Tobacco use and employment status: A cross-sectional analysis of the CONSTANCES cohort / Liens entre le statut tabagique et la situation vis-à-vis de l'emploi : analyse transversale de la cohorte CONSTANCES

This study aims to estimate the prevalence of tobacco use in 2017 and 2019 in the French population covered by the Régime Général d'Assurance Maladie according to employment status. From the French national CONSTANCES cohort, 18,008 randomly recruited volunteers aged between 18 and 69 years, affiliated to the Régime Général d'Assurance Maladie and enrolled in 2017, were included in the analysis. The prevalence of tobacco use according to employment status was estimated. Estimates of these prevalence data were calculated in 2017 and 2019 after correction for selection bias at inclusion and non-response at follow-up. In 2019, smoking prevalence was higher among unemployed people (29.2% among men and 20.7% among women) than among employed people (16.5% among men and 13.8% among women). Smoking prevalence was highest among those not in work for health reasons (38.5% among men and 35.8% among women). Smokers were more likely to be unemployed than non-smokers (OR 2.63 [95% confidence interval (CI): 1.79; 3.85] in men and OR 1.55 [95% CI: 1.08; 2.22] in women). Among men, the prevalence of employed people among light smokers (<10 cigarettes/day) significantly decreased between 2017 (87.1%) and 2019 (74.8%). These results underline the importance of reinforcing smoking prevention campaigns among the unemployed, particularly for health reasons.

Estimer les prévalences d'usage de tabac en 2017 et en 2019 en population française couverte par le Régime Général d'Assurance Maladie en fonction du statut vis-à-vis de l'emploi. À partir d'un échantillon de 18 008 volontaires inclus en 2017 dans CONSTANCES, une cohorte nationale en population générale française ayant recruté de manière aléatoire des volontaires de 18-69 ans affiliés au Régime Général d'Assurance Maladie, les prévalences d'usage du tabac en fonction de du statut vis-à-vis de l'emploi ont été estimées en 2017 et en 2019 après correction pour les biais de sélection à l'inclusion et de non-réponse au suivi. En 2019, la prévalence du tabagisme était plus élevée chez les actifs inoccupés (29,2 % chez les hommes et 20,7 % chez les femmes) par rapport aux actifs occupés (16,5 % chez les hommes et 13,8 % chez les femmes). La prévalence du tabagisme la plus élevée concernait les personnes sans activité professionnelle pour raisons de santé (38,5 % chez les hommes et 35,8 % chez les femmes). Les fumeurs étaient plus à risque d'être actifs inoccupés comparativement aux non-fumeurs (OR 2,63 [95 % Intervalle de confiance [IC] : 1,79 ; 3,85] chez les hommes et OR 1,55 [95 % IC : 1,08 ; 2,22] chez les femmes). Chez les hommes, la prévalence d'actifs occupés parmi les petits fumeurs (<10 cigarettes/jour) a baissé entre 2017 (87,1 %) et 2019 (74,8 %). Ces analyses soulignent l'importance d'intensifier les campagnes de prévention sur le tabagisme parmi les actifs inoccupés et les inactifs, en particulier pour raisons de santé.

Job loss and mental disorders: International evidence from the early stages of COVID-19 outbreak.

Using a rich individual level dataset from six countries, we examine the relationship between job loss and mental disorders during the first phase of the COVID-19 pandemic. We consider four indicators of mental disorders based on their severity, viz. anxiety, insomnia, boredom, and loneliness. We draw our conclusions based on two groups of countries that differ by the timing of their peak infections count. Using a logit and a two-stage least squares (TSLS) regression methods, we find that the people who lost their jobs due to the pandemic are more likely to suffer from mental disorders, especially insomnia and loneliness. Additionally, people with financial liabilities, such as housing mortgages, are among those vulnerable to anxiety. Women, urban residents, youth, low-income groups, and tobacco users are more prone to mental disorders. The findings from this research have significant policy implications on infectious disease control measures and mental health conditions due to lockdowns and social distancing.

The contribution of morbidity and unemployment for the reduced labor market participation of individuals with neurofibromatosis 1 in Finland.

