Associations between unemployment and cardiovascular risk factors varies with the unemployment rate: The Cardiovascular Risk Factor Study in Southern Sweden (CRISS)

Abstract

Aims: To investigate associations between CVD risk factors and socio-economic status (SES) in middle-age men during a period of economic changes. Methods: Crossectional surveys at age 37, 40 and 43 in a birth cohort of men in Helsingborg, Sweden. All male residents born 1953 - 4 (n=1460) were invited; participation rates were 68% (n=991) at baseline. Of these enrolled, 78% (n=770) were re-examined after three years and 71% (n=702) again after six years follow-up. Main outcome measures were body mass index (BMI), S-cholesterol, HDL-cholesterol, systolic and diastolic blood pressure (SBP, DBP), smoking and leisure time physical activity (LTPA), education, employment, ethnicity. Results: Baseline unemployment rate was low, n=23 (2.4%), but three and six years later it had increased to 61 (8.2%) and 51 (7.5%) respectively. At baseline, BMI and S-cholesterol were significantly higher in unemployed than in employed men (ΔBMI 1.6 kg/m2, CI: 0.2; 2.9, Δ S-cholesterol 0.6 mmol/L, CI: 0.1; 1.0), and in men with short versus long education (Δ BMI 0.9 kg/m2, CI: 0.4; 1.4, Δ S-cholesterol 0.2 mmol/L, CI: 0.03: 0.4), independent of other SES factors. Over the study period crossectional associations with employment status disappeared for BMI, but remained between short education and BMI. Short education was also associated with a significant increase in BMI (Δ=0.4 kg/m2, CI: 0.1; 0.7) during 6-year follow-up. Conclusions: This study shows that associations between unemployment and CVD risk factors were lost when unemployment rates increased. When the attributable risk of unemployment associated with CVD risk factors is estimated, it is vital to consider the general unemployment rates in society.