Scar on my heart: effects of unemployment experiences on coronary heart disease

Purpose The purpose of this paper is to study the impact of unemployment on coronary heart diseases (CHD) in Italy on a sample of male manual workers in the private sector. Design/methodology/approach The authors investigate the association between CHD and different unemployment experiences (ever unemployed; short, mid and long cumulative unemployment), exploiting a large Italian administrative database on careers and health. The study design is based on the balancing of individuals' characteristics during a 12-year pre-treatment period; the measurement of unemployment occurrence during a seven-year treatment period; the observation of CHD occurrence during a five-year follow up. The workers characteristics and the probability of receiving the treatment are balanced by means of propensity score matching. Standard diagnostics on the balancing assumption are discussed and satisfied, while the robustness to violations of the unconfoundedness assumption is evaluated by a simulation-based sensitivity analysis. Findings The authors find a significant increase of CHD probability was found among workers who experience more than three years of unemployment (relative risks (RR)=1.91, p<0.1), and among those who exit unemployment starting a self-employment activity (RR=1.70, p<0.1). Using different selections of the study population, a clear pattern emerges: the healthier and more labour market attached are workers during pre-treatment, the greater is the negative impact of long-term unemployment on health (RR=2.79, p<0.01). Originality/value The very large representative sample (n=69,937) and the deep longitudinal dimension of the data (1985-2008) allowed the authors to minimize the risks of health selection and unemployment misclassification. Moreover, the adopted definition of unemployment corrected some undercoverage and misclassification issues that affect studies based on a purely administrative definition and that treat unemployment as a unique career event disregarding the duration of the experience.