Neurofibromatosis 1 (NF1) is a multisystem disorder associated with, for example, a high risk for cancer, a variety of behavioral and cognitive deficits, low educational attainment and decreased income. We now examined the labor market participation of individuals with NF1. We analyzed the numbers of days of work, unemployment, and sickness allowance among 742 Finnish individuals with NF1 aged 20-59 years using nationwide register data from Statistics Finland and the Social Insurance Institution of Finland. The individuals with NF1 were compared with a control cohort of 8716 individuals matched with age, sex, and the area of residence. Individuals with NF1 had a significantly lower number of working days per year than the controls (rate ratio [RR] 0.93, 95% CI 0.91-0.95). Unemployment (RR 1.79, 95% CI 1.58-2.02), and sickness absence (RR 1.44, 95% CI 1.25-1.67) were more frequent in the NF1 than in the control group. The causes of sickness allowances were highly concordant with the previously reported morbidity profile of NF1 including neoplasms, cardiovascular disease, mental and behavioral diseases, and neurological diseases. In conclusion, NF1 significantly interferes with labor market participation via both unemployment and morbidity. Unemployment seems to cause more days of not working than sickness absence.

Joblessness, decreased income, and disability in intensive care unit survivors of nontraumatic intracranial hemorrhage in South Korea.

OBJECTIVES: To examine the proportions of unemployment, decreased household income, and newly acquired disability, and their impact on long-term mortality after intensive care unit (ICU) admission due to nontraumatic intracranial hemorrhage (IH). MATERIALS AND METHODS: This nationwide population-based retrospective cohort study enrolled adult patients admitted to the ICU because of nontraumatic IH between 2010 and 2018 in South Korea. Patients who were alive ≥365 days after ICU admission were defined as nontraumatic IH survivors. RESULTS: In total, 104,086 nontraumatic IH survivors were included in the final analysis. Among them, 7,225 (6.9 %) experienced job loss, 25,709 (24.7 %) experienced decreased household income, and 20,938 (20.1 %) had newly acquired disabilities, of whom 14,188 (13.6 %) had newly acquired brain disabilities. Male sex, increased duration of intensive care unit stay, comorbid status, hospital admission through the emergency room, nontraumatic intracerebral hemorrhage, receipt of surgery, mechanical ventilatory support, and increased total cost of hospitalization were associated with job loss, decreased household income, and newly acquired disabilities. However, these changes were not significantly associated with 2-year all-cause mortality (adjusted hazard ratio: 1.00, 95 % confidence interval: 0.95, 1.06; P = 0.997). CONCLUSIONS: Many nontraumatic IH survivors experienced unemployment, decreased household income, and newly acquired disability one year after ICU admission in South Korea. Some factors were potential risk factors for these changes, but the changes were not associated with 2-year all-cause mortality.

Lifetime exposure to unemployment and prior working conditions are associated with retiree's health: A retrospective study in a large population-based French cohort.

It is unclear whether unemployment exposure, as well as working conditions, can have sustained effects on the health of retirees who are no longer exposed. The aim of the present study is to investigate this issue in 29,281 French retirees from the CONSTANCES cohort in whom the prevalence of suboptimal self-rated health, disability for routine tasks, cardiovascular diseases and cancers is assessed according to lifetime exposure to unemployment and prior working conditions. The analyses are performed retrospectively using multivariable logistic regression models with adjustment for potential confounders such as sex, birth year, parental histories of cardiovascular disease and cancer, social position, retirement age and duration. High lifetime exposure to unemployment is associated with an increased prevalence of suboptimal self-rated health (adjusted odds ratio (95% CI), 1.39 (1.23-1.57)), disability for routine tasks (1.41 (1.26-1.57)) and several cardiovascular diseases including stroke (1.66 (1.19-2.31)), myocardial infarction (1.65 (1.18-2.31)) and peripheral arterial disease (2.38 (1.46-3.90)). Bad prior working conditions are associated with an increased prevalence of disability for routine tasks (1.17 (1.04-1.33)) and cancers (1.27 (1.04-1.54)), notably prostate cancer (1.60 (1.01-2.64)). These findings suggest that unemployment and working conditions have long-term health effects that may cumulate over lifetime, emphasizing that risk evaluation and preventive strategies in retirees, as in workers, should take into account the life-course of individuals in addition to traditional risk factors.

Using broadband infrastructure as a social sensor to detect inequities in unemployment during the COVID-19 pandemic.

