Unemployment, job loss may increase risk of stroke mortality, morbidity

A prospective study in Japan found that men and women who lost their jobs had higher risks of morbidity and mortality from total, hemorrhagic and ischemic stroke.

Lead researcher Ehab S. Eshak, PhD, of Osaka University in Japan, and colleagues published their results online in Stroke on April 13.

This analysis examined 21,902 Japanese men and 19,826 Japanese women who enrolled in the Japan Public Health Center-based prospective study from 1990 to 1993 at nine public health centers in Japan.

The participants, who were from 45 to 59 years old at baseline, completed a self-administered questionnaire at baseline and a follow-up survey five years later. The researchers followed the participants until 2009 to 2014.

The researchers categorized the participants into four groups based on their employment status: continuously employed (employed at both surveys), job loss (employed at first survey and unemployed at second survey), reemployed (unemployed at first survey and employed at second survey) and continuously unemployed (unemployed at both surveys).

During a mean follow-up period of 15 years, the researchers identified 973 newly diagnosed strokes (396 hemorrhagic and 577 ischemic) in men and 460 newly diagnosed strokes (133 hemorrhagic and 219 ischemic) in women.

During a mean follow-up period of 17 years, there were 275 stroke deaths (169 hemorrhagic and 49 ischemic) in men and 131 deaths (96 hemorrhagic and 16 ischemic) in women.

Compared with continuously employed participants, the multivariable hazard ratio [HR] for total stroke incidence was 1.58 for men who lost their jobs and 1.51 for women who lost their jobs. For mortality, the HR was 2.22 and 2.48, respectively.

For re-employed men, the multivariable HR was 2.96 for stroke incidence and 4.21 for mortality. For re-employed women, the multivariable HR was 1.30 and 1.28, respectively.

For continuously unemployed men, the multivariable HR was 1.36 for stroke incidence and 5.24 for mortality. For continuously employed women, the multivariable HR was 1.58 for stroke incidence and 5.35 for mortality.

For men who experienced at least one spell of unemployment, the multivariable HR was 1.76 for stroke incidence and 3.00 for mortality. For women who experienced at least one spell of unemployment, the multivariable HR was 1.38 for stroke incidence and 1.98 for mortality.

For men and women, having at least one spell of unemployment also was associated with an increased risk of hemorrhagic and ischemic stroke.

“The main implication is that job security during the most productive work ages could help reduce stroke risk,” study author Hiroyasu Iso, MD, PhD, MPH, of Osaka University, said in a news release. “Those who do suffer a job loss need help in rejoining the labor market in an appropriate career.”

The researchers acknowledged a few limitations of the study, including that they could not differentiate between voluntary and involuntary job loss and retirement. They also did not have information on participants who did not respond to the first survey. In addition, they did not have information on participants’ employment status in the five years between the two surveys.

“Middle-aged Japanese men and women who have experienced at least one spell of unemployment showed unhealthy pro les of behavior and psychological state and had an increased risk of stroke (both hemorrhagic and ischemic strokes) morbidity and mortality,” the researchers wrote. “Moreover, men, but not women, who have lost their jobs and then returned to the labor market were at a greater risk of stroke which may be attributed to greater job insecurity. Avoidance of unemployment and maintenance of job security during the productive ages could help reduce the stroke risk.”