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Unemployment may increase risk for stroke
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Periods of unemployment increased the risk for stroke in men and women in Japan, according to findings published in Stroke.
Japan’s employment system is different than in the United States, as employees are part of a “lifetime employment system” who will dedicate themselves to a steady job, Ehab S. Eshak, MD, MSc, PhD, visiting associate professor at Osaka University in Japan, said in a press release. If they happen to lose the position, it is possible that they will be re-employed into substandard or lower positions, he said.
Eshak and colleagues reviewed data from men (n = 21,902) and women (n = 19,826) aged 40 to 59 years in Japan. Those with a history of CVD or cancer at baseline were excluded from the study. Participants were categorized by employment status, which was determined through pre-baseline and baseline surveys: continuously employed, job loss, re-employed and continuously unemployed. Participants were followed until incidence of first stroke, death, relocation from the study area or the end of the study.
Throughout the follow-up period (mean, 15 years), men experienced 973 cases (577 ischemic, 396 hemorrhagic) of newly diagnosed stroke, and women experienced 460 cases (219 ischemic, 133 hemorrhagic).
The multivariable HR for stroke incidence in men who lost their jobs was 1.58 (95% CI, 1.18-2.13) and 1.51 (95% CI, 1.08-2.29) in women. The HR for mortality in women who lost their jobs was 2.48 (95% CI, 1.26-4.77) vs. 2.22 (95% CI, 1.34-3.68) in men.
Re-employed men experienced an increase in stroke incidence (multivariable HR = 2.96; 95% CI, 1.89-4.62) and mortality (multivariable HR = 4.21; 95% CI, 1.97-8.9), but re-employed women did not (multivariable HR for mortality = 1.28; 95% CI, 0.76-2.17; multivariable HR for incidence = 1.3; 95% CI, 0.98-1.69).
“For re-employed women, it is plausible not seeing an increased risk as that in men because the pattern of Japanese women’s participation in the labor force by age group is represented by an M shape, reflecting their tendency to have a career break during their 30s, in response to their family responsibilities, and then return to the labor force in their 40s, which is different from men in whom to proportion of working age men without job is relatively low in Japan,” Eshak and colleagues wrote.
Higher risks for stroke mortality was seen in men (multivariable HR = 5.24; 95% CI, 2.66-10.31) and women (multivariable HR = 5.35; 95% CI, 2.44-7.76) who were continuously unemployed.
Results were consistent between ischemic stroke and hemorrhagic stroke.
“The main implication is that job security during the most productive work ages could help reduce stroke risk,” Hiroyasu Iso, MD, PhD, MPH, professor at Osaka University, said in the release. “Those who do suffer a job loss need help in rejoining the labor market in an appropriate career.” – by Darlene Dobkowski
Disclosure: The researchers report no relevant financial disclosures.
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Ralph L. Sacco, MD, MS, FAHA, FAAN
This large study adds unemployment, losing a job or being out of work as a potential risk factor for vascular disease in men as well as women in Japan.
We’re not quite sure of the mechanism by which not working can increase the risk for vascular disease including stroke, but patients who aren’t working probably need to be even more vigilant about controlling their vascular risk factors. It could be keeping their diet and weight under control, exercising and eating right, even if they’re out of work.
We just need to be a little more cautious in those that are not working to make sure that they keep their stroke and CV risk under control.
It would be important to see this kind of work done in other cultures. These results come from a large study from Japan, but we’d like to see this kind of work generalized in other nations, including the United States. It has been shown that the stress of certain life events, including being out of a job, can have an impact on your CV health.
Generalizing results such as these to the United States is always a concern. Japan’s work culture is very different, and that is why the authors were also hypothesizing about why Japanese men who even returned to work may have still had an increased risk. They questioned whether if they returned to work, and they returned to a work that is under their normal job performance, that alone could be stressful. It’s always tricky to try to generalize from one culture to another in studies like this.
Like everything, there are effects of stress, including working and not working, on one’s CV health, and we need to put this into perspective of all the American Heart Association’s Life’s Simple 7 ideal CV health factors that we need to control.
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Eshak ES, et al. Stroke. 2017;doi:10.1161/STROKEAHA.117.016967.
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