This study explores the potential of using physical infrastructure as a "social sensor" for identifying marginalized communities. Prior work tends to explore biases in infrastructure as a retrospective "social autopsy". Instead, our study aims to create an introspective "social biopsy", using existing infrastructure gaps to inform how future policy and investment can address existing inequities more sharply and proactively. Specifically, this work explores the possibility of using U.S. county-level broadband penetration rates as a social sensor to predict rates of unemployment amidst the COVID-19 pandemic. The result is a 2 × 2 typology of where broadband as a social sensor is sharper (or coarser), as well as prone to error (either false positives or false negatives). We further explore combining broadband with other forms of physical infrastructure (i.e., bridges, buildings, and WiFi-enabled libraries) to create a sensor "array" to further enhance detection. Overall, this work proposes an "infrastructure-as-sensor" approach to better detect social vulnerability during times of crises in hopes of enhancing resilience through providing services more quickly and precisely to those who most need it.

Changes in alcohol consumption according to the duration of unemployment: prospective findings from the French CONSTANCES cohort.

OBJECTIVES: To prospectively examine the association between the duration of unemployment among job seekers and changes in alcohol use in a year. DESIGN: A prospective study. SETTING: French population-based CONSTANCES cohort. PARTICIPANTS: We selected 84 943 participants from the CONSTANCES cohort included between 2012 and 2019 who, at baseline and 1-year follow-up, were either employed or job-seeking. OUTCOME MEASURES: Multinomial logistic regression models computed the odds of reporting continuous no alcohol use, at-risk alcohol use, increased or decreased alcohol use compared with being continuously at low risk and according to employment status. The duration of unemployment was self-reported at baseline; thus, the employment status at 1-year follow-up was categorised as follows: (1) employed, (2) return to employment since less than a year, (3) unemployed for less than 1 year, (4) unemployed for 1 to 3 years and (5) unemployed for 3 years or more. Analyses were adjusted for age, gender, education, household monthly income, marital status, self-rated health, smoking status and depressive state. RESULTS: Compared with being continuously at low risk (ie, ≤10 drinks per week), the unemployment categories were associated in a dose-dependent manner with an increased likelihood of reporting continuous no alcohol use (OR: 1.74-2.50), being continuously at-risk (OR: 1.21-1.83), experiencing an increase in alcohol use (OR: 1.21-1.51) and a decrease in alcohol use (OR: 1.17-1.84). CONCLUSION: Although our results suggested an association between the duration of unemployment and a decrease in alcohol use, they also revealed associations between at-risk and increased alcohol use. Thus, screening for alcohol use among unemployed job seekers must be reinforced, especially among those with long-term unemployment.

Self-affirmation increases reemployment success for the unemployed.

Losing a job is one of life's most stressful events. Furthermore, maladaptive reactions to unemployment can trap people in a vicious cycle that derails their reemployment efforts. The current research tested whether a brief values-based self-affirmation intervention increases the odds of reemployment after a job loss and during unemployment, which presumably breaks this vicious cycle. Two field experiments, including one with a governmental employment agency, found that a 15-min self-affirmation exercise-i.e., reflecting on one's most important values-increased key employment-related outcomes after 4 wk, including the probability and speed of reemployment and the number of job offers. Because the ordeal of job loss and the probability of reemployment may be particularly challenging for individuals above the age of 50 y, we also explored whether the intervention was equally effective for those above and below 50 y of age. Demonstrating the generality of this effect, the efficacy of the intervention did not differ between individuals below and above the age of 50, and it was also effective for both recently unemployed and chronically unemployed individuals. Because self-affirmations have more typically been tested in educational contexts, the current research demonstrates the wide-ranging value of this intervention. By diminishing the vicious cycle of unemployment, the present studies show how a simple self-affirmation intervention can help individuals succeed in the labor market.

Distinct cardiovascular and cancer burdens associated with social position, work environment and unemployment: a cross-sectional and retrospective study in a large population-based French cohort.

