGoogle Scholar
  14. Falba T, Teng HM, Sindelar JL, Gallo WT (2005) The effect of involuntary job loss on smoking intensity and relapse. Addiction 100:1330–1339CrossRefGoogle Scholar
  15. Fergusson DM, Boden JM (2008) Cannabis use and later life outcomes. Addiction 103:969–976CrossRefGoogle Scholar
  16. Freyer-Adam J, Gaertner B, Tobschall S, John U (2011) Health risk factors and self-rated health among job-seekers. BMC Public Health 11:659CrossRefGoogle Scholar
  17. Gallo WT (2012) Evolution of research on the effect of unemployment on acute myocardial infarction risk. Arch Intern Med 172:1737–1738CrossRefGoogle Scholar
  18. Gallo WT, Bradley EH, Falba TA, Dubin JA, Cramer LD, Bogardus STJ, Kasl SV (2004) Involuntary job loss as a risk factor for subsequent myocardial infarction and stroke: findings from the health and retirement survey. Am J Ind Med 45:408–416CrossRefGoogle Scholar
  19. Gallo WT, Teng HM, Falba TA, Kasl SV, Krumholz HM, Bradley EH (2006) The impact of late career job loss on myocardial infarction and stroke: a 10-year follow-up using the health and retirement survey. Occup Environ Med 63:683–687CrossRefGoogle Scholar
  20. Gerdtham UG, Johannesson M (2003) A note on the effect of unemployment on mortality. J Health Econ 22:505–518CrossRefGoogle Scholar
  21. Gerdtham UG, Ruhm CJ (2006) Deaths rise in good economic times: evidence from the OECD. Econ Hum Biol 4:298–316CrossRefGoogle Scholar
  22. Greenwood M, Thomson PJ, Lowry RJ, Steen IN (2003) Oral cancer: material deprivation, unemployment and risk factor behaviour—an initial study. Int J Oral Maxillofac Surg 32:74–77CrossRefGoogle Scholar
  23. Hammarstrom A (1994) Health consequences of youth unemployment. Public Health 108:403–412CrossRefGoogle Scholar
  24. Hammarstrom A, Janlert U (2003) Unemployment—an important predictor for future smoking: a 14-year follow-up study of school leavers. Scand J Public Health 31:229–232CrossRefGoogle Scholar
  25. Hammarstrom A, Janlert U (2005) An agenda for unemployment research: a challenge for public health. Int J Health Serv 35:765–777CrossRefGoogle Scholar
  26. Hammer T (1997a) Factors predicting health behavior. Nord J Psychiatry 51:431–438CrossRefGoogle Scholar
  27. Hammer T (1997b) History dependence in youth unemployment. Eur Sociol Rev 13:17–33CrossRefGoogle Scholar
  28. Hercberg S (2005) Table de composition SU.VI.MAX des alimentsGoogle Scholar
  29. 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
  30. Hercberg S, Galan P, Preziosi P, Bertrais S, Mennen L, Malvy D, Roussel AM, Favier A, Briancon S (2004) The SU.VI.MAX study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals. Arch Intern Med 164:2335–2342CrossRefGoogle Scholar
  31. Hoffmann JP, Dufur M, Huang L (2007) Drug use and job quits: a longitudinal analysis. J Drug Issues 37:569–596CrossRefGoogle Scholar
  32. Janlert U (1997) Unemployment as a disease and diseases of the unemployed. Scand J Work Environ Health 23(Suppl 3):79–83Google Scholar
  33. Jin RL, Shah CP, Svoboda TJ (1995) The impact of unemployment on health: a review of the evidence. CMAJ 153:529–540Google Scholar
  34. Jusot F, Khlat M, Rochereau T, Serme C (2008) Job loss from poor health, smoking and obesity: a national prospective survey in France. J Epidemiol Community Health 62:332–337CrossRefGoogle Scholar
  35. Karanikolos M, Mladovsky P, Cylus J, Thomson S, Basu S, Stuckler D, Mackenbach JP, McKee M (2013) Financial crisis, austerity, and health in Europe. Lancet 381:1323–1331CrossRefGoogle Scholar
  36. 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
  37. Kesse-Guyot E, Touvier M, Henegar A, Czernichow S, Galan P, Hercberg S, Castetbon K (2011) Higher adherence to French dietary guidelines and chronic diseases in the prospective SU.VI.MAX cohort. Eur J Clin Nutr 65:887–894CrossRefGoogle Scholar
  38. Laitinen J, Ek E, Sovio U (2002a) Stress-related eating and drinking behavior and body mass index and predictors of this behavior. Prev Med 34:29–39CrossRefGoogle Scholar
  39. Laitinen J, Power C, Ek E, Sovio U, Jarvelin MR (2002b) Unemployment and obesity among young adults in a northern Finland 1966 birth cohort. Int J Obes Relat Metab Disord 26:1329–1338CrossRefGoogle Scholar
  40. 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
  41. 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
  42. Leino-Arjas P, Liira J, Mutanen P, Malmivaara A, Matikainen E (1999) Predictors and consequences of unemployment among construction workers: prospective cohort study. BMJ 319:600–605CrossRefGoogle Scholar
  43. Lundin A, Lundberg I, Hallsten L, Ottosson J, Hemmingsson T (2010) Unemployment and mortality—a longitudinal prospective study on selection and causation in 49,321 Swedish middle-aged men. J Epidemiol Community Health 64:22–28CrossRefGoogle Scholar
