title: Changes in the Employment Status and Risk of Stroke and Stroke Types.
abstract: Because of limited evidence, we investigated a long-term impact of changes in employment status on risk of stroke.
  
  
  
  This was a prospective study of 21 902 Japanese men and 19 826 women aged 40 to 59 years from 9 public health centers across Japan. Participants were followed up from 1990 to 1993 to the end of 2009 to 2014. Cox proportional hazard ratio of stroke (incidence and mortality) and its types (hemorrhagic and ischemic) was calculated according to changes in the employment status within 5 years interval between 1990 to 1993 and 1995 to 1998 (continuously employed, job loss, reemployed, and continuously unemployed).
  
  
  
  During the follow-up period, 973 incident cases and 275 deaths from stroke in men and 460 cases and 131 deaths in women were documented. Experiencing 1 spell of unemployment was associated with higher risks of morbidity and mortality from total, hemorrhagic, and ischemic stroke in both men and women, even after propensity score matching. Compared with continuously employed subjects, the multivariable hazard ratio (95% confidence interval) for total stroke incidence in job lost men was 1.58 (1.18-2.13) and in job lost women was 1.51 (1.08-2.29), and those for total stroke mortality were 2.22 (1.34-3.68) in men and 2.48 (1.26-4.77) in women. The respective hazard ratio (95% confidence interval) in reemployed men was 2.96 (1.89-4.62) for total stroke incidence and 4.21 (1.97-8.97) for mortality, whereas those in reemployed women were 1.30 (0.98-1.69) for incidence and 1.28 (0.76-2.17) for mortality.
  
  
  
  Job lost men and women and reemployed men had increased risks for both hemorrhagic and ischemic stroke incidence and mortality.
authors.affiliation: From the Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Yamadoka, Suita-shi, Japan (E.S.E., K.H., H.I.); Department of Public Health and Community Medicine, Minia University, Shalaby Land, Egypt (E.S.E.); Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan (A.I.); Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, Japan (M.I., N.S., S.T.); and AXA Department of Health and Human Security, The University of Tokyo, Hongo, Bunkyo-ku, Japan (M.I.).
authors.forename: Ehab S
authors.initials: ES
authors.lastname: Eshak
authors.affiliation: From the Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Yamadoka, Suita-shi, Japan (E.S.E., K.H., H.I.); Department of Public Health and Community Medicine, Minia University, Shalaby Land, Egypt (E.S.E.); Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan (A.I.); Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, Japan (M.I., N.S., S.T.); and AXA Department of Health and Human Security, The University of Tokyo, Hongo, Bunkyo-ku, Japan (M.I.).
authors.forename: Kaori
authors.initials: K
authors.lastname: Honjo
authors.affiliation: From the Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Yamadoka, Suita-shi, Japan (E.S.E., K.H., H.I.); Department of Public Health and Community Medicine, Minia University, Shalaby Land, Egypt (E.S.E.); Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan (A.I.); Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, Japan (M.I., N.S., S.T.); and AXA Department of Health and Human Security, The University of Tokyo, Hongo, Bunkyo-ku, Japan (M.I.). iso@pbhel.med.osaka-u.ac.jp.
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Iso
authors.affiliation: From the Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Yamadoka, Suita-shi, Japan (E.S.E., K.H., H.I.); Department of Public Health and Community Medicine, Minia University, Shalaby Land, Egypt (E.S.E.); Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan (A.I.); Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, Japan (M.I., N.S., S.T.); and AXA Department of Health and Human Security, The University of Tokyo, Hongo, Bunkyo-ku, Japan (M.I.).
authors.forename: Ai
authors.initials: A
authors.lastname: Ikeda
authors.affiliation: From the Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Yamadoka, Suita-shi, Japan (E.S.E., K.H., H.I.); Department of Public Health and Community Medicine, Minia University, Shalaby Land, Egypt (E.S.E.); Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan (A.I.); Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, Japan (M.I., N.S., S.T.); and AXA Department of Health and Human Security, The University of Tokyo, Hongo, Bunkyo-ku, Japan (M.I.).
authors.forename: Manami
authors.initials: M
authors.lastname: Inoue
authors.affiliation: From the Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Yamadoka, Suita-shi, Japan (E.S.E., K.H., H.I.); Department of Public Health and Community Medicine, Minia University, Shalaby Land, Egypt (E.S.E.); Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan (A.I.); Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, Japan (M.I., N.S., S.T.); and AXA Department of Health and Human Security, The University of Tokyo, Hongo, Bunkyo-ku, Japan (M.I.).
authors.forename: Norie
authors.initials: N
authors.lastname: Sawada
authors.affiliation: From the Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University, Yamadoka, Suita-shi, Japan (E.S.E., K.H., H.I.); Department of Public Health and Community Medicine, Minia University, Shalaby Land, Egypt (E.S.E.); Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan (A.I.); Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, Japan (M.I., N.S., S.T.); and AXA Department of Health and Human Security, The University of Tokyo, Hongo, Bunkyo-ku, Japan (M.I.).
authors.forename: Shoichiro
authors.initials: S
authors.lastname: Tsugane
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000453:epidemiology* / Q000401:mortality; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000401:mortality; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012306:Risk; D020521:Stroke / Q000453:epidemiology* / Q000401:mortality
keywords: employment; incidence; mortality; stroke; unemployment