OBJECTIVES: Distinguish the respective effects of social position, work environment and unemployment on cardiovascular and cancer risks. DESIGN: A cross-sectional and retrospective observational study. SETTING: A population-based French cohort (CONSTANCES). PARTICIPANTS: 130 197 adults enrolled between 2012 and 2021 without missing values. PRIMARY OUTCOME MEASURES: The associations of social position, work environment and unemployment exposure with the prevalence of cardiovascular events and cancers simultaneously tested using logistic regression models adjusting for common risk factors. RESULTS: While social position, work environment and unemployment exposure are strongly inter-related with each other, they are not linked to the same cardiovascular and cancer outcomes. Low social position and long unemployment duration are significantly associated with an increased prevalence of angina pectoris, myocardial infarction and peripheral arterial disease (OR=1.22 to 1.90, p<0.04 to p<0.0001) but not of stroke. In contrast, a bad work environment is associated with an increased prevalence of stroke (OR=1.29, p<0.01) but not of angina pectoris, myocardial infarction and peripheral arterial disease. Low social position is associated with an increased prevalence of cervical and lung cancers (OR=1.73 and 1.95, p<0.002 and p<0.03) and a decreased prevalence of skin cancer (OR=0.70, p<0.0001) while a bad work environment is associated with an increased prevalence of breast, skin, prostate and colon cancers (OR=1.31 to 2.91, p<0.0002 to p<0.0001). Unemployment exposure is not associated with the prevalence of any type of cancers. CONCLUSIONS: Social position, work environment and unemployment are associated with distinct cardiovascular and cancerous diseases that could add up during lifetime, they should therefore be considered all together in any preventive strategy.

Cardiovascular burden and unemployment: A retrospective study in a large population-based French cohort.

The specific effect of unemployment on cardiovascular health relatively to the effects of social position and work environment is still unclear. To clarify this effect, the associations between current or past unemployment and the prevalence of common cardiovascular risk factor and events were tested using multiple logistic regression models with adjustment for both social position and prior work environment. The analyses were performed in a population-based French cohort (CONSTANCES) that included 131,186 adults enrolled between 2012 and 2021. Participants who were unemployed at inclusion (n = 8278) were overexposed to non-moderate alcohol consumption, smoking, leisure-time physical inactivity and depression (odds ratios (ORs) from 1.19 to 1.58) whereas those who have been unemployed at least once in the past (n = 19,015) were additionally overexposed not only to the previous risk factors but also to obesity, diabetes and sleep disorders (ORs from 1.10 to 1.35). These latter were also more exposed to non-fatal myocardial infarction and peripheral arterial disease (ORs of 1.44 and 1.47 respectively), overexposures that persisted after further adjustment for cardiovascular risk factors (ORs of 1.36 and 1.33). The overexposures to risk factors and cardiovascular events were both dependent on the duration of past unemployment. They were equally observed in participants with low social position or bad work environment. These results suggest that unemployment increases cardiovascular risk independently from social position and work environment with a cumulative effect over time. The effect of unemployment could add up to those of low social position and bad work environment during lifetime to further increase cardiovascular risk. They also suggest that long-term unemployment increases the prevalence of cardiovascular events through pathways including but not limited to overexposure to common risk factors.

Assessment of Medical and Public Assistance Expenditures and Employment Among US Adults With Cancer Diagnoses.

Importance: Prior research suggests significant social value associated with increased longevity due to preventing and treating cancer. Other social costs associated with cancer, such as unemployment, public medical spending, and public assistance, may also be sizable. Objective: To examine whether a cancer history is associated with receipt of disability insurance, income, employment, and medical spending. Design, Setting, and Participants: This cross-sectional study used data from the Medical Expenditure Panel Study (MEPS) (2010-2016) for a nationally representative sample of US adults aged 50 to 79 years. Data were analyzed from December 2021 to March 2023. Exposure: Cancer history. Main Outcomes and Measures: The main outcomes were employment, public assistance receipt, disability, and medical expenditures. Variables for race, ethnicity, and age were used as controls. A series of multivariate regression models were used to assess the immediate and 2-year association of a cancer history with disability, income, employment, and medical spending. Results: Of 39 439 unique MEPS respondents included in the study, 52% were female, and the mean (SD) age was 61.44 (8.32) years; 12% of respondents had a history of cancer. Individuals with a cancer history who were aged 50 to 64 years were 9.80 (95% CI, 7.35-12.25) percentage points more likely to have a work-limiting disability and were 9.08 (95% CI, 6.22-11.94) percentage points less likely to be employed compared with individuals in the same age group without a history of cancer. Nationally, cancer accounted for 505 768 fewer employed individuals in the population aged 50 to 64 years. A cancer history was also associated with an increase of $2722 (95% CI, $2131-$3313) in medical spending, $6460 (95% CI, $5254-$7667) in public medical spending, and $515 (95% CI, $337-$692) in other public assistance spending. Conclusions and Relevance: In this cross-sectional study, a history of cancer was associated with increased likelihood of disability, higher medical spending, and decreased likelihood of employment. These findings suggest there may be gains beyond increased longevity if cancer can be detected and treated earlier.

