title: Association between voluntary/involuntary job loss and the development of stroke or cardiovascular disease: a prospective study of middle-aged to older workers in a rapidly developing Asian country.
abstract: BACKGROUND
  The aim of this research was to investigate the association between job loss and the development of stroke or cardiovascular disease among middle-aged to older individuals in Korea. We also examined how this relationship was modified by gender and the nature of the job loss.
  
  
  METHODS
  This study used samples from the first- to fourth-wave datasets from the Korean Longitudinal Study of Aging (KLoSA), which were collected in 2006, 2008, 2010, and 2012. The study collected data from a total of 10,254 subjects aged ≥ 45 years at baseline. After applying exclusion criteria, the final sample size for analysis consisted of 4,000 individuals. Information about employment status, development of stroke or cardiovascular disease, and covariates (age, income level, and behavioral factors) was obtained. Cox proportional hazards models were used to evaluate the association between voluntary/involuntary job loss and the development of stroke or cardiovascular disease. We performed these analyses separately according to disease, gender, and the nature of the job loss.
  
  
  RESULTS
  Involuntary job loss significantly increased the risk of stroke or cardiovascular disease among males (adjusted hazard ratio [HR]  = 3.560, 95% confidence interval [CI]  = 2.055-6.168). Voluntary retirement also increased the risk of cardiovascular disease or stroke among males (adjusted HR = 2.879, 95% CI = 1.533-5.409). Job loss was more closely associated with stroke than with cardiovascular disease (stroke, adjusted HR = 6.208, 95% CI = 2.417-15.943; cardiovascular disease, adjusted HR = 2.768, 95% CI = 1.402-5.465).
  
  
  CONCLUSIONS
  Our findings suggest that both voluntary retirement and involuntary job loss increase the risk for stroke or cardiovascular disease in middle-aged to older individuals, especially males.
authors.affiliation: Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Ulsan, South Korea; Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Mo-Yeol
authors.initials: MY
authors.lastname: Kang
authors.affiliation: Department of Occupational and Environmental Medicine, College of Medicine, the Catholic University of Korea, Seoul, South Korea.
authors.forename: Hyoung-Ryoul
authors.initials: HR
authors.lastname: Kim
mesh_terms: D000368:Aged; D044466:Asian People; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D056910:Republic of Korea / Q000453:epidemiology; D012179:Retirement; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D014478:Unemployment