Abstract
BackgroundPrevious studies have shown that unemployment has negative impacts on various aspects of health. However, little is known about the effect of unemployment on health-related quality of life. Our aim was to examine how unemployment impacts upon health-related quality of life among Swedish adults, and to investigate these effects on population subgroups defined by education level, marital status, previous health, and gender.MethodsAs part of a cross-sectional study, a questionnaire was sent to 2500 randomly selected individuals aged 20 to 64 years living in Sweden in 2016. The questionnaire included the EuroQol 5 dimensions (EQ-5D) instrument and was answered by 967 individuals (39%). Quality-adjusted life year (QALY) scores were derived from the EQ-5D responses. Of the respondents, 113 were unemployed and 724 were employed. We used inverse probability-weighted propensity scores in our analyses to estimate a risk difference. Gender, age, education level, marital status, and previous health were used as covariates in our analyses.ResultsThere was a statistically significant lower QALY score by 0.096 points for the unemployed compared to the employed. There were also statistically significant more problems due to unemployment for usual activities (6.6% more), anxiety/depression (23.6% more), and EQ-5D’s Visual Analogue Scale (7.5 point lower score). Grouped analyses indicated a larger negative health effect from becoming unemployed for men, those who are married, and young individuals.ConclusionsIn our study, we show that the health deterioration from unemployment is likely to be large, as our estimated effect implies an almost 10% worse health (in absolute terms) from being unemployed compared to being employed. This further highlights that unemployment is a public health problem that needs more focus. Our study also raises further demands for determining for whom unemployment has the most negative effects and thus suggesting groups of individuals who are in greatest need for labor market measures.
Highlights
Previous studies have shown that unemployment has negative impacts on various aspects of health
An advantage with the EuroQol 5 dimensions (EQ-5D) is that its value set, which is derived from responses to the descriptive system, allows it to be translated to so-called Quality Adjusted Life-Year (QALY) scores [12, 13]
The main emphasis in our study was on the QALY scores, but we present results for the other parts of the EQ-5D instrument, i.e. the dimensions themselves, and EuroQol Visual Analogue Scale (EQ-VAS)
Summary
Previous studies have shown that unemployment has negative impacts on various aspects of health. Our aim was to examine how unemployment impacts upon health-related quality of life among Swedish adults, and to investigate these effects on population subgroups defined by education level, marital status, previous health, and gender. Unemployment is in general something that has a negative effect on health [1,2,3], at the time of becoming unemployed, and in a longer time span [4,5,6,7,8] This relationship has previously been shown for different dimensions of self-assessed, mental and physical health and for depressive symptoms [2, 3]. QALYs enable comparisons between conducted and potential interventions in a systematic manner, which makes them attractive and commonly used in cost-effectiveness studies of new interventions
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