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Individual employment histories and subsequent cause specific hospital admissions and mortality: a prospective study of a cohort of male and female workers with 21 years follow up
  1. C Metcalfea,
  2. G Davey Smitha,
  3. J A C Sternea,
  4. P Heslopa,
  5. J Macleodb,
  6. C Hartc
  1. aDepartment of Social Medicine, University of Bristol, Bristol, UK, bDepartment of Primary Care and General Practice, University of Birmingham, Birmingham, UK, cDepartment of Public Health, University of Glasgow, Glasgow, UK
  1. Mr Metcalfe, MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK (chris.metcalfe{at}

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It is a widely held view that the labour market is demanding increased levels of flexibility, and that this is causing greater psychosocial stress among employees.1 Such stress may affect health, either through neuroendocrine pathways, or through increases in behaviours linked with poor health.2Previously we presented evidence linking an unstable employment history, as measured by a greater number of job changes and shorter duration of current job, with a greater prevalence of smoking and greater alcohol consumption, in male and female workers.3 4 Despite this, we did not observe clear detrimental effects of such instability on health related physiological measures (body mass index, diastolic blood pressure, cholesterol, and lung function), nor on current cardiovascular health (electrocardiogram determined ischaemia and reported symptoms of angina).

Finding work is easier for healthy persons, and those persons who need to find work repeatedly will be particularly likely to drop out of the workforce if their health deteriorates. Consequently, an occupational cohort, upon which our previous work was based, is least likely to include people of poor health with an …

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  • Conflicts of interest: none.