The Cumulative Effect of Unemployment on Risks for Acute Myocardial Infarction

Duke Clinical Research Institute, Duke University, Durham, North Carolina 27715, USA.
Archives of internal medicine (Impact Factor: 17.33). 12/2012; 172(22):1731-7. DOI: 10.1001/2013.jamainternmed.447
Source: PubMed


Employment instability is a major source of strain affecting an increasing number of adults in the United States. Little is known about the cumulative effect of multiple job losses and unemployment on the risks for acute myocardial infarction (AMI).
We investigated the associations between different dimensions of unemployment and the risks for AMI in US adults in a prospective cohort study of adults (N = 13,451) aged 51 to 75 years in the Health and Retirement Study with biennial follow-up interviews from 1992 to 2010. Unadjusted rates of age-specific AMI were used to demonstrate observed differences by employment status, cumulative number of job losses, and cumulative time unemployed. Cox proportional hazards models were used to examine the multivariate effects of cumulative work histories on AMI while adjusting for sociodemographic background and confounding risk factors.
The median age of the study cohort was 62 years, and 1061 AMI events (7.9%) occurred during the 165,169 person-years of observation. Among the sample, 14.0% of subjects were unemployed at baseline, 69.7% had 1 or more cumulative job losses, and 35.1% had spent time unemployed. Unadjusted plots showed that age-specific rates of AMI differed significantly for each dimension of work history. Multivariate models showed that AMI risks were significantly higher among the unemployed (hazard ratio, 1.35 [95% CI, 1.10-1.66]) and that risks increased incrementally from 1 job loss (1.22 [1.04-1.42]) to 4 or more cumulative job losses (1.63 [1.29-2.07]) compared with no job loss. Risks for AMI were particularly elevated within the first year of unemployment (hazard ratio, 1.27 [95% CI, 1.01-1.60]) but not thereafter. Results were robust after adjustments for multiple clinical, socioeconomic, and behavioral risk factors.
Unemployment status, multiple job losses, and short periods without work are all significant risk factors for acute cardiovascular events.

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Available from: Guangya Liu, Oct 16, 2014
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    • "The above findings might be explained by the association between personality and occupation, because a previous study reported that cause-specific mortality in Japan was different among the types of job (Wada et al. 2012). In addition, Dupre et al. (2012) also reported that unemployment status is a risk of acute myocardial infarction. Thus, we considered the association between personality and types of job. "
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    ABSTRACT: Background: The interactive effect of personal factors and social factors upon suicide risk is unclear. We conducted prospective cohort study to investigate whether the impact of the economic crisis in 1997-1998 upon suicide risk differed according to Neuroticism and Psychoticism personality traits. Methods: The Miyagi Cohort Study in Japan with a follow-up for 19 years from 1990 to 2008 has 29 432 subjects aged 40-64 years at baseline who completed a questionnaire about various health habits and the Japanese version of the Eysenck Personality Questionnaire - Revised Short Form in 1990. Results: The suicide mortality rate increased from 4.6 per 100 000 person-years before 1998 to 27.8 after 1998. Although both Neuroticism and Psychoticism were significantly associated with an increased risk of mortality during the whole period from 1990 to 2008, the impact of the economic crisis upon suicide risk differed between the Neuroticism and Psychoticism personality traits. Compared with the lowest category, the hazard ratios (HRs) for the highest Neuroticism increased from 0.66 before 1998 to 2.45 after 1998. On the other hand, the HRs for the highest Psychoticism decreased from 7.85 before 1998 to 2.05 after 1998. Conclusions: The impact of the 1997-1998 economic crisis upon suicide risk differed according to personality. Suicide risk increased among these with higher Neuroticism after the economic crisis, but this was not the case for other personality subscales.
    Psychological Medicine 07/2014; 45(3):1-15. DOI:10.1017/S0033291714001688 · 5.94 Impact Factor
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    • "Of the studies that ensure the temporal sequence of the exposure and outcome is maintained, the findings are fairly consistent. For example, the cohort study by Dupre et al. using data from the US Health and Retirement Study reported significant associations between unemployment status, job losses and episodes of not working with the incidence of acute cardiovascular events [6]. They found that those experiencing 4 or more job losses over the follow-up period had a 63% increase in the risk of acute myocardial infarction compared with those who had had none (HR 1.63 95% CI 1.29, 2.07). "
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    ABSTRACT: Background There is growing evidence to suggest unemployment has a role in the development and incidence of cardiovascular disease. This study explores the contribution of breaks in employment to the development of hypertension, a key risk factor for coronary heart disease. Methods We use data from the Survey of Health, Ageing, and Retirement in Europe to estimate the association between gaps in employment of 6 months or more (‘Not Working’, NW) and the incidence of hypertension in 9,985 individuals aged 50 or over across 13 European countries. Life history information including transitions in and out of employment was used to create a panel dataset where each visit represented one year of life between age 30 and incident hypertension or censoring (whichever came first). Pooled logistic models estimated the odds of hypertension according to the experience of not working, controlling for age at interview, age at each visit, gender, childhood socio-economic position, and country. Results We consistently found no association between NW and hypertension, irrespective of the metrics used in defining the exposure or model specification. Conclusion There is the possibility of bias contributing to the null findings. However, given the relatively consistent evidence for an association between unemployment and cardiovascular outcomes in the literature, our results suggest there may be mechanisms - outside of hypertension – that have a comparatively greater contribution to this association.
    BMC Public Health 05/2014; 14(1):536. DOI:10.1186/1471-2458-14-536 · 2.26 Impact Factor
  • International journal of cardiology 07/2013; 168(5). DOI:10.1016/j.ijcard.2013.07.028 · 4.04 Impact Factor
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