{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T05:48:24Z","timestamp":1791870504390,"version":"4.3.4"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T00:00:00Z","timestamp":1689552000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR-11-INBS-0002"],"award-info":[{"award-number":["ANR-11-INBS-0002"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020320","name":"Institut pour la recherche en sant\u00e9 publique","doi-asserted-by":"crossref","award":["IReSP-17-PREV-25"],"award-info":[{"award-number":["IReSP-17-PREV-25"]}],"id":[{"id":"10.13039\/501100020320","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Caisse nationale d\u2019assurance maladie"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1371\/journal.pone.0288747","type":"journal-article","created":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T17:26:38Z","timestamp":1689614798000},"page":"e0288747","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":17,"title":["Cardiovascular burden and unemployment: A retrospective study in a large population-based French cohort"],"prefix":"10.1371","volume":"18","author":[{"given":"Marina","family":"Sanchez Rico","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Plessz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3494-5083","authenticated-orcid":true,"given":"Guillaume","family":"Airagnes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9line","family":"Ribet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolas","family":"Hoertel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6161-5880","authenticated-orcid":true,"given":"Marcel","family":"Goldberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Zins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4611-1892","authenticated-orcid":true,"given":"Pierre","family":"Meneton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,7,17]]},"reference":[{"key":"pone.0288747.ref001","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1093\/pubmed\/fdz100","article-title":"Unemployment and mortality in a large Italian cohort.","volume":"43","author":"A d\u2019Errico","year":"2021","journal-title":"J Public Health"},{"key":"pone.0288747.ref002","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1001\/2013.jamainternmed.447","article-title":"The cumulative effect of unemployment on risks for acute myocardial infarction","volume":"172","author":"ME Dupre","year":"2012","journal-title":"Arch Intern Med"},{"key":"pone.0288747.ref003","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1001\/jamainternmed.2013.1835","article-title":"Evolution of research on the effect of unemployment on acute myocardial infarction risk","volume":"172","author":"WT Gallo","year":"2012","journal-title":"Arch Intern Med"},{"key":"pone.0288747.ref004","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1136\/oemed-2013-101721","article-title":"Unemployment and coronary heart disease among middle-aged men in Sweden: 39 243 men followed for 8 years","volume":"71","author":"A Lundin","year":"2014","journal-title":"Occup Environ Med"},{"key":"pone.0288747.ref005","doi-asserted-by":"crossref","first-page":"5190","DOI":"10.1016\/j.ijcard.2013.07.188","article-title":"The contribution of diet and lifestyle to socioeconomic inequalities in cardiovascular morbidity and mortality","volume":"168","author":"C Mejean","year":"2013","journal-title":"Int J Cardiol"},{"key":"pone.0288747.ref006","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1007\/s00420-014-0997-7","article-title":"Unemployment is associated with high cardiovascular event rate and increased all-cause mortality in middle-aged socially privileged individuals.","volume":"88","author":"P Meneton","year":"2015","journal-title":"Int Arch Occup Environ Health"},{"key":"pone.0288747.ref007","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1016\/j.socscimed.2011.01.005","article-title":"Losing life and livelihood: a systematic review and meta-analysis of unemployment and all-cause mortality","volume":"72","author":"DJ Roelfs","year":"2011","journal-title":"Soc Sci Med"},{"key":"pone.0288747.ref008","doi-asserted-by":"crossref","first-page":"e0232262","DOI":"10.1371\/journal.pone.0232262","article-title":"Association between unemployment and the co-occurrence and clustering of common risky health behaviors: Findings from the Constances cohort","volume":"15","author":"M Plessz","year":"2020","journal-title":"PLoS One"},{"key":"pone.0288747.ref009","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1136\/jech.2005.041350","article-title":"Explaining the social gradient in coronary heart disease: comparing relative and absolute risk approaches","volume":"60","author":"J