What is the effect of unemployment on all-cause mortality? A cohort study using propensity score matching

Clemens, T., Popham, F. and Boyle, P. (2015) What is the effect of unemployment on all-cause mortality? A cohort study using propensity score matching. European Journal of Public Health, 25(1), pp. 115-121. (doi:10.1093/eurpub/cku136) (PMID:25161201) (PMCID:PMC4677456)

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Background: There is a strong association between unemployment and mortality, but whether this relationship is causal remains debated. This study utilizes population-level administrative data from Scotland within a propensity score framework to explore whether the association between unemployment and mortality may be causal. Methods: The study examined a sample of working men and women aged 25–54 in 1991. Subsequent employment status in 2001 was observed (in work or unemployed) and the relative all-cause mortality risk of unemployment between 2001 and 2010 was estimated. To account for potential selection into unemployment of those in poor health, a propensity score matching approach was used. Matching variables were observed prior to unemployment and included health status up to the year of unemployment (hospital admissions and self-reported limiting long-term illness), as well as measures of socioeconomic position. Results: Unemployment was associated with a significant all-cause mortality risk relative to employment for men (hazard ratio [HR] 1.85; 95% confidence interval [CI] 1.33–2.55). This effect was robust to controlling for prior health and sociodemographic characteristics. Effects for women were smaller and statistically insignificant (HR 1.51; 95% CI 0.68–3.37). Conclusion: For men, the findings support the notion that the often-observed association between unemployment and mortality may contain a significant causal component; although for women, there is less support for this conclusion. However, female employment status, as recorded in the census, is more complex than for men and may have served to underestimate any mortality effect of unemployment. Future work should examine this issue further.

Item Type:Articles
Additional Information:Tom Clemens was funded by the ESRC (PTA-031-2006-00514) during completion of this work and Frank Popham is funded by the Medical Research Council (MC_A540_5TK10).
Glasgow Author(s) Enlighten ID:Popham, Dr Timothy
Authors: Clemens, T., Popham, F., and Boyle, P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO Unit
Journal Name:European Journal of Public Health
Publisher:Oxford University Press
ISSN (Online):1464-360X
Copyright Holders:Copyright © 2015 Oxford University Press
First Published:First published in European Journal of Public Health 25(1):115-121
Publisher Policy:Reproduced in accordance with the publisher policy

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