Abstract
BackgroundThis study describes the association between unemployment and cause-specific mortality for a cohort of working-age Canadians.MethodsWe conducted a cohort study over an 11-year period among a broadly representative 15% sample of the non-institutionalized population of Canada aged 30–69 at cohort inception in 1991 (888,000 men and 711,600 women who were occupationally active). We used cox proportional hazard models, for six cause of death categories, two consecutive multi-year periods and four age groups, to estimate mortality hazard ratios comparing unemployed to employed men and women.ResultsFor persons unemployed at cohort inception, the age-adjusted hazard ratio for all-cause mortality was 1.37 for men (95% confidence interval (CI): 1.32-1.41) and 1.27 for women (95% CI: 1.20-1.35). The age-adjusted hazard ratio for unemployed men and women was elevated for all six causes of death: malignant neoplasms, circulatory diseases, respiratory diseases, alcohol-related diseases, accidents and violence, and all other causes. For unemployed men and women, hazard ratios for all-cause mortality were equivalently elevated in 1991–1996 and 1997–2001. For both men and women, the mortality hazard ratio associated with unemployment attenuated with age.ConclusionsConsistent with results reported from other long-duration cohort studies, unemployed men and women in this cohort had an elevated risk of mortality for accidents and violence, as well as for chronic diseases. The persistence of elevated mortality risks over two consecutive multi-year periods suggests that exposure to unemployment in 1991 may have marked persons at risk of cumulative socioeconomic hardship.
Highlights
This study describes the association between unemployment and cause-specific mortality for a cohort of working-age Canadians
Compared to persons who were employed on census day, the age-adjusted hazard ratio for all-cause mortality over the eleven-year follow-up period for persons unemployed on census day in 1991 was 1.37 for men (95% confidence interval (CI): 1.32-1.41) (Table 3) and 1.27 for women (Table 4)
Compared to men who were employed on census day, age-adjusted hazard ratios for unemployed men over the eleven-year follow-up period were elevated for deaths due to malignant neoplasms (1.24, 95% CI: 1.18-1.31), circulatory diseases (1.22, 95% CI: 1.14-1.30), respiratory diseases (1.45, 95% CI: 1.21-1.74), accidents and violence (1.94, 95% CI: 1.78-2.12), and all other causes (1.59, 95% CI: 1.461.73) (Table 3)
Summary
This study describes the association between unemployment and cause-specific mortality for a cohort of working-age Canadians. Research on the relationship between unemployment and health examines a range of hypotheses concerning pathways and mechanisms for work-related health effects, ranging from the economic consequences of job loss to the disruptions of social ties, by which involuntary loss of employment might lead to disturbance in physical and mental health and function [13,14,18,19]. An alternate research design contrasts the relationship between unemployment and mortality in periods of low and high unemployment, under the hypothesis that those who are unemployed during periods of low unemployment are more likely to have pre-existing ill-health than those who are unemployed during periods of high unemployment [23]
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