Lynch","year":"2006","journal-title":"J Epidemiol Community Health"},{"key":"pone.0288747.ref010","doi-asserted-by":"crossref","first-page":"1973","DOI":"10.1161\/01.CIR.88.4.1973","article-title":"Socioeconomic factors and cardiovascular disease: a review of the literature","volume":"88","author":"GA Kaplan","year":"1993","journal-title":"Circulation"},{"key":"pone.0288747.ref011","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1186\/1479-5868-9-116","article-title":"Socioeconomic inequalities in occupational, leisure-time, and transport related physical activity among European adults: a systematic review","volume":"9","author":"MA Beenackers","year":"2012","journal-title":"Int J Behav Nutr Phys Act"},{"key":"pone.0288747.ref012","doi-asserted-by":"crossref","first-page":"i26","DOI":"10.1093\/alcalc\/agl073","article-title":"Social inequalities in alcohol consumption and alcohol-related problems in the study countries of the EU concerted action \u2018Gender, Culture and Alcohol Problems: a Multi-national Study\u2019.","volume":"41","author":"K Bloomfield","year":"2006","journal-title":"Alcohol Alcohol Suppl"},{"key":"pone.0288747.ref013","doi-asserted-by":"crossref","first-page":"109","DOI":"10.2190\/PM.40.1.i","article-title":"Education and risk for late life depression: a meta-analysis of published literature","volume":"40","author":"H Chang-Quan","year":"2010","journal-title":"Int J Psychiatry Med"},{"key":"pone.0288747.ref014","first-page":"127","article-title":"Sleep health disparity: the putative role of race, ethnicity and socioeconomic status.","volume":"2","author":"S Jehan","year":"2018","journal-title":"Sleep Med Disord"},{"key":"pone.0288747.ref015","doi-asserted-by":"crossref","first-page":"2348","DOI":"10.1001\/archinte.166.21.2348","article-title":"Socioeconomic status and trends in disparities in 4 major risk factors for cardiovascular disease among US adults, 1971\u20132002","volume":"166","author":"S Kanjilal","year":"2006","journal-title":"Arch Intern Med"},{"key":"pone.0288747.ref016","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1093\/epirev\/mxm001","article-title":"Socioeconomic status and obesity","volume":"29","author":"L McLaren","year":"2007","journal-title":"Epidemiol Rev"},{"key":"pone.0288747.ref017","doi-asserted-by":"crossref","first-page":"816","DOI":"10.2105\/AJPH.82.6.816","article-title":"Socioeconomic status and health: how education, income, and occupation contribute to risk factors for cardiovascular disease","volume":"82","author":"MA Winkleby","year":"1992","journal-title":"Am J Public Health"},{"key":"pone.0288747.ref018","first-page":"529","article-title":"The impact of unemployment on health: a review of the evidence","volume":"153","author":"RL Jin","year":"1995","journal-title":"CMAJ"},{"key":"pone.0288747.ref019","doi-asserted-by":"crossref","DOI":"10.1177\/0002764213487347","article-title":"Bad Jobs, Bad Health? How Work and Working Conditions Contribute to Health Disparities.","volume":"57","author":"SA Burgard","year":"2013","journal-title":"Am Behav Sci"},{"key":"pone.0288747.ref020","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1093\/aje\/kws336","article-title":"Job strain as a risk factor for leisure-time physical inactivity: an individual-participant meta-analysis of up to 170,000 men and women: the IPD-Work Consortium","volume":"176","author":"EI Fransson","year":"2012","journal-title":"Am J Epidemiol"},{"key":"pone.0288747.ref021","doi-asserted-by":"crossref","first-page":"e40101","DOI":"10.1371\/journal.pone.0040101","article-title":"Job strain and alcohol intake: a collaborative meta-analysis of individual-participant data from 140,000 men and women","volume":"7","author":"K Heikkil\u00e4","year":"2012","journal-title":"PLoS One"},{"key":"pone.0288747.ref022","doi-asserted-by":"crossref","first-page":"e35463","DOI":"10.1371\/journal.pone.0035463","article-title":"Job strain and tobacco smoking: an individual-participant data meta-analysis of 166,130 adults in 15 European studies","volume":"7","author":"K Heikkil\u00e4","year":"2012","journal-title":"PLoS One"},{"key":"pone.0288747.ref023","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.2105\/AJPH.2012.301153","article-title":"Job strain and ambulatory blood pressure: a meta-analysis and systematic review","volume":"103","author":"PA Landsbergis","year":"2013","journal-title":"Am J Public Health"},{"key":"pone.0288747.ref024","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.smrv.2014.10.010","article-title":"The effect of the work environment on future sleep disturbances: a systematic review.","volume":"23","author":"SJ Linton","year":"2015","journal-title":"Sleep Med