title: Loss of employment and mortality.
abstract: OBJECTIVE
  To assess effect of unemployment and early retirement on mortality in a group of middle aged British men.
  
  
  METHODS
  Prospective cohort study (British Regional Heart Study). Five years after initial screening, information on employment experience was obtained with a postal questionnaire.
  
  
  METHODS
  One general practice in each of 24 towns in Britain.
  
  
  METHODS
  6191 men aged 40-59 who had been continuously employed for at least five years before initial screening in 1978-80: 1779 experienced some unemployment or retired during the five years after screening, and 4412 remained continuously employed.
  
  
  METHODS
  Mortality during 5.5 years after postal questionnaire.
  
  
  RESULTS
  Men who experienced unemployment in the five years after initial screening were twice as likely to die during the following 5.5 years as men who remained continuously employed (relative risk 2.13 (95% confidence interval 1.71 to 2.65). After adjustment for socioeconomic variables (town and social class), health related behaviour (smoking, alcohol consumption, and body weight), and health indicators (recall of doctor diagnoses) that had been assessed at initial screening the relative risk was slightly reduced, to 1.95 (1.57 to 2.43). Even men who retired early for reasons other than illness and who appeared to be relatively advantaged and healthy had a significantly increased risk of mortality compared with men who remained continuously employed (relative risk 1.87 (1.35 to 2.60)). The increased risk of mortality from cancer was similar to that of mortality from cardiovascular disease (adjusted relative risk 2.07 and 2.13 respectively).
  
  
  CONCLUSIONS
  In this group of stably employed middle aged men loss of employment was associated with an increased risk of mortality even after adjustment for background variables, suggesting a causal effect. The effect was non-specific, however, with the increased mortality involving both cancer and cardiovascular disease.
authors.affiliation: Department of Public Health, Royal Free Hospital School of Medicine, London.
authors.forename: J K
authors.initials: JK
authors.lastname: Morris
authors.forename: D G
authors.initials: DG
authors.lastname: Cook
authors.forename: A G
authors.initials: AG
authors.lastname: Shaper
mesh_terms: D000328:Adult; D017677:Age Distribution; D015984:Causality; D002423:Cause of Death; D015331:Cohort Studies; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies; D011897:Random Allocation; D012307:Risk Factors; D012923:Social Class; D014478:Unemployment / Q000706:statistics & numerical data*; D006113:United Kingdom / Q000453:epidemiology