Unemployment increases risk of heart attack

Robin Wulffson MD's picture
heart attack, myocardial infarction, MI, unemployment, job loss
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With the current economic downturn, many Americans are unemployed. The financial impact of job loss can be devastating; however, a new study has reported that it may also increase the risk of an acute myocardial infarction (MI; heart attack). Researchers affiliated with Duke University (Durham, North Carolina) published their findings online on November 19 in the journal Archives of Internal Medicine.

The researchers noted that employment instability is a major source of strain affecting an increasing number of adults in the United States. They explained that the medical literature contains scant information regarding the cumulative effect of multiple job losses and unemployment on the risks for acute myocardial infarction. Therefore, they conducted a study to investigate the associations between different dimensions of unemployment and the risks for an acute myocardial infarction in US adults.

The study group comprised 13,451 individuals aged 51 to 75 years (average age: 62 years) who were enrolled in the Health and Retirement Study with biennial follow-up interviews from 1992 through 2010. Unadjusted rates of age-specific an acute myocardial infarction were used to demonstrate observed differences by employment status, cumulative number of job losses, and cumulative time unemployed. The impact of cumulative work histories on the risk of an acute myocardial infarction was adjusted for socio-demographic background and confounding risk factors.

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The investigators found that 1,061 acute myocardial infarction events (7.9%) occurred during the 165,169 person-years of observation. Among the sample, 14.0% of the subjects were unemployed at baseline, 69.7% had one or more cumulative job losses, and 35.1% had spent time unemployed. Unadjusted plots showed that age-specific rates of acute myocardial infarction differed significantly for each dimension of work history. The risk of an acute myocardial infarction was significantly higher among the unemployed (hazard ratio: 1.35) and that risks increased incrementally from one job loss (hazard ratio: 1.22) to four or more cumulative job losses (hazard ratio: 1.63) compared with no job loss. Risks for an acute myocardial infarction were particularly elevated within the first year of unemployment (hazard ratio: 1.27) but not thereafter. The researcher noted that the results remained significant after adjustments for multiple clinical, socioeconomic, and behavioral risk factors.

The authors concluded that unemployment status, multiple job losses, and short periods without work are all significant risk factors for acute cardiovascular events.

An accompanying editorial noted that the study adds to decades of research linking job loss with health effects and that research should now turn to examining how and why that happens. Theories include that the stress of losing a job may trigger a heart attack in individuals with atherosclerosis or heart disease and that the unemployed lose health insurance and access to medical care that can help keep them healthy.

Reference: Archives of Internal Medicine

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