Impact of asthma on working life: an analysis of the French CONSTANCES cohort.

OBJECTIVES: Asthma has significant occupational consequences. The objective of our study was to investigate the links between asthma and the career path, taking into account gender and age at asthma onset. METHODS: Using cross-sectional data collected at inclusion in the French CONSTANCES cohort in 2013-2014, we studied the links between each career path indicator (number of job periods, total duration of employment, numbers of part-time jobs and work interruptions due to unemployment or health issues, employment status at inclusion) on the one hand, and current asthma and asthma symptom score in the last 12 months on the other hand, as reported by the participants. Multivariate analyses were performed separately for men and women using logistic and negative binomial regression models adjusted for age, smoking status, body mass index and educational level. RESULTS: When the asthma symptom score was used, significant associations were observed with all of the career path indicators studied: a high symptom score was associated with a shorter total duration of employment as well as a greater number of job periods, part-time jobs and work interruptions due to unemployment or health issues. These associations were of similar magnitude in men and women. When current asthma was used, the associations were more pronounced in women for some career path indicators. CONCLUSION: The career path of asthmatic adults is more often unfavourable than that of those without asthma. Efforts should be made to support people with asthma in the workplace, in order to maintain employment and facilitate the return to work.

Enhanced unemployment benefits, mental health, and substance use among low-income households during the COVID-19 pandemic.

OBJECTIVE: To buffer the economic impacts of the pandemic-induced economic downturns, the U.S. government passed major economic stimulus bills that provided cash payments to affected citizens and a large boost to unemployment benefits. We ask what impact these enhanced safety-net policies have had on mental health and stress-induced substance use among low-income Americans, especially enhanced unemployment insurance (UI) benefits, which constituted a large economic transfer to those eligible. METHODS: Using individual fixed effects analysis of a panel of nearly 900 low-income Americans since the start of the pandemic from the Understanding America Survey, we examine how receipt of enhanced unemployment benefits has impacted the mental health burden and substance use behaviors of low-income Americans. We additionally examine the buffering effect of a set of other safety-net measures (Stimulus, Medicaid, SNAP, TANF, housing assistance, EITC, WIC, and CHIP). RESULTS: We found that job loss, regardless of benefit receipt, was associated with increased stress and decreased average substance use, driven by reduced smoking when compared with those were employed. Yet, when factoring in UI receipt we see that receiving UI was associated with reduced stress, but no impact on depression or substance use. In contrast, those who did not receive UI experienced greater stress compared with those who were employed. Overall, we found that people who remained employed used substances more than people who were unemployed regardless of UI receipt with the exception of drinking. CONCLUSIONS: We conclude that enhanced unemployment offset some of the negative mental health effects of the pandemic and did not increase routine substance use among the unemployed.

The shattered "Iron Rice Bowl": effects of Chinese state-owned enterprise reform on depressive symptoms in later life.

OBJECTIVES: The SOE reform was the first time that economic insecurity was introduced since 1949 in China, with hundreds of million employees affected by the laid off. This study took the State-Owned Enterprises (SOE) reform in China as a natural experiment to explore the impact of economic insecurity on depressive symptoms in later life. METHODS: Data were obtained from the China Health and Retirement Longitudinal Survey (CHARLS), 2014 and 2015. CHARLS is a nationally representative survey covering 28 provinces in China. CHARLS used the probabilities proportional to size (PPS) sampling method and involved 450 villages/resident committees, 150 counties/districts and 12,400 households. A total of 5113 urban dwellers born earlier than 1971 (aged 25 years old and above at the start of the SOE reform, 1995) were involved. Using the province-level  economic loss from the layoffs, we examined the impact of economic insecurity exposure on the score of depressive symptoms using a difference-in-differences model (DID). RESULTS: Individuals with economic insecurity exposure had a significantly increased risk of higher depressive symptoms scores, in which a 1 percentage point increase in expected economic loss would increase the CESD-10 score by 0.10. For an individual at the median distribution (CESD-10 = 5), this implies a shift to the 58th percentile (CESD-10 = 6). Given that the average intensity of expected economic loss is 10.22% and the mean CESD-10 is 6.92, exposure to the SOE reform led to an average increase in the CESD-10 score by 1.02 and by at least 14.74%. The heterogeneity analyses showed that the role of SOE reform in depressive symptoms scores was robust in both female and male groups and groups with different educational attainment. CONCLUSIONS: Economic insecurity exposure increased the depressive symptoms score later in life in the context of China. Programs, such as adequate unemployment insurance benefits, can protect individuals against the risk of financial loss, thereby reducing their negative impact on depressive symptoms. Providing mental symptoms surveillance and psychological counseling to those experienced at a time of great uncertainty is important for preventing depression in times of economic insecurity.