  44. Lynge E (1997) Unemployment and cancer: a literature review. IARC Sci Publ 138:343–351Google Scholar
  45. Mahmood SS, Levy D, Vasan RS, Wang TJ (2014) The Framingham Heart Study and the epidemiology of cardiovascular disease: a historical perspective. Lancet 383:999–1008CrossRefGoogle Scholar
  46. Martikainen PT (1990) Unemployment and mortality among Finnish men, 1981–5. BMJ 301:407–411CrossRefGoogle Scholar
  47. McKee-Ryan F, Song Z, Wanberg CR, Kinicki AJ (2005) Psychological and physical well-being during unemployment: a meta-analytic study. J Appl Psychol 90:53–76CrossRefGoogle Scholar
  48. McLeod CB, Lavis JN, MacNab YC, Hertzman C (2012) Unemployment and mortality: a comparative study of Germany and the United States. Am J Public Health 102:1542–1550CrossRefGoogle Scholar
  49. Mejean C, Droomers M, van der Schouw YT, Sluijs I, Czernichow S, Grobbee DE, Bueno-de-Mesquita HB, Beulens JW (2013) The contribution of diet and lifestyle to socioeconomic inequalities in cardiovascular morbidity and mortality. Int J Cardiol 168:5190–5195CrossRefGoogle Scholar
  50. Meneton P, Lanoe JL, Menard J (2012) Health insurance coverage is the single most prominent socioeconomic factor associated with cardiovascular drug delivery in the French population. J Hypertens 30:617–623CrossRefGoogle Scholar
  51. Milner A, Page A, LaMontagne AD (2013) Long-term unemployment and suicide: a systematic review and meta-analysis. PLoS One 8:e51333CrossRefGoogle Scholar
  52. Montgomery SM, Bartley MJ, Cook DG, Wadsworth ME (1996) Health and social precursors of unemployment in young men in Great Britain. J Epidemiol Community Health 50:415–422CrossRefGoogle Scholar
  53. Montgomery SM, Cook DG, Bartley MJ, Wadsworth ME (1998) Unemployment, cigarette smoking, alcohol consumption and body weight in young British men. Eur J Public Health 8:21–27CrossRefGoogle Scholar
  54. Morrell SL, Taylor RJ, Kerr CB (1998) Jobless. Unemployment and young people’s health. Med J Aust 168:236–240Google Scholar
  55. Morris JK, Cook DG, Shaper AG (1992) Non-employment and changes in smoking, drinking, and body weight. BMJ 304:536–541CrossRefGoogle Scholar
  56. Moser KA, Goldblatt PO, Fox AJ, Jones DR (1987) Unemployment and mortality: comparison of the 1971 and 1981 longitudinal study census samples. Br Med J (Clin Res Ed) 294:86–90CrossRefGoogle Scholar
  57. Peretti-Watel P, Constance J (2009) “It’s all we got left”. Why poor smokers are less sensitive to cigarette price increases. Int J Environ Res Public Health 6:608–621CrossRefGoogle Scholar
  58. Reine I, Novo M, Hammarstrom A (2004) Does the association between ill health and unemployment differ between young people and adults? Results from a 14-year follow-up study with a focus on psychological health and smoking. Public Health 118:337–345CrossRefGoogle Scholar
  59. Robinson N, Yateman NA, Protopapa LE, Bush L (1989) Unemployment and diabetes. Diabet Med 6:797–803CrossRefGoogle Scholar
  60. Rodwin VG (2003) The health care system under French national health insurance: lessons for health reform in the United States. Am J Public Health 93:31–37CrossRefGoogle Scholar
  61. Roelfs DJ, Shor E, Davidson KW, Schwartz JE (2011) Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality. Soc Sci Med 72:840–854CrossRefGoogle Scholar
  62. Ruhm CJ (2007) A healthy economy can break your heart. Demography 44:829–848CrossRefGoogle Scholar
  63. Salm M (2009) Does job loss cause ill health? Health Econ 18:1075–1089CrossRefGoogle Scholar
  64. Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M (2009) The public health effect of economic crises and alternative policy responses in Europe: an empirical analysis. Lancet 374:315–323CrossRefGoogle Scholar
  65. Weber A, Lehnert G (1997) Unemployment and cardiovascular diseases: a causal relationship? Int Arch Occup Environ Health 70:153–160CrossRefGoogle Scholar
  66. Weisz D, Gusmano MK, Rodwin VG, Neuberg LG (2008) Population health and the health system: a comparative analysis of avoidable mortality in three nations and their world cities. Eur J Public Health 18:166–172CrossRefGoogle Scholar
  67. 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

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Pierre Meneton
    • 1
    Email author
  • Emmanuelle Kesse-Guyot
    • 2
  • Caroline Méjean
    • 2
  • Léopold Fezeu
    • 2
  • Pilar Galan
    • 2
  • Serge Hercberg
    • 2
  • Joël Ménard
    • 3
  1. 1.INSERM U1142 LIMICS, UMR_S 1142 Sorbonne Universités, UPMC Université Paris 06Université Paris 13ParisFrance
  2. 2.UREN, INSERM U557, INRA U1125, CNAM, SMBH, Sorbonne Paris CitéUniversité Paris 13BobignyFrance
  3. 3.INSERM CIC9201Université Paris DescartesParisFrance

Personalised recommendations