Rev"},{"key":"pone.0288747.ref025","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1111\/j.1365-2796.2011.02482.x","article-title":"Job strain in relation to body mass index: pooled analysis of 160,000 adults from 13 cohort studies.","volume":"272","author":"ST Nyberg","year":"2012","journal-title":"J Intern Med"},{"key":"pone.0288747.ref026","doi-asserted-by":"crossref","first-page":"2268","DOI":"10.2337\/dc13-2936","article-title":"Job strain as a risk factor for type 2 diabetes: a pooled analysis of 124,808 men and women.","volume":"37","author":"ST Nyberg","year":"2014","journal-title":"Diabetes Care"},{"key":"pone.0288747.ref027","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1186\/s12889-015-1954-4","article-title":"A systematic review including meta-analysis of work environment and depressive symptoms.","volume":"15","author":"T Theorell","year":"2015","journal-title":"BMC Public Health"},{"key":"pone.0288747.ref028","doi-asserted-by":"crossref","first-page":"e008073","DOI":"10.1161\/JAHA.117.008073","article-title":"Association Between Work-Related Stress and Coronary Heart Disease: A Review of Prospective Studies Through the Job Strain, Effort-Reward Balance, and Organizational Justice Models","volume":"7","author":"JD Sara","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"pone.0288747.ref029","doi-asserted-by":"crossref","first-page":"223","DOI":"10.2190\/HS.40.2.d","article-title":"A micro-level model of employment relations and health inequalities","volume":"40","author":"J Benach","year":"2010","journal-title":"Int J Health Serv"},{"key":"pone.0288747.ref030","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1007\/s10654-015-0096-4","article-title":"The French CONSTANCES population-based cohort: design, inclusion and follow-up","volume":"30","author":"CONSTANCES Team","year":"2015","journal-title":"Eur J Epidemiol"},{"key":"pone.0288747.ref031","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1136\/oemed-2016-103678","article-title":"CONSTANCES: a general prospective population-based cohort for occupational and environmental epidemiology: cohort profile","volume":"74","author":"M Goldberg","year":"2017","journal-title":"Occup Environ Med"},{"key":"pone.0288747.ref032","doi-asserted-by":"crossref","first-page":"e0131521","DOI":"10.1371\/journal.pone.0131521","article-title":"How to Establish and Follow up a Large Prospective Cohort Study in the 21st Century\u2014Lessons from UK COSMOS","volume":"10","author":"MB Toledano","year":"2015","journal-title":"PLoS One"},{"key":"pone.0288747.ref033","doi-asserted-by":"crossref","first-page":"2920","DOI":"10.1002\/sim.3944","article-title":"Bias and efficiency of multiple imputation compared with complete-case analysis for missing covariate values","volume":"29","author":"IR White","year":"2010","journal-title":"Stat Med"},{"key":"pone.0288747.ref034","doi-asserted-by":"crossref","first-page":"e0230661","DOI":"10.1371\/journal.pone.0230661","article-title":"Social deprivation among socio-economic contrasted french areas: Using item response theory analysis to assess differential item functioning of the EPICES questionnaire in stroke patients","volume":"15","author":"A Guilloteau","year":"2020","journal-title":"PLoS One"},{"key":"pone.0288747.ref035","doi-asserted-by":"crossref","first-page":"e021373","DOI":"10.1161\/JAHA.121.021373","article-title":"Respective Mediating Effects of Social Position and Work Environment on the Incidence of Common Cardiovascular Risk Factors","volume":"11","author":"N Hoertel","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"pone.0288747.ref036","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1016\/S0277-9536(03)00351-4","article-title":"The measurement of effort-reward imbalance at work: European comparisons.","volume":"58","author":"J Siegrist","year":"2004","journal-title":"Soc Sci Med"},{"key":"pone.0288747.ref037","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1093\/aje\/kwx152","article-title":"Primary Cardiovascular Disease Risk Factors Predicted by Poor Working Conditions in the GAZEL Cohort","volume":"186","author":"P Meneton","year":"2017","journal-title":"Am J Epidemiol"},{"key":"pone.0288747.ref038","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.socscimed.2018.09.042","article-title":"Work environment mediates a large part of social inequalities in the incidence of several common cardiovascular risk factors: Findings from the Gazel cohort.","volume":"216","author":"P Meneton","year":"2018","journal-title":"Soc Sci Med"},{"key":"pone.0288747.ref039","doi-asserted-by":"crossref","first-page":"1513","DOI":"10.1016\/S0140-6736(18)30134-X","article-title":"Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599\u2008912 