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.

Download full-text


Available from: Guangya Liu, Oct 16, 2014
  • Source
    • "Myocardial infarction (MI), also referred to as acute myocardial infarction (AMI), accounts for the majority of the overall mortality in CAD (Korosoglou et al., 2011). In 2010, over one million people in America experienced either their first or recurrent MI, and more than half of them died from it (Dupre et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Recently, the rs1042713 G > A and rs1042714 C > G polymorphisms in the beta-2 adrenergic receptor (ADRB2) gene were shown to be related to atherosclerosis diseases. Therefore, we performed a systemic meta-analysis to determine whether the two functional polymorphisms are related to the risk of myocardial infarction (MI) and coronary artery disease (CAD). We identified published studies that are relevant to our topic of interest. Seven case-control studies, with a total of 6,843 subjects, were incorporated into the current meta-analysis. Our analysis showed a higher frequency of rs1042713 G > A variant in patients with MI or CAD compared to healthy controls. A similar result was also obtained with the rs1042714 C > G variant under both the allele and dominant models. Ethnicity-stratified subgroup analysis suggested that the rs1042714 C > G variant correlated with an increased risk of the two diseases in both Asians and Caucasians, while rs1042713 G > A only contributes to the risk of two diseases in Asians. In the disease type-stratified subgroups, the frequencies of both the rs1042713 G > A and rs1042714 C > G variants were higher in the cases than in the controls in both the MI and CAD subgroups. Collectively, our data contribute towards understanding the correlation between the rs1042713 G > A and rs1042714 C > G polymorphisms in ADRB2 and the susceptibility to MI and CAD.
    Preview · Article · Dec 2015 · Genetics and Molecular Biology
  • Source
    • "They concluded that for males, the adjusted mortality risk for stroke and CHD increase with the duration of unemployment in a quadratic way. Dupre et al. (2012) studied the impact of total number of spells of unemployment on the insurgence of acute myocardial infarction (AMI), using a large representative sample of North American elder workers. They found that AMI risks were significantly higher among the unemployed and the relative risk raised incrementally from one (1.22; "
    [Show abstract] [Hide abstract]
    ABSTRACT: Unemployment has not only economic consequences but also health ones, through several pathways: physiological, psychological and behavioural. Although these pathways have been widely investigated, evaluating their net impact on health is hindered by the fact that bad health in turn may affect unemployment. In this paper we investigate this theme in Italy, exploiting a very long database which helps us addressing the reverse causality issue. We design a 12-years pre-treatment period, on which we balance individual characteristics of workers, their general health condition and their career features; a 7-years treatment period to measure the occurrence of unemployment; and a 5-years follow up to measure the occurrence of Coronary Heart Diseases (CHD). The characteristics of workers and the probability of receiving the treatment are balanced by means of propensity score matching, by which a quasi-experimental setup is reproduced. We find a significant increase of CHD probability for workers who experience more than three years of unemployment during the treatment, and for those who exit unemployment starting a self-employment activity. Using different selections of the study population a clear pattern emerges: the healthier and more labour market attached are workers during pre-treatment, the greater is the negative impact of unemployment on health, pointing to a plausible disappointment effect.
    Full-text · Article · Nov 2015
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jul 2014 · Psychological Medicine
Show more