School of Population and Public Health at the University of British Columbia, Vancouver, BC, Canada.
Am J Public Health. 2012 Aug;102(8):1542-50. doi: 10.2105/AJPH.2011.300475. Epub 2012 Jun 14.
We examined the relationship between unemployment and mortality in Germany, a coordinated market economy, and the United States, a liberal market economy.
We followed 2 working-age cohorts from the German Socio-economic Panel and the US Panel Study of Income Dynamics from 1984 to 2005. We defined unemployment as unemployed at the time of survey. We used discrete-time survival analysis, adjusting for potential confounders.
There was an unemployment-mortality association among Americans (relative risk [RR]=2.4; 95% confidence interval [CI]=1.7, 3.4), but not among Germans (RR=1.4; 95% CI=1.0, 2.0). In education-stratified models, there was an association among minimum-skilled (RR=2.6; 95% CI=1.4, 4.7) and medium-skilled (RR=2.4; 95% CI=1.5, 3.8) Americans, but not among minimum- and medium-skilled Germans. There was no association among high-skilled Americans, but an association among high-skilled Germans (RR=3.0; 95% CI=1.3, 7.0), although this was limited to those educated in East Germany. Minimum- and medium-skilled unemployed Americans had the highest absolute risks of dying.
The higher risk of dying for minimum- and medium-skilled unemployed Americans, not found among Germans, suggests that the unemployment-mortality relationship may be mediated by the institutional and economic environment.
我们考察了在协调型市场经济的德国和自由市场经济的美国，失业与死亡率之间的关系。
我们对德国社会经济面板调查和美国收入动态面板研究中的两个工作年龄队列进行了随访，随访时间从 1984 年至 2005 年。我们将失业定义为调查时失业。我们使用离散时间生存分析，调整了潜在的混杂因素。
在美国人中有失业与死亡率之间的关联（相对风险[RR]=2.4；95%置信区间[CI]=1.7, 3.4），但在德国人中没有（RR=1.4；95% CI=1.0, 2.0）。在教育分层模型中，低技能（RR=2.6；95% CI=1.4, 4.7）和中等技能（RR=2.4；95% CI=1.5, 3.8）美国人之间存在关联，但低技能和中等技能德国人之间没有关联。高技能美国人之间没有关联，但高技能德国人之间存在关联（RR=3.0；95% CI=1.3, 7.0），尽管这仅限于在东德接受教育的人。失业的低技能和中等技能美国人的绝对死亡风险最高。
在德国人中未发现的低技能和中等技能失业美国人的死亡风险较高，这表明失业与死亡率之间的关系可能受到制度和经济环境的影响。
