The association of unemployment with glucose metabolism: a systematic review and meta-analysis
Unemployment has been linked with poor health. We hypothesized that being unemployed is associated with disorders of glucose metabolism and performed a systematic review and meta-analysis of the literature to ascertain the relationship.
We searched the databases of Scopus, Medline Ovid and Web of Science for population-based original studies for past 20 years. Random effects meta-analyses were used to estimate odds ratios (OR) with 95% confidence intervals (CI) for prediabetes and type 2 diabetes among the unemployed as compared to those employed, separately for men and women when possible.
Out of 981 articles found, 12 articles were included in the systematic review and eight articles in the meta-analyses. Unemployment was associated with 1.6-fold odds for prediabetes (OR 1.58; 95% CI 1.07–2.35), and 1.7-fold odds for type 2 diabetes (OR 1.72; 95% CI 1.14–2.58) in the total sample. The corresponding associations for type 2 diabetes were also found stratified for men (OR 1.53; 95% CI 1.47–1.60) and women (OR 1.60; 95% CI 1.33–1.92).
Unemployment is associated with prediabetes and type 2 diabetes, global concerns of public health with potential for prevention.
KeywordsUnemployment Glucose metabolism Prediabetes Type 2 diabetes Systematic review Meta-analysis
Compliance with ethical standards
Conflict of interest
Author Tuulia Varanka-Ruuska declares she has no conflicts of interest. Author Nina Rautio declares she has no conflicts of interest. Author Heli Lehtiniemi declares she has no conflicts of interest. Author Jouko Miettunen declares he has no conflicts of interest. Author Sirkka Keinänen-Kiukaanniemi declares she has no conflicts of interest. Author Sylvain Sebert declares he has no conflicts of interest. Author Leena Ala-Mursula declares she has no conflicts of interest.
This article is based on a secondary analysis of existing literature and does not contain any studies with human participants nor animals conducted by the authors. Obtaining approval by an ethics committee is not required under national regulations. Good scientific standards have been followed according to MOOSE guidelines.
This project has received funding from the Academy of Finland (#268336) and the European Union’s Horizon 2020 research and innovation program (under Grant agreement no. 633595) for the DynaHEALTH action. The funders had no role in study design, data analysis, data interpretation and writing of the paper.
- Al-Baghli NA, Al-Ghamdi AJ, Al-Turki KA, Al Elq AH, El-Zubaier AG, Bahnassy A (2010) Prevalence of diabetes mellitus and impaired fasting glucose levels in the Eastern Province of Saudi Arabia: results of a screening campaign. Singap Med J 51:923–930Google Scholar
- Azimi-Nezhad M, Ghayour-Mobarhan M, Parizadeh MR, Safarian M, Esmaeili H, Parizadeh SMJ, Khodaee G, Hosseini J, Abasalti Z, Hassankhani B, Ferns G (2008) Prevalence of type 2 diabetes mellitus in Iran and its relationship with gender, urbanisation, education, marital status and occupation. Singap Med J 49:571–576Google Scholar
- Bird Y, Lemstra M, Rogers M, Moraros J (2015) The relationship between socioeconomic status/income and prevalence of diabetes and associated conditions: a cross-sectional population-based study in Saskatchewan, Canada. Int J Equity Health 14:93. doi: 10.1186/s12939-015-0237-0 CrossRefPubMedPubMedCentralGoogle Scholar
- Centers for Disease Control and Prevention (2015) Distribution of age at diagnosis of diabetes among adult incident cases aged 18–79 years, United States, 2011. http://www.cdc.gov/diabetes/statistics/age/fig1.htm. Accessed 3 Sept 2015
- Dodu N (2005) Is employment good for well-being? A literature review. J Occup Psychol Employ Disabil 7:17–33Google Scholar
