Associations between unemployment and cardiovascular risk factors varies with the unemployment rate: The Cardiovascular Risk Factor Study in Southern Sweden (CRISS)

Abstract

Aims: To investigate associations between CVD risk factors and socio-economic status (SES) in middle-age men during a period of economic changes. Methods: Crossectional surveys at age 37, 40 and 43 in a birth cohort of men in Helsingborg, Sweden. All male residents born 1953 - 4 (n=1460) were invited; participation rates were 68% (n=991) at baseline. Of these enrolled, 78% (n=770) were re-examined after three years and 71% (n=702) again after six years follow-up. Main outcome measures were body mass index (BMI), S-cholesterol, HDL-cholesterol, systolic and diastolic blood pressure (SBP, DBP), smoking and leisure time physical activity (LTPA), education, employment, ethnicity. Results: Baseline unemployment rate was low, n=23 (2.4%), but three and six years later it had increased to 61 (8.2%) and 51 (7.5%) respectively. At baseline, BMI and S-cholesterol were significantly higher in unemployed than in employed men (ΔBMI 1.6 kg/m², CI: 0.2; 2.9, Δ S-cholesterol 0.6 mmol/L, CI: 0.1; 1.0), and in men with short versus long education (Δ BMI 0.9 kg/m², CI: 0.4; 1.4, Δ S-cholesterol 0.2 mmol/L, CI: 0.03: 0.4), independent of other SES factors. Over the study period crossectional associations with employment status disappeared for BMI, but remained between short education and BMI. Short education was also associated with a significant increase in BMI (Δ=0.4 kg/m², CI: 0.1; 0.7) during 6-year follow-up. Conclusions: This study shows that associations between unemployment and CVD risk factors were lost when unemployment rates increased. When the attributable risk of unemployment associated with CVD risk factors is estimated, it is vital to consider the general unemployment rates in society.

Keywords

Blood pressure Body Mass Index Education S-cholesterol.

Get full access to this article

View all access options for this article.

References

Worth RM , Kato H. , Rhoads GG , Kagan A. , Syme SL Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii, and California: mortality. Am J Epidemiol 1975; 102: 481 - 90.

Marmot MG , Rose G. , Shipley M. , Hamilton JS Employment grade and coronary heart disease in British civil servants . J Epidemiol Commun H 1978; 32: 244 - 9.

Kaplan GA , Keil JE Socioeconomic factors and cardiovascular disese; a review of the literature . Circulation 1993; 88: 1973-98.

Marmot MG , Davey GS , Stansfeld S. , C P. , F N. , J H. , et al. Health inequalities among British civil servants: the Whitehall II study. Lancet 1991; 337: 1387 - 93.

Black D. , Morris JN , Smith C. , Townsend P. , Whithead M. Inequalities in Health: The Black Report; The Health Divide. London: Penguin Group; 1992.

Karasek RA , Theorell T. , Schwarz JE , Schnell PL , Pieper CF , Michela JL Job characteristics in relation to the prevalence of myocardial infarction in the US Health examination Survey (HES) and the Health and Nutrition Examination Survey (HANES). Am J Public Health 1988; 78: 1136 - 9.

Smith GD , Hart C. , Hole D. , McKinnon P. , Gillis C. , Watt G. , et al. Education and occupational social class: which is the more important indicator of mortality risk? J Epidemiol Commun H 1998; 52: 153 - 60.

Barker DJP. Fetal origins of coronary heart disease. BMJ 1995; 311: 171 - 4.

Blane D. , Hart CL , Smith D. , Gillis CR , Hole DJ , Hawthorn VM Association of cardiovascular disease risk factors with socioeconomic position during childhood and during adulthood. BMJ 1996; 313: 1434 - 8.

10.

Smith GD , Hart C. , Blane D. , Gillis C. , Hawthorne V. Lifetime socioeconomic position and mortality: prospective observational study . BMJ 1997; 314: 547-52.

11.

Sundqvist J. Living conditions and health. A population-based study of labour migrants and Latin American refugees in Sweden and those who were repatriated. Scand J Prim Health Care 1995; 13: 128 - 34.

12.

Winkleby MA , Cubbin C. , Kahn DA , Kraemer HC Pathways by which SES and ethnicity influence cardiovascular disease risk factors. Ann N Y Acad Sci 1999; 896: 191-209.

