Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Department of Public Health Sciences, Stockholm University, Stockholm, Sweden.
BMC Public Health. 2019 Apr 29;19(1):457. doi: 10.1186/s12889-019-6825-y.
Previous studies have shown that unemployment has negative impacts on various aspects of health. However, little is known about the effect of unemployment on health-related quality of life. Our aim was to examine how unemployment impacts upon health-related quality of life among Swedish adults, and to investigate these effects on population subgroups defined by education level, marital status, previous health, and gender.
As part of a cross-sectional study, a questionnaire was sent to 2500 randomly selected individuals aged 20 to 64 years living in Sweden in 2016. The questionnaire included the EuroQol 5 dimensions (EQ-5D) instrument and was answered by 967 individuals (39%). Quality-adjusted life year (QALY) scores were derived from the EQ-5D responses. Of the respondents, 113 were unemployed and 724 were employed. We used inverse probability-weighted propensity scores in our analyses to estimate a risk difference. Gender, age, education level, marital status, and previous health were used as covariates in our analyses.
There was a statistically significant lower QALY score by 0.096 points for the unemployed compared to the employed. There were also statistically significant more problems due to unemployment for usual activities (6.6% more), anxiety/depression (23.6% more), and EQ-5D's Visual Analogue Scale (7.5 point lower score). Grouped analyses indicated a larger negative health effect from becoming unemployed for men, those who are married, and young individuals.
In our study, we show that the health deterioration from unemployment is likely to be large, as our estimated effect implies an almost 10% worse health (in absolute terms) from being unemployed compared to being employed. This further highlights that unemployment is a public health problem that needs more focus. Our study also raises further demands for determining for whom unemployment has the most negative effects and thus suggesting groups of individuals who are in greatest need for labor market measures.
先前的研究表明，失业对健康的各个方面都有负面影响。然而，对于失业对健康相关生活质量的影响知之甚少。我们的目的是研究失业如何影响瑞典成年人的健康相关生活质量，并调查这些影响在受教育程度、婚姻状况、既往健康和性别定义的人口亚组中的表现。
作为一项横断面研究的一部分，2016 年向瑞典随机抽取的 2500 名年龄在 20 至 64 岁的个体发送了一份问卷。问卷包括欧洲五维健康量表（EQ-5D），共有 967 人（39%）作答。从 EQ-5D 回复中得出了调整后的质量调整生命年（QALY）评分。在受访者中，有 113 人失业，724 人就业。我们在分析中使用了逆概率加权倾向评分来估计风险差异。性别、年龄、教育程度、婚姻状况和既往健康被用作分析中的协变量。
与就业者相比，失业者的 QALY 评分低 0.096 分，有统计学意义。失业者在日常活动（多 6.6%）、焦虑/抑郁（多 23.6%）和 EQ-5D 视觉模拟量表（得分低 7.5 分）方面的问题也更多，具有统计学意义。分组分析表明，男性、已婚者和年轻人失业后健康恶化的负面影响更大。
在我们的研究中，我们表明，失业对健康的恶化很可能是巨大的，因为我们估计的效果表明，与就业相比，失业导致的健康状况（绝对值）下降近 10%。这进一步凸显了失业是一个公共卫生问题，需要更多的关注。我们的研究还进一步要求确定哪些人失业的负面影响最大，从而为那些最需要劳动力市场措施的人群提供建议。