current drinkers in 83 prospective studies","volume":"391","author":"AM Wood","year":"2018","journal-title":"Lancet"},{"key":"pone.0288747.ref040","doi-asserted-by":"crossref","first-page":"e0155431","DOI":"10.1371\/journal.pone.0155431","article-title":"Screening for Depression in the General Population with the Center for Epidemiologic Studies Depression (CES-D): A Systematic Review with Meta-Analysis","volume":"11","author":"G Vilagut","year":"2016","journal-title":"PLoS One"},{"key":"pone.0288747.ref041","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/S0895-4356(01)00409-7","article-title":"Factors associated with self-reporting of chronic health problems in the French GAZEL cohort","volume":"55","author":"MH Metzger","year":"2002","journal-title":"J Clin Epidemiol"},{"key":"pone.0288747.ref042","doi-asserted-by":"crossref","first-page":"597","DOI":"10.22237\/jmasm\/1257035100","article-title":"New Effect Size Rules of Thumb","volume":"8","author":"SS Sawilowsky","year":"2009","journal-title":"Journal of Modern Applied Statistical Methods"},{"key":"pone.0288747.ref043","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1080\/03610910902859574","article-title":"Using the Standardized Difference to Compare the Prevalence of a Binary Variable between Two Groups","volume":"38","author":"PC Austin","year":"2009","journal-title":"Observational Research. Commun Statis Simulat Comput"},{"key":"pone.0288747.ref044","article-title":"Create \u2018Table 1\u2019 to Describe Baseline Characteristics with or without Propensity Score Weights","author":"K Yoshida","year":"2022"},{"key":"pone.0288747.ref045","doi-asserted-by":"crossref","first-page":"573","DOI":"10.7326\/0003-4819-147-8-200710160-00010","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"147","author":"E von Elm","year":"2007","journal-title":"Ann Intern Med"},{"key":"pone.0288747.ref046","doi-asserted-by":"crossref","first-page":"101042","DOI":"10.1016\/j.ehb.2021.101042","article-title":"Unemployment and sleep: evidence from the United States and Europe","volume":"43","author":"DG Blanchflower","year":"2021","journal-title":"Econ Hum Biol"},{"key":"pone.0288747.ref047","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1097\/JOM.0b013e318209915e","article-title":"Health indicators among unemployed and employed young adults","volume":"53","author":"AJ Caban-Martinez","year":"2011","journal-title":"J Occup Environ Med"},{"key":"pone.0288747.ref048","doi-asserted-by":"crossref","first-page":"4","DOI":"10.2174\/1874473711104010004","article-title":"Unemployment and substance use: a review of the literature (1990\u20132010).","volume":"4","author":"D Henkel","year":"2011","journal-title":"Curr Drug Abuse Rev"},{"key":"pone.0288747.ref049","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.ypmed.2016.12.045","article-title":"Unemployment, underweight, and obesity: Findings from Understanding Society (UKHLS).","volume":"97","author":"A Hughes","year":"2016","journal-title":"Prev Med"},{"key":"pone.0288747.ref050","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1016\/j.jvb.2009.01.001","article-title":"Unemployment impairs mental health","volume":"74","author":"KI Paul","year":"2009","journal-title":"Meta-analyses. Journal of Vocational Behavior"},{"key":"pone.0288747.ref051","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/j.pcd.2017.03.010","article-title":"Accumulated exposure to unemployment is related to impaired glucose metabolism in middle-aged men: A follow-up of the Northern Finland Birth Cohort 1966","volume":"11","author":"N Rautio","year":"2017","journal-title":"Prim Care Diabetes"},{"key":"pone.0288747.ref052","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1136\/jech.53.7.390","article-title":"Working conditions and social inequalities in health","volume":"53","author":"S Moncada","year":"1999","journal-title":"J Epidemiol Community Health"},{"key":"pone.0288747.ref053","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1146\/annurev-soc-071913-043237","article-title":"The Far-Reaching Impact of Job Loss and Unemployment","volume":"41","author":"JE Brand","year":"2015","journal-title":"Annu Rev Sociol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0288747","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T17:27:16Z","timestamp":1689614836000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0288747"}},"subtitle":[],"editor":[{"given":"Seyed Aria","family":"Nejadghaderi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2023,7,17]]},"references-count":53,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0288747","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,7,17]]}}}