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Unemployment and coronary heart disease among middle-aged men in Sweden: 39 243 men followed for 8 years
  1. Andreas Lundin1,
  2. Daniel Falkstedt2,
  3. Ingvar Lundberg1,
  4. Tomas Hemmingsson1,3
  1. 1Division of Occupational Medicine, Karolinska institutet, Institute of Environmental Medicine, Stockholm, Sweden
  2. 2Department of Public Health Sciences, Karolinska institutet, Stockholm, Sweden
  3. 3Centre for Social Research on Alcohol and Drugs, Stockholm University, Stockholm, Sweden
  1. Corresponding to Dr Andreas Lundin, Division of Occupational Medicine, Karolinska institutet, Institute of Environmental Medicine, SE-17176 Stockholm, Sweden; Andreas.lundin{at}


Background Although unemployment may be a stressful life event, its association with coronary heart disease (CHD) remains unclear. This study examines the association between unemployment and later hospitalisation due to CHD.

Methods The study was based on a Swedish military conscription cohort of 18 to 20-year-old men from 1969/1970 (n=49 321) with information provided on health status and health behaviours. Information on unemployment in middle age was obtained from national registers. CHD information was obtained from hospital registers and the cause of death register. Cox proportional hazard analyses were run on the 39 243 individuals who were in paid employment in 1996 and 1997.

Results It was found that ≥90 days of unemployment was associated with subsequent CHD during 8 years follow-up (crude HR=1.47, 95% CI 1.23 to 1.75). Controlling for known risk factors for CHD reduced the association but a significant association remained (HR=1.24, 95% CI 1.04 to 1.48); ≥90 days of unemployment was significantly associated with CHD during the first 4 years (HR adjusted for known risk factors=1.31, 95% CI 1.01 to 1.71).

Conclusions Unemployment was associated with increased risk of CHD after adjustment for confounders. We interpret the increased risk of CHD associated with unemployment as potentially the somatic result of a process started by stress.

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