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Can Our Economic Insecurity Really Increase Our Risk for Diabetes And Heart Disease?

Job insecurity found to prompt 19% increase in  diabetes, myocardial infarction or coronary death risk.

Job insecurity has been associated with certain health outcomes. So the role of job insecurity was examined as a risk factor to incident diabetes. And the results came from a recent published meta-analysis in CMAJ.  From 19 other studies, researchers also showed an association between job insecurity and the risk for dyslipidemia, coronary heart disease, and diabetes complications.

Jane E. Ferrie, PhD, of the University of Bristol, analyzed the 19 studies from the U.S., Europe, and Australia to assess the relationship between self-reported job insecurity and the level of risk for new diabetes cases.

In pooling the data not only from this study but other studies, it gave the researchers enough information to make the association between job insecurity and new-onset coronary events. This meta-analysis showed job insecurity to be associated with a 19% increased risk of myocardial infarction or coronary death. Since diabetes is a risk factor for coronary heart disease, they felt it important to see if job insecurity was also associated with an increased risk of weight gain and new-onset diabetes. No one had examined this question previously.

Researchers calculated study-specific estimates of the association between job insecurity reported at baseline and incident diabetes over the follow-up period.  They then pooled the estimates in a meta-analysis to produce a summary risk estimate.  Among the 19 cohort studies examined, eight were open-access and 11 were taken from European cohort studies. Data were assessed on a total of 140,825 participants, all of whom were diabetes-free at baseline. During the average follow-up of 9.4 years (range of 4.0-21.1 years), there were 3,954 new cases of diabetes among the participants.

Job insecurity was self-reported through scaled questionnaires administered at baseline, inquiring on the individual’s level of insecurity or satisfaction with their current job, or level of fear over a layoff or unemployment. For diabetes diagnosis, studies reviewed in the meta-analysis utilized either the World Health Organization criteria or the International Statistical Classification of Diseases and Related Health Problems 10th Revision code E11.

Other variables measured included the level of physical activity, smoking status, alcohol use, age, sex, obesity status, and socioeconomic position. The researchers used a risk estimate to evaluate the relationship between job insecurity and risk of diabetes after computing individual estimates from each of the studies included.

Reportedly high levels of insecurity with a job were linked to a moderately increased risk of developing diabetes.  After adjusting for all aforementioned variables, the results were similar. When the authors restricted the multivariable analysis to only high-quality studies, the results were also comparable.

For the analysis, they included all women and men from the cohort studies who were employed and free of diabetes at baseline and for whom complete data on job insecurity were available.

From the results, it suggests that people who feel their job to be insecure have a modest increased risk of developing diabetes. There were no surprises primarily because of the association with coronary events described above and indicative evidence from this study.

In addition to coronary event risk, the authors also discussed how the current findings were supported by their past research on the association between job insecurity and weight gain, which is a known risk factor for diabetes.

In an interview, Ferrie added that job insecurity poses a valid public health threat and should be treated accordingly. “Ideally these findings should be interpreted in a public health context, which would mean, in this case, that measures were taken to reduce the number of jobs that are insecure. Sadly, at present the increasing preference of employers for zero-hours contracts is moving things in the opposite direction. At the level of the individual, both workers and healthcare professionals should be aware that people exposed to job insecurity may be at a modest increased risk of diabetes, so any symptoms of diabetes should be taken seriously.”

While the study examined a large, comprehensive sample group spanning several countries, data on job insecurity were collected typically through one question and differed throughout the various studies, and researchers found the results of the meta-analysis should be “replicated in other populations and settings to ensure that they are not context-dependent.”

Practice Pearls:

  • High levels of job insecurity were associated with a 19% increased risk in developing diabetes.
  • Note that in a prior meta-analysis, job insecurity was associated with a 19% increased risk of myocardial infarction or coronary death.
  • Also, in other studies, it was found that weight gain was associated with job insecurity.

Source Reference: Ferrie J, et al. “Job insecurity and risk of diabetes: a meta-analysis of individual participant data” CMAJ 2016; DOI: 10.1503/cmaj.150942.