Roelfs David J, Shor Eran, Blank Aharon, Schwartz Joseph E
Department of Sociology, University of Louisville, Louisville, KY.
Department of Sociology, McGill University, Montreal, Quebec, Canada.
Ann Epidemiol. 2015 May;25(5):312-22. doi: 10.1016/j.annepidem.2015.02.005. Epub 2015 Feb 19.
Individual-level unemployment has been consistently linked to poor health and higher mortality, but some scholars have suggested that the negative effect of job loss may be lower during times and in places where aggregate unemployment rates are high. We review three logics associated with this moderation hypothesis: health selection, social isolation, and unemployment stigma. We then test whether aggregate unemployment rates moderate the individual-level association between unemployment and all-cause mortality.
We use six meta-regression models (each using a different measure of the aggregate unemployment rate) based on 62 relative all-cause mortality risk estimates from 36 studies (from 15 nations).
We find that the magnitude of the individual-level unemployment-mortality association is approximately the same during periods of high and low aggregate-level unemployment. Model coefficients (exponentiated) were 1.01 for the crude unemployment rate (P = .27), 0.94 for the change in unemployment rate from the previous year (P = .46), 1.01 for the deviation of the unemployment rate from the 5-year running average (P = .87), 1.01 for the deviation of the unemployment rate from the 10-year running average (P = .73), 1.01 for the deviation of the unemployment rate from the overall average (measured as a continuous variable; P = .61), and showed no variation across unemployment levels when the deviation of the unemployment rate from the overall average was measured categorically. Heterogeneity between studies was significant (P < .001), supporting the use of the random effects model.
We found no strong evidence to suggest that unemployment experiences change when macroeconomic conditions change. Efforts to ameliorate the negative social and economic consequences of unemployment should continue to focus on the individual and should be maintained regardless of periodic changes in macroeconomic conditions.
个人层面的失业一直与健康状况不佳和较高死亡率相关，但一些学者认为，在总体失业率较高的时期和地区，失业的负面影响可能较小。我们回顾了与这种调节假说相关的三种逻辑：健康选择、社会隔离和失业污名化。然后，我们检验总体失业率是否调节了失业与全因死亡率之间的个体层面关联。
我们基于来自15个国家的36项研究的62个相对全因死亡风险估计值，使用了六个元回归模型（每个模型使用不同的总体失业率衡量指标）。
我们发现，在总体失业率高和低的时期，个体层面失业与死亡率之间关联的大小大致相同。粗失业率的模型系数（指数化）为1.01（P = 0.27），上一年失业率变化的模型系数为0.94（P = 0.46），失业率与5年移动平均值偏差的模型系数为1.01（P = 0.87），失业率与10年移动平均值偏差的模型系数为1.01（P = 0.73），失业率与总体平均值偏差（作为连续变量测量）的模型系数为1.01（P = 0.61），当按类别测量失业率与总体平均值的偏差时，各失业水平之间没有差异。研究之间的异质性显著（P < 0.001），支持使用随机效应模型。
我们没有发现有力证据表明宏观经济状况变化时失业经历会改变。改善失业负面社会和经济后果的努力应继续关注个体，无论宏观经济状况的周期性变化如何都应持续进行。
