Worrying news for policy makers, employers, and occupational health professionals: downsizing at work can double the risk of cardiovascular death among remaining staff, a large prospective cohort study has suggested.

The Finnish study found a significant trend between the extent of downsizing in local government staff during an important national recession in 1991–6 and deaths from all causes in those still employed. Major downsizing—loss of more than 18% of the workforce—doubled the risk of cardiovascular death over no downsizing and increased it fivefold in the first four years after downsizing occurred. Sex and behavioural risk factors—smoking or drinking alcohol—potential confounders generally associated with lower socioeconomic state, did not affect the risk.

The cohort came from four towns selected from the Finnish ten town study, which had electronic employee records from 1991 to 2000, coinciding with the high unemployment period. There were 22 430 subjects (5909 men and 16 521 women), aged 19–62 years at entry, employed in local government for more than six months in both 1991 and 1993, before and during downsizing. Staff lost owing to downsizing or who left their jobs during 1992–3 were excluded. Data on deaths from July1993 to the end of 2000, including date and cause, were accessed from national statistics with the employees’ personal identification number. Baseline characteristics and data on employment were obtained from employers’ records.

This is the first study to confirm results of non-occupational studies suggesting that stressful events can trigger cardiovascular death.