Experiencias, actitudes y expectativas laborales de personas con trastornos mentales severos en un hospital de día del sector privado / Experiences, attitudes and expectations towards work among individuals with severe mental disorders in a private day hospital

INTRODUCCIÓN: El empleo es uno de los componentes centrales de la recuperación en personas con trastornos mentales severos y un aspecto clave en la validación social. El objetivo del estudio fue conocer la experiencia laboral, el interés por trabajar, las conductas específicas de búsqueda laboral, el estatus ocupacional y las actitudes frente al trabajo en esta población. MÉTODOS: Un total de 103 personas en tratamiento en una institución de salud mental de la ciudad de Buenos Aires completaron un cuestionario censal en 2018 con preguntas abiertas y cerradas. El análisis fue mixto, con cálculo y comparación de frecuencias según grupos y análisis temático. RESULTADOS: La mayoría de los participantes tenía experiencia laboral, aunque solo el 29% estaba trabajando. El 93% de quienes no trabajaban dijo tener interés en hacerlo. Solo un 33% de quienes no tenían trabajo realizaban actividades para conseguirlo. Un 85% consideró que podría tener problemas en caso de trabajar y el 15% señaló que podría hacerle mal. No se observaron diferencias significativas según diagnóstico o género. DISCUSIÓN: El elevado interés por trabajar de las personas con trastornos mentales severos contrasta con un porcentaje considerable que, pese a ello, no busca trabajo y anticipa dificultades laborales. El estigma podría ser uno de los mayores obstáculos para la búsqueda y la inclusión laboral. Los programas de apoyo al empleo deben considerar algunos de los problemas hallados en este estudio.

Financial toxicity following surgical treatment for colorectal cancer: a cross-sectional study.

PURPOSE: Financial toxicity has become a global public health issue. The purpose of the study is to investigate and analyze the influencing factors of financial toxicity in patients with non-metastatic colorectal cancer. METHODS: A convenient sample of 250 patients with stage I-III colorectal cancer was investigated in the study. They completed a set of questionnaires, including the Comprehensive Score for Financial Toxicity questionnaire, the Perceived Social Support Scale, and the Hospital Anxiety and Depression Scale. Univariate and multivariate linear regression were performed to investigate the influencing factors of financial toxicity. RESULTS: Over half (52.8%, n = 132) of the colorectal cancer survivors experienced financial toxicity. Multivariate regression analysis showed that the factors associated with financial toxicity were young age, unemployment, low annual household income, chemotherapy, and the lack of sufficient social support (p < 0.05). CONCLUSIONS: Financial toxicity is common among non-metastatic colorectal cancer survivors. Young age, lower annual household income, unemployment, chemotherapy, and insufficient social support were associated with financial toxicity.

Unemployment risk of all employed working-age cancer survivors after cancer diagnosis in South Korea: a retrospective cohort analysis of population-based administrative data.

PURPOSE: As the cancer survival rate increases, discussions on the employment status of cancer survivors should be actively carried out worldwide. This study examined patients' working status changes after cancer diagnosis to provide the basis for cancer survivors' return to work. METHODS: We established a nationwide cohort to determine long-term work changes after cancer diagnosis. All patients aged 19 to 50 years who were newly diagnosed with cancer while working for the previous 3 years were considered as the case group in 2010. Using propensity score matching (PSM), the cases were matched by sex and age at a ratio of 1:3 with the control group. Kaplan-Meier curve and Cox hazard model analyses were performed to determine the occurrence of unemployment and return to work in the case and control groups on a yearly basis. RESULTS: According to the 6-year follow-up after cancer diagnosis, 26.5% of cancer patients and 23.2% of controls had lost their jobs by the end of the follow-up (P < .0001). Meanwhile, 50.5% of cancer patients and 57.4% of controls had returned to work after unemployment (P < .0001). Subsequently, based on the Cox hazard model, the unemployment risk of cancer patients was 1.42 times higher than that of the general population, while the proportion of those who returned to work was 1.15 times lower. CONCLUSION: Employment is very closely related to the quality of life of cancer survivors. These results highlight the need for a system that can support cancer survivors' work maintenance and return to work after unemployment during the treatment period and the fact that awareness of this must be improved.