13.

Morris JK , Cook DG , Shaper AG Non-employment and changes in smoking drinking and body weight. BMJ 1992; 304: 536-41.

14.

Bobak M. , Hertzman C. , Skodova Z. , Marmot M. Socioeconomic status and cardiovascular risk factors in the Czech Republic . Int J Epidemiol 1999; 28: 46 - 52.

15.

Peltonen M. , Huhtasaari F. , Stegmayr B. , Lundberg V. , Asplund K. Secular trends in social patterning of cardiovascular risk factor levels in Sweden. The Northern Sweden MONICA Study 1986 - 1994 . J Intern Med 1998; 244: 1-9.

16.

Iribarren C. , Luepker RV , McGovern PG , Arnett DK , Blackburn H.

Twelve-Year Trends in Cardiovascular Disease Risk Factors in the Minnesota Heart Survey- are Socioeconomic Differences Widening?

Arch Intern Med 1997; 157: 873 - 81.

17.

Dotevall A. , Rosengren A. , Lappas G. , Wilhelmsen L. Does immigration contribute to decreasing CHD incidence? Coronary risk factors among immigrants in Göteborg. J Intern Med 2000; 247: 331-9.

18.

Rosvall M. , Östegren PO , Hedblad B. , Isacsson S-O. , Janzon L. , Berglund G. Occupational Status, Education Level, and the Prevalence of Carotid Artheriosclerosis in a General Population Sample of Middle-aged Swedish Men and Women: Results from the Malmö Diet and Cancer Study. Am J Epidemiol 2000; 152: 334-46.

19.

Diderichsen F. , Hallqvist J. Trends in occupational mortality among middle-aged men in Sweden 1961- 1990. Int J Epidemiol 1997: 782 - 7.

20.

Cook DG , Cummins RO , Bartley MJ , Shaper AG Health of unemployed middle aged men in Great Britain. Lancet 1982; i: 1290-4.

21.

Mattiasson I. , Lindgärde F. , Nilsson JÅ , Theorell T. Threat of unemployment and cardiovascular risk factors: longitudinal study of quality of sleep and serum cholesterol concentration in men threatened with redundancy. BMJ 1990; 301: 461 - 6.

22.

Morris JK , Cook DG , Shaper AG Loss of employment and mortality. BMJ 1994 ; 308.

23.

Ferrie JE , Shipley MJ , Marmot MG , Stansfeld SA , Smith GD An uncertain future: the health effects of threats to employment security in white-collar men and women. Am J Public Health 1998: 1030 - 6.

24.

Weber A. , Lehnert G. Unemployment and cardiovascular disease: a causal relationship. Int Arch Occup Environ Health 1997; 70: 153 - 60.

25.

Jin RL , Shah CP , Svoboda TJ The impact of unemployment on health: a review of the evidence. CMAJ 1995; 153(5): 529 - 40.

26.

Råstam L. , Hannan PJ , Luepker R. , Mittelmark MB , Murray DM , Slater JS Seasonal variation in plasma cholesterol distributions: implications for screening and referral. Am J Prev Med 1992; 8: 360 - 6.

27.

Martikainen PT Unemployment and mortality among Finnish men . BMJ 1990; 301: 407 - 11.

28.

Moser KA , Goldblatt PO , Fox AJ , Jones DR Unemployment and mortality: comparison of the 1971 and 1981 longitudinal study census samples. BMJ 1987; 294: 86 - 90.

29.

Martikainen PT , Valkonen T. Excess mortality of unemployed men and women during a period of rapidly increasing unemployment. Lancet 1996; 348: 909 - 12.

30.

Schnall PL , Landsbergis PA , Pieper CF , Schwartz J. , Dietz D. , Gerin W. , et al. The impact of anticipation of job loss on psychological distress and worksite blood pressure. Am J Intern Med 1992; 21: 417 - 32.

31.

Statistiska centralbyrån. Statistical Year Book of Sweden; 1999.

32.

Pekkanen J. , Ututela A. , Valkonen T. , Vartiainen E. , Tuomilehto J. , Puska P. Coronary risk factor levels: differences between educational groups in 1972 - 87. J Epidemiol Commun H 1995; 49: 144 - 9.