Unemployment is associated with high cardiovascular event rate and increased all-cause mortality in middle-aged socially privileged individuals

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Abstract

To assess prospectively the association between employment status and cardiovascular health outcomes in socially privileged individuals.

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The SU.VI.MAX Study: a randomized, placebo-controlled trial of the health effects of antioxidant vitamins and minerals.

Serge Hercberg, Pilar Galan, Paul Preziosi … (2004)

It has been suggested that a low dietary intake of antioxidant vitamins and minerals increases the incidence rate of cardiovascular disease and cancer. To date, however, the published results of randomized, placebo-controlled trials of supplements containing antioxidant nutrients have not provided clear evidence of a beneficial effect. We tested the efficacy of nutritional doses of supplementation with a combination of antioxidant vitamins and minerals in reducing the incidence of cancer and ischemic cardiovascular disease in the general population. The Supplementation en Vitamines et Mineraux Antioxydants (SU.VI.MAX) study is a randomized, double-blind, placebo-controlled primary prevention trial. A total of 13 017 French adults (7876 women aged 35-60 years and 5141 men aged 45-60 years) were included. All participants took a single daily capsule of a combination of 120 mg of ascorbic acid, 30 mg of vitamin E, 6 mg of beta carotene, 100 mug of selenium, and 20 mg of zinc, or a placebo. Median follow-up time was 7.5 years. No major differences were detected between the groups in total cancer incidence (267 [4.1%] for the study group vs 295 [4.5%] for the placebo group), ischemic cardiovascular disease incidence (134 [2.1%] vs 137[2.1%]), or all-cause mortality (76 [1.2%] vs 98 [1.5%]). However, a significant interaction between sex and group effects on cancer incidence was found (P = .004). Sex-stratified analysis showed a protective effect of antioxidants in men (relative risk, 0.69 [95% confidence interval [CI], 0.53-0.91]) but not in women (relative risk, 1.04 [95% CI, 0.85-1.29]). A similar trend was observed for all-cause mortality (relative risk, 0.63 [95% CI, 0.42-0.93] in men vs 1.03 [95% CI, 0.64-1.63] in women; P = .11 for interaction). After 7.5 years, low-dose antioxidant supplementation lowered total cancer incidence and all-cause mortality in men but not in women. Supplementation may be effective in men only because of their lower baseline status of certain antioxidants, especially of beta carotene.

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Welfare state regimes, unemployment and health: a comparative study of the relationship between unemployment and self-reported health in 23 European countries.

T Eikemo, C Bambra (2009)

The relationship between unemployment and increased risk of morbidity and mortality is well established. However, what is less clear is whether this relationship varies between welfare states with differing levels of social protection for the unemployed. The first (2002) and second (2004) waves of the representative cross-sectional European Social Survey (37 499 respondents, aged 25-60 years). Employment status was main activity in the last 7 days. Health variables were self-reported limiting long-standing illness (LI) and fair/poor general health (PH). Data are for 23 European countries classified into five welfare state regimes (Scandinavian, Anglo-Saxon, Bismarckian, Southern and Eastern). In all countries, unemployed people reported higher rates of poor health (LI, PH or both) than those in employment. There were also clear differences by welfare state regime: relative inequalities were largest in the Anglo-Saxon, Bismarckian and Scandinavian regimes. The negative health effect of unemployment was particularly strong for women, especially within the Anglo-Saxon (OR(LI) 2.73 and OR(PH) 2.78) and Scandinavian (OR(LI) 2.28 and OR(PH) 2.99) welfare state regimes. The negative relationship between unemployment and health is consistent across Europe but varies by welfare state regime, suggesting that levels of social protection may indeed have a moderating influence. The especially strong negative relationship among women may well be because unemployed women are likely to receive lower than average wage replacement rates. Policy-makers' attention therefore needs to be paid to income maintenance, and especially the extent to which the welfare state is able to support the needs of an increasingly feminised European workforce.

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Cannabis use and later life outcomes.

J. Boden, David M. Fergusson (2008)

To examine the associations between the extent of cannabis use during adolescence and young adulthood and later education, economic, employment, relationship satisfaction and life satisfaction outcomes. A longitudinal study of a New Zealand birth cohort studied to age 25 years. Measures of: cannabis use at ages 14-25; university degree attainment to age 25; income at age 25; welfare dependence during the period 21-25 years; unemployment 21-25 years; relationship quality; life satisfaction. Also, measures of childhood socio-economic disadvantage, family adversity, childhood and early adolescent behavioural adjustment and cognitive ability and adolescent and young adult mental health and substance use. There were statistically significant bivariate associations between increasing levels of cannabis use at ages 14-21 and: lower levels of degree attainment by age 25 (P < 0.0001); lower income at age 25 (P < 0.01); higher levels of welfare dependence (P < 0.0001); higher unemployment (P < 0.0001); lower levels of relationship satisfaction (P < 0.001); and lower levels of life satisfaction (P < 0.0001). These associations were adjusted for a range of potentially confounding factors including: family socio-economic background; family functioning; exposure to child abuse; childhood and adolescent adjustment; early adolescent academic achievement; and comorbid mental disorders and substance use. After adjustment, the associations between increasing cannabis use and all outcome measures remained statistically significant (P < 0.05). The results of the present study suggest that increasing cannabis use in late adolescence and early adulthood is associated with a range of adverse outcomes in later life. High levels of cannabis use are related to poorer educational outcomes, lower income, greater welfare dependence and unemployment and lower relationship and life satisfaction. The findings add to a growing body of knowledge regarding the adverse consequences of heavy cannabis use.