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2015 ; 25
(1
): 115-21
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What is the effect of unemployment on all-cause mortality? A cohort study using
propensity score matching
#MMPMID25161201
Clemens T
; Popham F
; Boyle P
Eur J Public Health
2015[Feb]; 25
(1
): 115-21
PMID25161201
show ga
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.