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Deprecated: Implicit conversion from float 247.2 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Eur+J+Public+Health 2015 ; 25 (1): 115-21 Nephropedia Template TP
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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 PMID25161201show ga
Background: There is a strong association between unemployment and mortality but whether this relationship is causal remains debated. This study utilises 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 to 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 socio-economic position. Results: Unemployment was associated with a significant all-cause mortality risk relative to employment for men (hazard ratio 1.85 95% CI 1.33-2.55). This effect was robust to controlling for prior health and socio-demographic 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 though 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 under-estimate any mortality effect of unemployment. Future work should examine this issue further.