Eshak and colleagues reviewed data from men (n = 21,902) and women (n = 19,826) aged 40 to 59 years in Japan. Those with a history of CVD or cancer at baseline were excluded from the study. Participants were categorized by employment status, which was determined through pre-baseline and baseline surveys: continuously employed, job loss, re-employed and continuously unemployed. Participants were followed until incidence of first stroke, death, relocation from the study area or the end of the study.
Throughout the follow-up period (mean, 15 years), men experienced 973 cases (577 ischemic, 396 hemorrhagic) of newly diagnosed stroke, and women experienced 460 cases (219 ischemic, 133 hemorrhagic).
The multivariable HR for stroke incidence in men who lost their jobs was 1.58 (95% CI, 1.18-2.13) and 1.51 (95% CI, 1.08-2.29) in women. The HR for mortality in women who lost their jobs was 2.48 (95% CI, 1.26-4.77) vs. 2.22 (95% CI, 1.34-3.68) in men.
Re-employed men experienced an increase in stroke incidence (multivariable HR = 2.96; 95% CI, 1.89-4.62) and mortality (multivariable HR = 4.21; 95% CI, 1.97-8.9), but re-employed women did not (multivariable HR for mortality = 1.28; 95% CI, 0.76-2.17; multivariable HR for incidence = 1.3; 95% CI, 0.98-1.69).
“For re-employed women, it is plausible not seeing an increased risk as that in men because the pattern of Japanese women’s participation in the labor force by age group is represented by an M shape, reflecting their tendency to have a career break during their 30s, in response to their family responsibilities, and then return to the labor force in their 40s, which is different from men in whom to proportion of working age men without job is relatively low in Japan,” Eshak and colleagues wrote.
Higher risks for stroke mortality was seen in men (multivariable HR = 5.24; 95% CI, 2.66-10.31) and women (multivariable HR = 5.35; 95% CI, 2.44-7.76) who were continuously unemployed.