JOB LOSS AND CARDIOVASCULAR HEALTH: A LARGE-SCALE ANALYSIS ON THE IMPACT OF UNEMPLOYMENT ON MAJOR ADVERSE CARDIOVASCULAR EVENTS AND ALL-CAUSE MORTALITY
Author(s)
Lisa-Marie Müller, MSc1, Jonas Krampe, Dr. rer. nat.1, Ulrich Laufs, Prof. Dr. med.2, Alexander Kogel, Dr. med.2.
1Gesundheitsforen Leipzig GmbH, Leipzig, Germany, 2Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany.
1Gesundheitsforen Leipzig GmbH, Leipzig, Germany, 2Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany.
OBJECTIVES: To investigate the short- and mid-term effects of job loss on the incidence of major adverse cardiovascular events (MACE) and all-cause mortality in a large, unselected German cohort.
METHODS: This retrospective study utilized data from the German Analysis Database for Evaluation and Health Services Research (2013-2023), encompassing approximately 4.4 million individuals. Inclusion required one baseline year, a reporting year, and three follow-up years or death after baseline. Job loss was defined as employment during the baseline year followed by unemployment in the reporting year. MACE included acute coronary syndrome, stroke, and incident heart failure. A 1:1 exact matching for age, gender, and reporting year, and propensity score matching for traditional coronary artery disease risk factors and Charlson Comorbidity Index (CCI) were applied to generate a control cohort. Odds ratios (OR) were calculated using the Baptista-Pike method, with significance tested by Fisher’s exact test.
RESULTS: Among 57,203 individuals with job loss, 2% were unmatched and excluded. Both cohorts had a mean age of 50 ± 11 years, with 47.2% women. During follow-up, 3,899 MACE occurred in the job loss cohort versus 3,310 in controls. Job loss was associated with a increased risk of MACE (OR 1.21, 95% CI 1.16-1.26). The risk was modest in the reporting year (OR 1.07, 95% CI 1.02-1.13), peaked in the first follow-up year (OR 1.32, 95% CI 1.20-1.45), and declined gradually thereafter. Men showed a slightly higher risk (OR 1.21) compared to women (OR 1.16). All-cause mortality was also elevated in the job loss group (OR 1.17, 95% CI 1.08-1.26).
CONCLUSIONS: Job loss significantly increases the risk of major cardiovascular events and all-cause mortality, particularly within the first year following unemployment. These findings support recognizing job loss as a cardiovascular risk factor and underscore the need for targeted preventive strategies.
METHODS: This retrospective study utilized data from the German Analysis Database for Evaluation and Health Services Research (2013-2023), encompassing approximately 4.4 million individuals. Inclusion required one baseline year, a reporting year, and three follow-up years or death after baseline. Job loss was defined as employment during the baseline year followed by unemployment in the reporting year. MACE included acute coronary syndrome, stroke, and incident heart failure. A 1:1 exact matching for age, gender, and reporting year, and propensity score matching for traditional coronary artery disease risk factors and Charlson Comorbidity Index (CCI) were applied to generate a control cohort. Odds ratios (OR) were calculated using the Baptista-Pike method, with significance tested by Fisher’s exact test.
RESULTS: Among 57,203 individuals with job loss, 2% were unmatched and excluded. Both cohorts had a mean age of 50 ± 11 years, with 47.2% women. During follow-up, 3,899 MACE occurred in the job loss cohort versus 3,310 in controls. Job loss was associated with a increased risk of MACE (OR 1.21, 95% CI 1.16-1.26). The risk was modest in the reporting year (OR 1.07, 95% CI 1.02-1.13), peaked in the first follow-up year (OR 1.32, 95% CI 1.20-1.45), and declined gradually thereafter. Men showed a slightly higher risk (OR 1.21) compared to women (OR 1.16). All-cause mortality was also elevated in the job loss group (OR 1.17, 95% CI 1.08-1.26).
CONCLUSIONS: Job loss significantly increases the risk of major cardiovascular events and all-cause mortality, particularly within the first year following unemployment. These findings support recognizing job loss as a cardiovascular risk factor and underscore the need for targeted preventive strategies.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
P13
Topic
Clinical Outcomes, Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)