Unemployment is associated with high cardiovascular event rate and increased all-cause mortality in middle-aged socially privileged individuals.
OBJECTIVE
To assess prospectively the association between employment status and cardiovascular health outcomes in socially privileged individuals.


METHODS
The incidence of fatal and non-fatal cardiovascular events and all-cause mortality rate were monitored during 12 years in a national sample of 5,852 French volunteers, aged 45-64 years, who were free of cardiovascular disease or other overt disease at baseline. The association between health outcomes and employment status was tested using Cox proportional modelling with adjustment for confounding factors.


RESULTS
Compared to randomly selected individuals, these volunteers were characterized by higher education level and socio-economic status and lower cardiovascular risk and mortality rate. A total of 242 cardiovascular events (3.5 events per 1,000 person-years) and 152 deaths from all causes (2.2 deaths per 1,000 person-years) occurred during follow-up. After adjustment for age and gender, both cardiovascular event risk [HR (95% CI) 1.84 (1.15-2.83), p = 0.01] and all-cause mortality [2.79 (1.66-4.47), p = 0.0002] were increased in unemployed individuals compared to workers. These poor health outcomes were observed to the same extent after further adjustment for clinical, behavioural and socio-demographic characteristics of individuals at baseline [HR (95% CI) 1.74 (1.07-2.72), p = 0.03 and 2.89 (1.70-4.69), p = 0.0002, respectively]. In contrast, neither cardiovascular event risk nor all-cause mortality was significantly increased in retired individuals compared to workers after adjustment for confounding factors.


CONCLUSIONS
These results support the existence of a link between unemployment and poor cardiovascular health and suggest that this link is not mediated by conventional risk factors in middle-aged socially privileged individuals.
INSERM U1142 LIMICS, UMR_S 1142 Sorbonne Universités, UPMC Université Paris 06, Université Paris 13, Campus des Cordeliers, 15 rue de l'Ecole de Médecine, 75006, Paris, France, pierre.meneton@spim.jussieu.fr.
Pierre
P
Meneton
Emmanuelle
E
Kesse-Guyot
Caroline
C
Méjean
Léopold
L
Fezeu
Pilar
P
Galan
Serge
S
Hercberg
Joël
J
Ménard
D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012923:Social Class; D013997:Time Factors; D014478:Unemployment / Q000523:psychology / Q000706:statistics & numerical data*