title: Mortality following unemployment during an economic downturn: Swedish register-based cohort study.
abstract: OBJECTIVE
  To investigate if unemployment during an economic downturn is associated with mortality, even among men with markers of better health (higher cognitive function scores and qualifications), and to assess whether the associations vary by age at unemployment.
  
  
  METHODS
  Longitudinal register-based cohort study.
  
  
  METHODS
  Study entry was in 1990 and 2001 when Sweden was entering periods of significant economic contraction.
  
  
  METHODS
  A representative sample of men from the general population (n=234 782) born between 1952 and 1956 who participated in military conscription examinations. Men in receipt of disability or sickness benefit at study entry were excluded.
  
  
  METHODS
  All-cause mortality.
  
  
  RESULTS
  Unemployment compared with employment in 1991 (ages 34-38 years) produced adjusted HRs (with 95% CIs) for all-cause mortality (3651 deaths) during follow-up to 2001 and after stratification by education of 2.35 (1.99 to 2.76) for compulsory education, 2.25 (1.97 to 2.58) for up to 3 years postcompulsory education and 1.90 (1.40 to 2.57) for more than 3 years postcompulsory education. When unemployment was compared with employment in 2001 (ages 45-49 years) with follow-up to 2010, the pattern of mortality risk (4271 deaths) stratified by education was reversed, producing adjusted HRs of 2.81 (2.47 to 3.21) for compulsory education, 2.87 (2.58 to 3.19) for up to 3 years postcompulsory education and 3.44 (2.78 to 4.25) for more than 3 years postcompulsory education. Interaction testing confirmed effect modification by age/period (p=0.003). The degree of gradient reversal was slightly less pronounced after stratification by cognitive function but produced a similar pattern of results (p=0.004).
  
  
  CONCLUSIONS
  Unemployment at older ages is associated with greater mortality risk than at younger ages, with the greatest relative increase in risk among men with markers of better health, suggesting the greater vulnerability of all older workers to unemployment-associated exposures.
authors.affiliation: Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden.
authors.forename: Scott
authors.initials: S
authors.lastname: Montgomery
authors.forename: Ruzan
authors.initials: R
authors.lastname: Udumyan
authors.forename: Anders
authors.initials: A
authors.lastname: Magnuson
authors.forename: Walter
authors.initials: W
authors.lastname: Osika
authors.forename: Per-Ola
authors.initials: PO
authors.lastname: Sundin
authors.forename: David
authors.initials: D
authors.lastname: Blane
keywords: Mortality; Suicide; Unemployment