This is very important research that is bound to create significant reactions. When governments tolerate certain levels of unemployment, they are also in effect tolerating certain levels of mortality in particular groups of citizens.
Social Science & Medicine
Volume 72, Issue 6, March 2011, Pages 840-854
doi:10.1016/j.socscimed.2011.01.005 | How to Cite or Link Using DOI
Copyright © 2011 Elsevier Ltd All rights reserved.
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Losing life and livelihood: A systematic review and meta-analysis of unemployment and all-cause mortality
David J. Roelfsa, , , Eran Shorb, Karina W. Davidsonc and Joseph E. Schwartzd
a Department of Sociology, Stony Brook University, S-401 SBS Building, Stony Brook, NY 11794-4356, USA
b Department of Sociology, McGill University, Montreal, Quebec, Canada
c Department of Medicine and Psychiatry, Columbia University, New York, NY, USA
d Department of Psychiatry and Behavioral Medicine, Stony Brook University, Stony Brook, NY, USA
Available online 27 January 2011.
Unemployment rates in the United States remain near a 25-year high and global unemployment is rising. Previous studies have shown that unemployed persons have an increased risk of death, but the magnitude of the risk and moderating factors have not been explored. The study is a random effects meta-analysis and meta-regression designed to assess the association between unemployment and all-cause mortality among working-age persons. We extracted 235 mortality risk estimates from 42 studies, providing data on more than 20 million persons. The mean hazard ratio (HR) for mortality was 1.63 among HRs adjusted for age and additional covariates. The mean effect was higher for men than for women. Unemployment was associated with an increased mortality risk for those in their early and middle careers, but less for those in their late career. The risk of death was highest during the first 10 years of follow-up, but decreased subsequently. The mean HR was 24% lower among the subset of studies controlling for health-related behaviors. Public health initiatives could target unemployed persons for more aggressive cardiovascular screening and interventions aimed at reducing risk-taking behaviors.
► The risk of death for unemployed persons was 63% higher than the risk of death for employed persons. ► The relative mortality risk associated with unemployment was 37% higher for men than for women. ► The relative mortality risk associated with unemployment was significantly lower for workers approaching retirement age (50-65 years of age). ► The relative mortality risk associated with unemployment remained elevated among studies with lengthy follow-up periods, suggesting that becoming unemployed induces a long-term change in the underlying mortaity risk.
Keywords: Unemployment; All-cause mortality; Meta-analysis; Meta-regression; Systematic review; Psychosocial stress; Health behaviors
Mediating and confounding health factors in unemployment research
The latent sickness hypothesis
The coping hypothesis
Search strategy and coding procedures
Statistical methods and inclusion criteria
sub-group meta-analyses and meta-regression analyses
Section 1: Full search algorithms for Medline.
Section 2: Coding procedures and variables for which data were sought.
Section 3: Additional information on the conversion of odds ratios and relative risks to hazard ratios.
Section 4: Additional information on the estimation of death rates and standard errors.
Section 5: Additional information on method for adjusting inverse variance weights.