title: What is the effect of unemployment on all-cause mortality? A cohort study using propensity score matching.
abstract: BACKGROUND
  There is a strong association between unemployment and mortality, but whether this relationship is causal remains debated. This study utilizes population-level administrative data from Scotland within a propensity score framework to explore whether the association between unemployment and mortality may be causal.
  
  
  METHODS
  The study examined a sample of working men and women aged 25-54 in 1991. Subsequent employment status in 2001 was observed (in work or unemployed) and the relative all-cause mortality risk of unemployment between 2001 and 2010 was estimated. To account for potential selection into unemployment of those in poor health, a propensity score matching approach was used. Matching variables were observed prior to unemployment and included health status up to the year of unemployment (hospital admissions and self-reported limiting long-term illness), as well as measures of socioeconomic position.
  
  
  RESULTS
  Unemployment was associated with a significant all-cause mortality risk relative to employment for men (hazard ratio [HR] 1.85; 95% confidence interval [CI] 1.33-2.55). This effect was robust to controlling for prior health and sociodemographic characteristics. Effects for women were smaller and statistically insignificant (HR 1.51; 95% CI 0.68-3.37).
  
  
  CONCLUSIONS
  For men, the findings support the notion that the often-observed association between unemployment and mortality may contain a significant causal component; although for women, there is less support for this conclusion. However, female employment status, as recorded in the census, is more complex than for men and may have served to underestimate any mortality effect of unemployment. Future work should examine this issue further.
authors.affiliation: 1 School of GeoSciences, The University of Edinburgh, Institute of Geography, Edinburgh EH8 9XP, Scotland2 MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8RZ, Scotland3 School of Geography & Geosciences, University of St Andrews, Fife, KY16 9AL, Scotland tom.clemens@ed.ac.uk.
authors.forename: Tom
authors.initials: T
authors.lastname: Clemens
authors.affiliation: 1 School of GeoSciences, The University of Edinburgh, Institute of Geography, Edinburgh EH8 9XP, Scotland2 MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8RZ, Scotland3 School of Geography & Geosciences, University of St Andrews, Fife, KY16 9AL, Scotland.
authors.forename: Frank
authors.initials: F
authors.lastname: Popham
authors.affiliation: 1 School of GeoSciences, The University of Edinburgh, Institute of Geography, Edinburgh EH8 9XP, Scotland2 MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G12 8RZ, Scotland3 School of Geography & Geosciences, University of St Andrews, Fife, KY16 9AL, Scotland.
authors.forename: Paul
authors.initials: P
authors.lastname: Boyle
mesh_terms: D000328:Adult; D017677:Age Distribution; D002423:Cause of Death; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012606:Scotland; D017678:Sex Distribution; D014478:Unemployment / Q000706:statistics & numerical data*