title: The health effects of US unemployment insurance policy: does income from unemployment benefits prevent cardiovascular disease?
abstract: OBJECTIVE
  Previous studies suggest that unemployment predicts increased cardiovascular disease (CVD) risk, but whether unemployment insurance programs mitigate this risk has not been assessed. Exploiting US state variations in unemployment insurance benefit programs, we tested the hypothesis that more generous benefits reduce CVD risk.
  
  
  METHODS
  Cohort data came from 16,108 participants in the Health and Retirement Study (HRS) aged 50-65 at baseline interviewed from 1992 to 2010. Data on first and recurrent CVD diagnosis assessed through biennial interviews were linked to the generosity of unemployment benefit programmes in each state and year. Using state fixed-effect models, we assessed whether state changes in the generosity of unemployment benefits predicted CVD risk.
  
  
  RESULTS
  States with higher unemployment benefits had lower incidence of CVD, so that a 1% increase in benefits was associated with 18% lower odds of CVD (OR:0.82, 95%-CI:0.71-0.94). This association remained after introducing US census regional division fixed effects, but disappeared after introducing state fixed effects (OR:1.02, 95%-CI:0.79-1.31).This was consistent with the fact that unemployment was not associated with CVD risk in state-fixed effect models.
  
  
  CONCLUSIONS
  Although states with more generous unemployment benefits had lower CVD incidence, this appeared to be due to confounding by state-level characteristics. Possible explanations are the lack of short-term effects of unemployment on CVD risk. Future studies should assess whether benefits at earlier stages of the life-course influence long-term risk of CVD.
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America; Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Stefan
authors.initials: S
authors.lastname: Walter
authors.affiliation: Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California, United States of America; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Maria
authors.initials: M
authors.lastname: Glymour
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America; LSE Health and Social Care, London School of Economics and Political Science, London, United Kingdom.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Avendano
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D005843:Geography; D006801:Humans; D015994:Incidence; D007342:Insurance Benefits; D007348:Insurance, Health; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014478:Unemployment; D014481:United States / Q000453:epidemiology