Mortality among the unemployed differs greatly by the magnitude of workplace downsizing: a register-based follow-up study of Finnish men and women

Netta Mäki, University of Helsinki

Unemployment is related to increased mortality, but it is not fully established whether this association results from selection into unemployment or from negative causations that unemployment has on health. Information on the extent of workplace downsizing of those employees who have been made redundant can be used to increase our understanding of the association, since downsizing and, especially, workplace closure results in unselective unemployment. If unemployment had causal effect on mortality it should occur as similar relative mortality among the unemployed irrespective of different establishment downsizing. Respectively, selection into unemployment should occur as higher relative mortality among those unemployed who were made redundant by secure establishments or those only moderately downsizing. In this study workplace downsizing information from registers was linked to individual-level register data containing information on socio-demographic and employment status. We included those unemployed who were 35–64 years old in 1989 and 1994. Mortality was followed up for five years in 1990–1994 and 1995–1999, respectively. These two datasets were then merged. Altogether 793 deaths were recorded among the unemployed. We used Cox regression model and adjusted for age, sex, education, time period as well as branch of industry. Hazard ratio for mortality was 1.93-fold (95% CI 1.43–2.59) among those unemployed who had been working in secure establishments and 1.80-fold (95% CI 1.31-2.47) among those in moderately downsizing workplaces compared to those unemployed who had been working in severely downsizing workplaces or in establishments that had closed altogether. HRs were similar for diseases and for accidents and violent causes of death. By showing that mortality among the unemployed is much smaller in the context of workplace downsizing or closure – when unemployment is unselective - this study suggests that the high mortality among the unemployment is largely non-causal by nature.