Reversal of Upward Trends in Mortality During the Great Recession by Employment Status at Baseline in a National Longitudinal Study

What is the relationship between changes in the size of economies and mortality derived population health measures in high income countries: A causal systematic review

CONTEXT

The economy has been long recognised as an important determinant of population health and a healthy population is considered important for economic prosperity.

AIM

To systematically review the evidence for a causal bidirectional relationship between aggregate economic activity (AEA) at national level for High Income Countries, and 1) population health (using mortality and life expectancy rates as indicators) and 2) inequalities in population health.

METHODS

We undertook a systematic review of quantitative studies considering the relationship between AEA (GDP, GNI, GNP or recession) and population health (mortality or life expectancy) and inequalities for High Income Countries. We searched eight databases and grey literature. Study quality was assessed using an adapted version of the Effective Public Health Practice Project's Quality Assessment tool. We used Gordis' adaptation of the Bradford-Hill framework to assess causality. The studies were synthesised using Cochrane recommended alternative methods to meta-analysis and reported following the Synthesis without Meta-analysis (SWiM) guidelines. We assessed the certainty of the evidence base in line with GRADE principles.

FINDINGS

Of 21,099 records screened, 51 articles were included in our analysis. There was no evidence for a consistent causal relationship (either beneficial or harmful) of changes in AEA leading to changes in population health (as indicated by mortality or life expectancy). There was evidence suggesting that better population health is causally related to greater AEA, but with low certainty. There was insufficient evidence to consider the causal impact of AEA on health inequalities or vice versa.

CONCLUSIONS

Changes in AEA in High Income Countries did not have a consistently beneficial or harmful causal relationship with health, suggesting that impacts observed may be contextually contingent. We tentatively suggest that improving population health might be important for economic prosperity. Whether or not AEA and health inequalities are causally linked is yet to be established.

Effect of trajectory of employment status on all-cause mortality in the late middle-aged and older population: results of the Korea Longitudinal Study of Aging (2006-2020)

OBJECTIVES

This study conducted a longitudinal analysis of the effect of trajectory of employment status (TES) on all-cause mortality in late middle-aged and older Koreans based on the Korean Longitudinal Study of Aging (KLoSA).

METHODS

After excluding missing values, data on 2,774 participants were analyzed using the chi-square test and the group-based trajectory model (GBTM) for data from the first to fifth KLoSA and the chi-square test, log-rank test, and Cox proportional hazard regression for data from the fifth to eighth KLoSA.

RESULTS

The GBTM analysis identified 5 TES groups: sustained white collar (WC; 18.1%), sustained standard blue collar (BC; 10.8%), sustained self-employed BC (41.1%), WC to job loss (9.9%), and BC to job loss (20.1%). Compared to the sustained WC group, the WC to job loss group had higher mortality at 3 years (hazard ratio [HR], 4.04, p=0.044), 5 years (HR, 3.21, p=0.005), and 8 years (HR, 3.18, p<0.001). The BC to job loss group had higher mortality at 5 years (HR, 2.57, p=0.016) and 8 years (HR, 2.20, p=0.012). Those aged 65 years and older and males in the WC to job loss and BC to job loss groups had an increased risk of death at 5 years and 8 years.

CONCLUSIONS

There was a close association between TES and all-cause mortality. This finding highlights the need for policies and institutional measures to reduce mortality within vulnerable groups with an increased risk of death due to a change in employment status.

The long-term effect of the Great Recession on European mortality

Some European countries, such as Greece and Spain, were severely hit by the 2008 economic crisis whereas others, such as Germany, were practically spared by it. This divergence allowed us to implement a difference in differences research design which offered the possibility to observe the long-lasting effects produced by the crisis on European life expectancy. Our analysis—based on Eurostat data from 2001 to 2019—shows that life expectancy increased faster, after the onset of the crisis, in those countries where the rise in unemployment was more intense. Furthermore, our results show that this gain in life expectancy persisted, and sometimes further increased, until 2019 when most macro-economic variables had returned to their pre-crisis values. Previous research has identified that mortality behaves procyclically in developed countries: when the economy slows down mortality decreases and vice versa. Our findings show, by contrast, that life expectancy behaves asymmetrically: it responded to an increase but not to a decrease in unemployment. This calls for a reconsideration of the causal mechanisms linking together the economic cycle and mortality in developed countries.

Business cycle and mortality in Spain

In the last couple of decades, there has been a lot of interest on the impact of macroeconomic fluctuations on health and mortality rates. Many studies, for different countries, find that mortality is procyclical. However, studies examining the effects of more recent recessions are less conclusive, finding mortality to be less procyclical, or even countercyclical. In this paper, using data of Spanish provinces from 1999 to 2016, we investigate how this relationship works in the context of a country that is subject to extreme business cycle fluctuations. Furthermore, we analyze the impact of unemployment for different mortality causes and we explore differences by sex, age group and level of education. In general terms, we find mortality to be procyclical so that when the economy is in a recession, mortality falls. When exploring mortality causes, we show that deaths from cardiovascular disease, cancer, senility, transport accidents and homicides are procyclical. By sex, we find procyclicality for both men and women. By age, mortality is procyclical for all age groups; however, the causes of death that result in this procyclical behavior are specific to each age group. By educational level, suicide appears as a countercyclical cause for individuals with intermediate levels of education.

Happiness and life expectancy by main occupational position among older workers: Who will live longer and happy?

Current concerns about aging populations are being translated into legislations to postpone the statutory age at retirement. However, if this is done without considering inequalities in longevity across occupational groups, some may face higher vulnerabilities than others. We examine differences in life expectancy and happiness by occupational position for the Spanish population aged 50 and over. We use happiness as a measure of subjective wellbeing, and compute life expectancy and happy life expectancy by sex and main occupation. Age-specific death rates are calculated using administrative data, and happiness prevalence comes from the European Social Survey. We show that both men and women in managerial positions were advantaged in terms of life expectancy, but only men record more years with happiness. In addition, women in routine jobs were the ones who could expect to live shorter and unhappier. Postponing the statutory age at retirement without considering these differences could be detrimental to women's wellbeing and health.

Association between employment status and risk of all-cause and cause-specific mortality: a population-based prospective cohort study

Background

Unemployment has been reported to be associated with an increased risk of mortality. While most available studies focused on the effects of temporary unemployment on mortality, it remains unclear whether similar trends can be found in subjects who were never employed or are retirement. Therefore, this study examined the associations between temporary unemployment, never employed and retirement, integrating the risk of all-cause and cause-specific mortality in US adults.

Methods

Data from the National Health Interview Survey from 2001 to 2013 Linked Mortality files through 31 December 2015 were used. A total of 282 364 participants aged 18 to 65 years were included. Their employment status was categorised into four groups: employed, never employed, temporary unemployed and retired.

Results

During the mean follow-up time of 8.2 years, 12 645 subjects died from a variety of causes. Compared with employed participants, temporary unemployed, never employed or retired participants faced an increased risk of mortality for all-cause (temporary unemployed HR 1.76, 95% CI 1.67 to 1.86; never employed HR 1.63, 95% CI 1.47 to 1.81; retired HR 1.27, 95% CI 1.17 to 1.37). Cause-specific mortality analysis showed that compared with employed participants, temporary unemployed or never employed participants faced a significantly increased risk of mortality from cancer, cardiovascular disease, chronic lower respiratory disease, diabetes and kidney disease.

Conclusion

This study showed that retired, temporary unemployed and never employed participants aged 18 to 65 years were strongly associated with higher mortality, indicating that both temporary and long-term unemployment are associated with a higher risk of mortality and adversely affect longevity.