Open Access Highly Accessed Research article

Mortality following unemployment in Canada, 1991–2001

Cameron A Mustard12*, Amber Bielecky1, Jacob Etches1, Russell Wilkins34, Michael Tjepkema4, Benjamin C Amick15, Peter M Smith126 and Kristan J Aronson7

Author Affiliations

1 Institute for Work & Health, 481 University Ave, Suite 800, Toronto, Ontario, Canada

2 Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada

3 Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada

4 Health Analysis Division, Statistics Canada, Ottawa, Ontario, Canada

5 School of Public Health, University of Texas, Houston, Texas, USA

6 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

7 Department of Community Health and Epidemiology, Queen’s University, Kingston, Ontario, Canada

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BMC Public Health 2013, 13:441  doi:10.1186/1471-2458-13-441

Published: 4 May 2013



This study describes the association between unemployment and cause-specific mortality for a cohort of working-age Canadians.


We conducted a cohort study over an 11-year period among a broadly representative 15% sample of the non-institutionalized population of Canada aged 30–69 at cohort inception in 1991 (888,000 men and 711,600 women who were occupationally active). We used cox proportional hazard models, for six cause of death categories, two consecutive multi-year periods and four age groups, to estimate mortality hazard ratios comparing unemployed to employed men and women.


For persons unemployed at cohort inception, the age-adjusted hazard ratio for all-cause mortality was 1.37 for men (95% confidence interval (CI): 1.32-1.41) and 1.27 for women (95% CI: 1.20-1.35). The age-adjusted hazard ratio for unemployed men and women was elevated for all six causes of death: malignant neoplasms, circulatory diseases, respiratory diseases, alcohol-related diseases, accidents and violence, and all other causes. For unemployed men and women, hazard ratios for all-cause mortality were equivalently elevated in 1991–1996 and 1997–2001. For both men and women, the mortality hazard ratio associated with unemployment attenuated with age.


Consistent with results reported from other long-duration cohort studies, unemployed men and women in this cohort had an elevated risk of mortality for accidents and violence, as well as for chronic diseases. The persistence of elevated mortality risks over two consecutive multi-year periods suggests that exposure to unemployment in 1991 may have marked persons at risk of cumulative socioeconomic hardship.

Unemployment; Mortality; Occupational health