The Cumulative Effect of Unemployment on Risks for Acute Myocardial Infarction

Study Questions:

What is the significance of the cumulative effect of multiple job losses and unemployment on the risks for acute myocardial infarction (AMI)?

Methods:

The associations between different dimensions of unemployment and the risks for AMI in US adults were assessed in a prospective cohort study of adults (N = 13,451) ages 51-75 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 coronary risk factors.

Results:

The median age of the study cohort was 62 years, and 1,061 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 one or more cumulative job losses, and 35.1% had spent time unemployed. 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 [HR], 1.35; 95% confidence interval [CI], 1.10-1.66), and that risks increased incrementally from one job loss (HR, 1.22; 95% CI, 1.04-1.42) to four or more cumulative job losses (HR, 1.63; 95% CI, 1.29-2.07) compared with no job loss. Risks for AMI were particularly elevated within the first year of unemployment (HR, 1.27; 95% CI, 1.01-1.60), but not thereafter. Results were robust after adjustments for multiple clinical, socioeconomic, and behavioral risk factors.

Conclusions:

The authors concluded that unemployment status, multiple job losses, and short periods without work are all significant risk factors for acute cardiovascular events.

Perspective:

Psychosocial stress has been considered a risk factor for acute coronary events, but it is difficult to separate stress/anxiety/depression from poor diet, smoking, hypertension, diabetes, and lack of exercise. This very large study demonstrated that single and cumulative job loss is a risk factor for AMI in the first and subsequent years. Additional studies should investigate the mechanisms contributing to work-related disparities in AMI, identify those at high risk, and identify targets for successful interventions.

Clinical Topics: Diabetes and Cardiometabolic Disease, Prevention, Diet, Exercise, Hypertension, Smoking

Keywords: Depression, Myocardial Infarction, Employment, Exercise, Unemployment, Smoking, Cardiovascular Diseases, Retirement, Confidence Intervals, Diet, Pregnancy, Prolonged, Hypertension, Diabetes Mellitus


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