Unemployment increases death risk among US but not German workers
MedWire News: Unskilled and moderately skilled Americans who are out of work have a much higher mortality risk than their fellow citizens who are in employment, which may be related to a lack of social and economic support, a study suggests.
The research compared the relationship between unemployment and mortality in the USA and Germany between 1984 and 2005. It showed that unemployed US workers were 2.4 times as likely to die as their employed peers were over an average follow-up of 12.7 years (relative risk [RR]=2.4). No increase in mortality was found among out-of-work Germans, however (RR=1.4; nonsignificant), report Christopher McLeod (University of British Columbia, Vancouver, British Columbia, Canada) and colleagues.
"The higher risk of dying for the unemployed in the United States compared with those in Germany supports the hypothesis that the institutional environment, including higher levels of unemployment and employment protection, mediates the unemployment-mortality relationship," they write in the American Journal of Public Health.
The investigators used data from the German Socio-Economic Panel American Panel Study of Income Dynamics, two longitudinal studies that collect information over time about economic and social conditions in individual households.
In an analysis stratified by education levels, they found that minimally skilled unemployed US workers had a nearly three-fold relative risk for mortality compared with their employed peers (RR=2.6) and moderately-skilled unemployed workers had a similarly high risk (RR=2.4).
Unemployed highly skilled US workers were not at greater risk for death than similarly skilled workers with a job, but highly skilled out-of-work Germans did have a higher risk than their employed counterparts (RR=3.0). The excess risk for better-trained Germans was limited only to those who had been educated in the former East Germany, however.
The authors note that Germany has stronger worker protections than does the USA, and that 75% of unemployed German workers received unemployment compensation, compared with 19% of unemployed US workers.
"It appears that individuals with a high level of education may be best suited to take advantage of the more flexible labor markets within the United States. The highly skilled were also more likely to receive benefits, when unemployed, than were those of lower skill levels. These individuals may also have other resources (eg, savings, familial resources, and social or business contacts from educational or professional organizations) to draw upon that would buffer the effect of unemployment on health," the investigators write.
"For minimum- and medium-skilled workers, unemployment comes with an increased risk of death. In particular, those at the bottom of the labor market and educational hierarchy- the minimum-skilled unemployed - are much more likely to die, reflecting the accumulation of health disadvantage within this group in the United States," they comment.
By Neil Osterweil