Unemployment may heighten MI risk

Unemployment, multiple job losses and short periods without work may increase a person’s risk for acute MI, new data published in the Archives of Internal Medicine indicate.

Among 13,451 participants (median age, 62 years) in the Health and Retirement Study, 7.9% acute MI events occurred during 165,169 person-years of observation. At baseline, 14% of the study sample was unemployed; 69.7% had one or more cumulative job losses; and 35.1% had spent time unemployed, researchers wrote.

Risks for acute MI were significantly higher among the unemployed (HR=1.35; 95% CI, 1.1-1.66), according to multivariate analyses. Risks also increased incrementally from one job loss (HR=1.22; 95% CI, 1.04-1.42) to four or more cumulative job losses (HR=1.63; 95% CI, 1.29-2.07) vs. no job loss. The researchers also noted that risks for acute MI were especially higher within the first year of unemployment (HR=1.27; 95% CI, 1.01-1.6), although not thereafter. These associations remained strong even after adjustments for clinical, socioeconomic and behavioral risk factors.

Additionally, unadjusted plots revealed significant differences for each dimension of work history in age-specific rates of acute MI, the researchers said.

“As rates of job instability continue to increase and unemployment reaches 30-year highs after recent constrictions to the US economy, the cardiovascular costs of repeated job losses in younger cohorts are not yet known,” the researchers wrote. “Although employment background is not amenable to medical intervention, knowledge about employment status, number of job losses, and the amount of time unemployed may help to identify individuals at risk for [acute MI].”

The Health and Retirement Study is an ongoing prospective cohort study of adults aged older than 50 years. Participants included in this analysis had been interviewed biennially from 1992 to 2010.

In an accompanying editorial, William T. Gallo, PhD, said there is sufficient evidence linking unemployment to negative health outcomes, and a focus on research into new, related areas is needed.

“The gist of my argument is that the report by Dupre et al should mark the end of an era in which outcomes studies of unemployment have been pursued. Plenty of compelling evidence exists to move on. Egregiously absent is research on why and how a socioeconomic exposure, such as job loss, influences health. Explorations of these questions, however limited, should mark the beginning of the next period of research,” Gallo wrote. “The next generation of studies should identify reasonable pathways from job separation to illness so that nonoccupational interventions may be developed and targeted to the most vulnerable individuals.”

For more information:

Dupre ME. Arch Intern Med. 2012;doi:10.1001/2013/jamainternmed.447.

Gallo WT. Arch Intern Med. 2012;doi:10.1001/jamainternmed.2013.1835.

Disclosure: The researchers report no relevant financial disclosures. Gallo reports no relevant financial disclosures.