摘要：Objectives. We analyzed how recessions and job loss jointly shape mortality risks among older US adults. Methods. We used data for 50 states from the Health and Retirement Study and selected individuals who were employed at ages 45 to 66 years during 1992 to 2011. We assessed whether job loss affects mortality risks, whether recessions moderate the effect of job loss on mortality, and whether individuals who do and do not experience job loss are differentially affected by recessions. Results. Compared with individuals not experiencing job loss, mortality risks among individuals losing their job in a recession were strongly elevated (hazard ratio = 1.6; 95% confidence interval = 1.1, 2.3). Job loss during normal times or booms is not associated with mortality. For employed workers, we found a reduction in mortality risks if local labor market conditions were depressed, but this result was not consistent across different model specifications. Conclusions. Recessions increase mortality risks among older US adults who experience job loss. Health professionals and policymakers should target resources to this group during recessions. Future research should clarify which health conditions are affected by job loss during recessions and whether access to health care following job loss moderates this relation. This study addressed 3 gaps in research on the effect of job loss and recessions on mortality risks among older US adults. First, many studies have shown that job loss causes economic strain, 1–4 stress, 5–7 mental illness, 8–12 and cardiovascular disease 13,14 in the US population. However, with notable exceptions, 15,16 few studies have used longitudinal data that are representative of the growing population of older US adults still active on the labor market to determine whether job loss has adverse mortality effects. Second, whether recessions exacerbate or mitigate the effect of job loss on mortality among older workers is unclear. Research on European countries has yielded inconsistent findings, and direct evidence for the United States is lacking. Third, although many studies have examined the effect of the business cycle on mortality rates at the aggregate level, questions remain about how recent recessions have affected mortality rates among older workers, what role labor market mechanisms play, and whether individuals who lose their job and those who remain employed are differentially affected. Few studies have examined the effect of job loss on mortality among older workers in the United States. Available evidence finds effects for the general population, 15–17 but 2 studies showed that effects were weaker among older workers. 15,18 Research focusing on older workers was based on cross-sectional comparisons between employed and unemployed workers. 15 We contribute to this literature by using longitudinal data representative of the US population aged 50 years or older. We tested whether involuntary job loss had a causal effect on mortality and whether this effect varied over the business cycle. We used an extensive list of demographic, socioeconomic, and health-related covariates to test whether our effect estimates were sensitive to the inclusion of these controls and performed numerous other robustness checks to rule out confounding. We expected that recessions would magnify the adverse effect of job loss on mortality. Individuals losing their job during recessions face lower reemployment prospects, because more jobless workers compete for fewer job openings. 2,19 This mismatch between job seekers and vacancies results in longer unemployment spells and, if a new job is found, worse job quality, including lower earnings and increased risk of involuntary part-time employment. 2,19–21 Compared with younger workers, older workers generally have greater difficulties finding reemployment and replacing lost earnings and savings. 22–24 Moreover, recessions also force some older workers via unemployment into early retirement, 25,26 permanently lowering their chances of reemployment and recouping lost earnings. Job loss and recessions therefore raise risks of a permanently lowered standard of living among older workers. 27,28 The shock to liquidity and social status that job loss entails triggers both immediate and chronic stress and mental health problems, which result in elevated risks of death from cardiovascular disease and suicide. 13,14,29 Because recessions increase the risk that job loss leads to permanent scars of individual economic and social status, we expected the mortality effect of job loss to be more severe during recessions. 18,27,30,31 Our primary hypothesis contrasts with influential studies by Martikainen et al., 32,33 who examined the effect of job loss on mortality in Finland and found weaker effects of job loss during recessions compared with boom years. Studies from other European countries generally have not confirmed the Finnish results. 34–36 European studies may not be informative for the United States, which lacks generous welfare state institutions that protect unemployed workers in European countries. 3,4,12,17,37–39 Because the safety net for unemployed workers is particularly weak in the United States, we expected the consequences of job loss during recessions to be especially severe. Related research on the United States yielded disparate findings. Two studies testing whether contextual unemployment moderated the effect of job loss on mortality among men reached opposing results. 31,40 Studies also disagree on whether high contextual unemployment rates exacerbate the negative effect of job loss on mental health 41,42 or mitigate it. 43 Other studies found no evidence of effect moderation. 44–46 None of these studies explicitly addressed older workers. Related literature has analyzed the effect of recessions on mortality at the aggregate level. 47–52 Initial studies found evidence of lower mortality rates during recessions, 47,53 but more recent work found no association between aggregate unemployment and mortality rates among US adults aged 45 to 64 years in recent recessions. 49,50 However, it remains unclear what role individual labor market transitions play. 18,50,54,55 In summary, it is unclear whether there is a causal effect of job loss on mortality among older US workers, whether this effect is stronger or weaker during recessions, and whether recessions differentially affect individuals who lose their job and those who remain employed. We used data from the Health and Retirement Study to study mortality in a representative sample of older US adults who were at risk for job loss during the observation period (1992–2011). Our analysis sample included 9284 employed individuals aged 45 to 66 years, of whom 1652 experienced job loss resulting from layoff or business closure. We operationalized the business cycle as local labor demand, which we measured with the first principal component extracted from 4 unemployment rate series. We exploited variation in labor demand across local labor markets and over time to test whether the effect of job loss on mortality was particularly hazardous during recessions. We also analyzed individuals who did and did not experience job loss separately to test whether these groups are differentially affected by recessions. We observed periods of extremely low labor demand (i.e., recessionary local labor demand conditions) in 1992 to 1994 and 2009 to 2011. Because follow-up from the 2009 to 2011 period is still too short, our identifying variation for the effects of recessionary local labor demand was from the years 1992 to 1994.
