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Original research
Association between employment status and risk of all-cause and cause-specific mortality: a population-based prospective cohort study
  1. Jing Nie1,
  2. Jianglin Wang2,
  3. Dagfinn Aune3,4,5,
  4. Wentao Huang6,
  5. Dong Xiao7,
  6. Yafeng Wang8,
  7. Xiong Chen9
  1. 1 Department of Sociology and Institute for Empirical Social Science Research, School of Humanities and Social Sciences, Xi’an Jiaotong University, Xi'an, Shaanxi, China
  2. 2 Department of Pharmacy, Central South University Third Xiangya Hospital, Changsha, Hunan, China
  3. 3 Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
  4. 4 Department of Nutrition, Bjørknes University College, Oslo, Norway
  5. 5 Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
  6. 6 School of Nursing, Guangdong Pharmaceutical University, Guangzhou, Guangdong, China
  7. 7 Department of Human Resource, Wenzhou Medical University First Affiliated Hospital, Wenzhou, Zhejiang, China
  8. 8 Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
  9. 9 Department of Endocrinology, Wenzhou Medical University First Affiliated Hospital, Wenzhou, Zhejiang, China
  1. Correspondence to Dr Yafeng Wang, Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan 430072, China; wonyhfon{at}whu.edu.cn; Dr Xiong Chen, Department of Endocrinology, Wenzhou Medical University First Affiliated Hospital, Wenzhou, Zhejiang, China; chasecx{at}126.com

Abstract

Background Unemployment has been reported to be associated with an increased risk of mortality. While most available studies focused on the effects of temporary unemployment on mortality, it remains unclear whether similar trends can be found in subjects who were never employed or are retirement. Therefore, this study examined the associations between temporary unemployment, never employed and retirement, integrating the risk of all-cause and cause-specific mortality in US adults.

Methods Data from the National Health Interview Survey from 2001 to 2013 Linked Mortality files through 31 December 2015 were used. A total of 282 364 participants aged 18 to 65 years were included. Their employment status was categorised into four groups: employed, never employed, temporary unemployed and retired.

Results During the mean follow-up time of 8.2 years, 12 645 subjects died from a variety of causes. Compared with employed participants, temporary unemployed, never employed or retired participants faced an increased risk of mortality for all-cause (temporary unemployed HR 1.76, 95% CI 1.67 to 1.86; never employed HR 1.63, 95% CI 1.47 to 1.81; retired HR 1.27, 95% CI 1.17 to 1.37). Cause-specific mortality analysis showed that compared with employed participants, temporary unemployed or never employed participants faced a significantly increased risk of mortality from cancer, cardiovascular disease, chronic lower respiratory disease, diabetes and kidney disease.

Conclusion This study showed that retired, temporary unemployed and never employed participants aged 18 to 65 years were strongly associated with higher mortality, indicating that both temporary and long-term unemployment are associated with a higher risk of mortality and adversely affect longevity.

  • mortality
  • cohort studies
  • unemployment

https://doi.org/10.1136/jech-2019-213179

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    Footnotes

    • JN and JW contributed equally.

    • Contributors JN, YW and XC were responsible for the conception and design of the study. JN and YW were responsible for the acquisition of data and analysis. JN and YW were responsible for the statistical analysis. JW, YW, JN, DA, WH, DX and XC wrote and revised the manuscript. All authors read and approved the final manuscript.

    • Funding The study was funded by the Research Incubation Project of the First Affiliated Hospital of Wenzhou Medical University (FHY2019015).

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval Institutional Review Board approval was not required since this study was based on secondary analyses of publicly available and deidentified data (https://www.cdc.gov/nchs/nhis/index.htm).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available in a public, open access repository (https://www.cdc.gov/nchs/data_access/ftp_data.htm%23nhis). This study included the publicly available, deidentified data.