Bariatric metabolic surgery eliminates body mass index as a risk factor for unemployment.

BACKGROUND: The effects of bariatric metabolic surgery (BMS) on health and comorbidities are well-known. Socioeconomic factors have been increasingly in focus in recent investigations. OBJECTIVE: The aim of this study was to analyze the effects of BMS on predictive variables for unemployment. SETTING: This study as performed in one reference center for BMS. Patients were treated between 2011 and 2017. METHODS: The study design was a retrospective cohort study. Inclusion criteria were Roux-en-Y gastric bypass surgery, follow-up of 60 months, and complete data on employment rate. Exclusion criteria were secondary BMS, secondary referral, loss of follow-up, or patients aged 60 years and above. Patients were stratified as employed independent of part-time work and as unemployed if the patient had no current employment at the time of the visit. Follow-up visits were performed after 6, 12, 24, 48, and 60 months. RESULTS: This study included 623 patients; prior to BMS, 239 (38.36%) patients were employed and 384 (61.64%) unemployed. Risk factors for baseline unemployment included increased body mass index (BMI) (odds ratio [OR], 1.03; 95% confidence interval [CI], 1.01 to 1.05; P = .010) and increased American Society of Anesthesiology (ASA) score (OR, 3.55; 95% CI, 2.56 to 4.90; P < .001). Unemployment rate dropped to 32.4% after 24 months (P < .001) and increased to 62.8% after 60 months. The BMI continuously decreased. Following BMS, the unemployment rate was no longer associated with BMI (24 months: OR, 0.97; 95% CI, 0.95 to 1.01; P = .220; 60 months: 1.04; 95% CI, 0.97 to 1.11; P = .269). The initial ASA status remained associated with unemployment (OR, 2.20; 95% CI, 1.60 to 3.01; P < .001). CONCLUSION: BMI showed some association with the unemployment rate prior to BMI. The unemployment rate significantly decreased 24 months after BMS but increased to baseline values after 60 months. Following BMS, BMI was no longer associated with unemployment.

Smoking and labour market participation: a 5-year prospective cohort study of transitions between work, unemployment and sickness absence.

AIM: To examine whether smokers are at higher risk of unemployment and sickness absence and have a lower chance of getting employed compared to never smokers. METHODS: The study sample in this prospective register-based cohort study consisted of 87,830 men and women between 18 and 60 years of age from the Danish National Health Survey 2010. Assessment of smoking status was obtained at baseline and the participants were followed in the Danish register-based evaluation of marginalisation database from 2010 to 2015. Data were analysed by Cox proportional hazards. RESULTS: The median age was 44.5 years and 47.3% were men. At baseline, 88.8% were categorised as working, 7.7% as unemployed and 3.5% as being on sickness absence. At the 5-year follow-up, hazard ratios for transitions from work to unemployment were 1.31 (95% confidence interval (CI) 1.22-1.40; P<0.001) for current smokers (<15/day) and 1.52 (95% CI 1.43-1.62; P<0.001) for current heavy smokers (⩾15/day), compared to never smokers. Hazard ratios for transitions from work to sickness absence were 1.31 (95% CI 1.24-1.38; P<0.001) for current smokers (<15/day) and 1.64 (95% CI 1.56-1.71; P<0.001) for current heavy smokers (⩾15/day). Current heavy smokers (⩾15/day) also had a lower chance of becoming re-employed with a hazard ratio of 0.81 (95% CI 0.75-0.88; P<0.001) compared to never smokers.Smoking was associated with a higher risk of unemployment and sickness absence, and a lower chance of becoming employed. More focus on smoking prevention and smoking cessation could therefore be implemented in relation to job seeking and sickness absence.