Association of Job Expectations Among High School Students With Early Death During Adulthood

Chandra Muller,Alicia Duncombe,Anna S Mueller,Jamie M Carroll,Eric Grodsky,John Robert Warren

doi:10.1001/jamanetworkopen.2020.27958

Abstract

Deaths from self-injury are increasing. Understanding the sources of risk is important for prevention and treatment. To estimate the risks of suicide and drug poisoning deaths among adult men whose adolescent occupational expectations were not met in adulthood. This cohort study included a sample of men interviewed as part of the High School and Beyond study, a nationally representative study of US high school sophomores and seniors in 1980, who were interviewed every 2 years through 1986; those who were sophomores in 1980 were reinterviewed in 1992. Men who survived to 1992 and reported occupational expectations were included in the present study. Death records prior to 2018 were linked to mortality databases and released in 2019. Data analysis was conducted from May to October 2020. Occupational expectations. Survival or death by suicide, drug poisoning, chronic liver disease, heart disease, cancer, or some other cause, categorized from International Classification of Diseases, Ninth Revision and Tenth Revision codes. Competing risk Fine-Gray survival models regressed cause of death on adolescent occupational expectations and covariates. The 11 680 men in the High School and Beyond cohort study had a median (interquartile range) age of 29 (28-30) years in 1992, when the analysis of their future mortality began. Most men survived until 2015 (11 060 [weighted percentage, 95.0%]). Reported causes of death were suicide (60 [weighted percentage, 0.5%]), drug poisoning (40 [weighted percentage, 0.4%]), chronic liver disease (20 [weighted percentage, 0.2%]), heart disease (130 [weighted percentage, 1.0%]), cancer (100 [weighted percentage, 1.0%]), and other (280 [weighted percentage, 2.0%]). Subhazard ratios for death by suicide and drug poisoning were 2.91 (95% CI, 1.07-7.88; P = .04) and 2.62 (95% CI, 1.15-5.94; P = .02) times higher, respectively, among those who in 1980 expected to hold a subbaccalaureate occupation that later declined in labor market share compared with those with professional occupational expectations. The actual job held by men did not attenuate the hazards of deaths from suicide and drug poisoning. In this cohort study, men whose occupational expectations were not met because of labor market declines were at a higher risk of death from suicide or drug poisoning than men with different occupational expectations. Interventions to mitigate labor market changes should account for individuals' expectational ideals.

Highlights

Mortality from self-injury, especially suicide and drug poisoning, has risen dramatically in recent decades, among men without a bachelor’s degree.[1,2,3] The twin epidemics have cooccurred with 2 trends that suggest despair as a possible common root cause
Subhazard ratios for death by suicide and drug poisoning were 2.91 and 2.62 times higher, respectively, among those who in 1980 expected to hold a subbaccalaureate occupation that later declined in labor market share compared with those with professional occupational expectations
In this cohort study, men whose occupational expectations were not met because of labor market declines were at a higher risk of death from suicide or drug poisoning than men with different occupational expectations

Summary

Introduction

Mortality from self-injury, especially suicide and drug poisoning, has risen dramatically in recent decades, among men without a bachelor’s degree.[1,2,3] The twin epidemics have cooccurred with 2 trends that suggest despair as a possible common root cause. Lower wages, and worse benefits contributed to the overall degradation of working-class men’s ability to earn a family wage.[1,4] Second, early mortality from other causes researchers classify as preventable, such as heart disease and cancer, has steadily declined, in part due to advances in medicine and public health.[5] In stark contrast, between 1980 and 2013, deaths by suicide and drug poisoning increased by 9 and 31 per 100 000 individuals, respectively, among non-Hispanic White men aged 45 to 55 years.[6] Combined, the trends suggest that closed pathways to sustaining working-class jobs may contribute to men’s increasing rates of suicide and drug poisoning mortality.[7,8] This study investigates this possibility with newly available and uniquely suitable data

Methods

Results

Discussion

Conclusion