title: The cumulative effect of unemployment on risks for acute myocardial infarction.
abstract: BACKGROUND
  Employment instability is a major source of strain affecting an increasing number of adults in the United States. Little is known about the cumulative effect of multiple job losses and unemployment on the risks for acute myocardial infarction (AMI).
  
  
  METHODS
  We investigated the associations between different dimensions of unemployment and the risks for AMI in US adults in a prospective cohort study of adults (N = 13,451) aged 51 to 75 years in the Health and Retirement Study with biennial follow-up interviews from 1992 to 2010. Unadjusted rates of age-specific AMI were used to demonstrate observed differences by employment status, cumulative number of job losses, and cumulative time unemployed. Cox proportional hazards models were used to examine the multivariate effects of cumulative work histories on AMI while adjusting for sociodemographic background and confounding risk factors.
  
  
  RESULTS
  The median age of the study cohort was 62 years, and 1061 AMI events (7.9%) occurred during the 165,169 person-years of observation. Among the sample, 14.0% of subjects were unemployed at baseline, 69.7% had 1 or more cumulative job losses, and 35.1% had spent time unemployed. Unadjusted plots showed that age-specific rates of AMI differed significantly for each dimension of work history. Multivariate models showed that AMI risks were significantly higher among the unemployed (hazard ratio, 1.35 [95% CI, 1.10-1.66]) and that risks increased incrementally from 1 job loss (1.22 [1.04-1.42]) to 4 or more cumulative job losses (1.63 [1.29-2.07]) compared with no job loss. Risks for AMI were particularly elevated within the first year of unemployment (hazard ratio, 1.27 [95% CI, 1.01-1.60]) but not thereafter. Results were robust after adjustments for multiple clinical, socioeconomic, and behavioral risk factors.
  
  
  CONCLUSIONS
  Unemployment status, multiple job losses, and short periods without work are all significant risk factors for acute cardiovascular events.
authors: Duke Clinical Research Institute, Duke University, Durham, North Carolina 27715, USA. matthew.dupre@duke.edu
authors: Matthew E
authors: ME
authors: Dupre
authors: Linda K
authors: LK
authors: George
authors: Guangya
authors: G
authors: Liu
authors: Eric D
authors: ED
authors: Peterson
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D015996:Survival Rate / Q000639:trends; D014478:Unemployment / Q000523:psychology*; D014481:United States / Q000453:epidemiology