- Friedrich N, Schneider HJ, John U, Dörr M, Baumeister SE, Homuth G, Völker U, Wallaschofski H (2013) Correlates of adverse outcomes in abdominally obese individuals: findings from the 5-year followup of the population-based study of health in Pomerania. J Obes. doi: 10.1155/2013/762012 PubMedPubMedCentralGoogle Scholar
- International Diabetes Federation (2015) IDF diabetes atlas, 7th edn. International Diabetes Federation, BrusselsGoogle Scholar
- Lindström J, Peltonen M, Eriksson JG, Ilanne-Parikka P, Aunola S, Keinänen-Kiukaanniemi S, Uusitupa M, Tuomilehto J (2013) Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study (DPS). Diabetologia 56:284–293CrossRefPubMedGoogle Scholar
- Montgomery S, Cook D, Bartley M, Wadsworth M (1998) Unemployment, cigarette smoking, alcohol consumption and body weight in young British men. European J Public Health 8(1):21–27Google Scholar
- Morikawa Y, Nakagawa H, Miura K, Soyama Y, Ishizaki M, Kido T, Naruse Y, Suwazono Y, Nogawa K (2005) Shift work and the risk of diabetes mellitus among Japanese male factory workers. Scand J Work Environ Health 31(3):179–183Google Scholar
- Müller G, Hartwig S, Greiser KH, Moebus S, Pundt N, Schipf S, Völzke H, Maier W, Meisinger C, Tamayo T, Rathmann W, Berger K (2013a) Gender differences in the association of individual social class and neighbourhood unemployment rate with prevalent type 2 diabetes mellitus: a cross-sectional study from the DIAB-CORE consortium. BMJ Open. doi: 10.1136/bmjopen-2013-002601 Google Scholar
- Müller G, Kluttig A, Greiser KH, Moebus S, Slomiany U, Schipf S, Völzke H, Maier W, Meisinger C, Tamayo T, Rathmann W, Berger K (2013b) Regional and neighborhood disparities in the odds of type 2 diabetes: results from 5 population-based studies in Germany (DIAB-CORE consortium). Am J Epidemiol 178:221–230. doi: 10.1093/aje/kws466 CrossRefPubMedGoogle Scholar
- OECD (2014b) Foreign-born unemployment (indicator). https://data.oecd.org/migration/foreign-born-unemployment.htm. Accessed 1 Mar 2017 (the data 2014 used). doi: 10.1787/ba5d2ce0-en
- Rautio N, Varanka-Ruuska T, Vaaramo E, Palaniswamy S, Nedelec R, Miettunen J, Karppinen J, Auvinen J, Järvelin M-R, Keinänen-Kiukaanniemi S, Sebert S, Ala-Mursula L (2017) Accumulated exposure to unemployment is related to impaired glucose metabolism in middle-aged men: a follow-up of the Northern Finland Birth Cohort 1966. Prim Care Diabetes 11:365–372. doi: 10.1016/j.pcd.2017.03.010 CrossRefPubMedGoogle Scholar
- Sterne J (2009) Meta-analysis in Stata: an updated collection from the Stata Journal| Jonathan Sterne| 9781597180498| CRC PRESSGoogle Scholar
- Tuomilehto J, Lindström J, Eriksson JG, Valle TT, Hämäläinen H, Ilanne-Parikka P, Keinänen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344:1343–1350. doi: 10.1056/NEJM200105033441801 CrossRefPubMedGoogle Scholar
- Virtanen M, Ferrie JE, Tabak AG, Akbaraly TN, Vahtera J, Singh-Manoux A, Kivimäki M (2014) Psychological distress and incidence of type 2 diabetes in high-risk and low-risk populations: the Whitehall II cohort study. Diabetes Care 37:2091–2097. doi: 10.2337/dc13-2725 CrossRefPubMedPubMedCentralGoogle Scholar
- Waddell G, Burton KA (2006) Is work good for your health and well-being?. TSO, LondonGoogle Scholar
- World Bank (2016) Labor force participation rate, female (% of female population ages 15 +) (modeled ILO estimate). http://data.worldbank.org/indicator/SL.TLF.CACT.FE.ZS. Accessed 28 Nov 2016
- World Health Organization (1999) Definition, diagnosis and classification of diabetes mellitus and its complication. Report of a WHO consultation. Part 1: diagnosis and classification of diabetes mellitus. World Health Organization, Geneva, Report No 99.2Google Scholar
- World Health Organization (2013) Diagnostic criteria and classification of hyperglycaemia first detected in pregnancyGoogle Scholar