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Meta-Analysis
. 2011 Mar;72(6):840-54.
doi: 10.1016/j.socscimed.2011.01.005. Epub 2011 Jan 27.

Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality

David J Roelfs  1 , Eran Shor, Karina W Davidson, Joseph E Schwartz
Affiliations
Meta-Analysis

Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality

David J Roelfs et al. Soc Sci Med. 2011 Mar.

Abstract

Unemployment rates in the United States remain near a 25-year high and global unemployment is rising. Previous studies have shown that unemployed persons have an increased risk of death, but the magnitude of the risk and moderating factors have not been explored. The study is a random effects meta-analysis and meta-regression designed to assess the association between unemployment and all-cause mortality among working-age persons. We extracted 235 mortality risk estimates from 42 studies, providing data on more than 20 million persons. The mean hazard ratio (HR) for mortality was 1.63 among HRs adjusted for age and additional covariates. The mean effect was higher for men than for women. Unemployment was associated with an increased mortality risk for those in their early and middle careers, but less for those in their late career. The risk of death was highest during the first 10 years of follow-up, but decreased subsequently. The mean HR was 24% lower among the subset of studies controlling for health-related behaviors. Public health initiatives could target unemployed persons for more aggressive cardiovascular screening and interventions aimed at reducing risk-taking behaviors.

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Figures

Figure 1
Figure 1
Flow Diagram.
Figure 2
Figure 2
Funnel plot of logarithmic hazard ratio vs. sample size.a aVertical line denotes the mean log hazard ratio of 0.52. To better show the dispersion of points, they axis-scale is less condensed from 0 to 500,000 and more condensed from 500,000 to 5,000,000
See this image and copyright information in PMC

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