Unemployment and mortality: a comparative study of Germany and the United States.
OBJECTIVE
We examined the relationship between unemployment and mortality in Germany, a coordinated market economy, and the United States, a liberal market economy.


METHODS
We followed 2 working-age cohorts from the German Socio-economic Panel and the US Panel Study of Income Dynamics from 1984 to 2005. We defined unemployment as unemployed at the time of survey. We used discrete-time survival analysis, adjusting for potential confounders.


RESULTS
There was an unemployment-mortality association among Americans (relative risk [RR]=2.4; 95% confidence interval [CI]=1.7, 3.4), but not among Germans (RR=1.4; 95% CI=1.0, 2.0). In education-stratified models, there was an association among minimum-skilled (RR=2.6; 95% CI=1.4, 4.7) and medium-skilled (RR=2.4; 95% CI=1.5, 3.8) Americans, but not among minimum- and medium-skilled Germans. There was no association among high-skilled Americans, but an association among high-skilled Germans (RR=3.0; 95% CI=1.3, 7.0), although this was limited to those educated in East Germany. Minimum- and medium-skilled unemployed Americans had the highest absolute risks of dying.


CONCLUSIONS
The higher risk of dying for minimum- and medium-skilled unemployed Americans, not found among Germans, suggests that the unemployment-mortality relationship may be mediated by the institutional and economic environment.
School of Population and Public Health at the University of British Columbia, Vancouver, BC, Canada. chris.mcleod@ubc.ca
Christopher B
CB
McLeod
John N
JN
Lavis
Ying C
YC
MacNab
Clyde
C
Hertzman
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003625:Data Collection; D004467:Economics; D005260:Female; D005858:Germany; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012306:Risk; D014478:Unemployment / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult