Involuntary unemployment and mortality in Taiwan.

BACKGROUND AND PURPOSE: Unemployment is known to be associated with increased mortality, but little data is available from Taiwan, where dramatic structural changes in the economy have increased unemployment in recent years. The aim of this study was to investigate the effect of unemployment on mortality in Taiwan. METHODS: The study design was a cohort study with a control group. The unemployed group included 92,563 involuntarily unemployed individuals in 2001. Those in the control group (n = 92,599) were randomly selected from 1,230,000 employees, and matched with those in the unemployed group, by age, gender, income, firm size and urbanization, using a frequency matching mechanism. All subjects were followed during the period from January 2001 to December 2002. The adjusted hazard ratio was estimated using the Cox proportional hazards model. RESULTS: After adjusting for other factors, unemployment was associated with a higher risk of mortality (hazard ratio, 1.99; 95% confidence interval [CI], 1.60-2.48). The gender-specific adjusted hazard ratios for unemployment were 2.07 (95% CI, 1.59-2.70) for men and 1.82 (95% CI, 1.22-2.69) for women. Unemployed men had a significantly higher mortality risk for cardiovascular disease, digestive system diseases, all other diseases (except for cancer, digestive system and cardiovascular diseases), and other external causes (not including suicide) than men who were employed. In contrast, unemployed women had a significantly higher mortality risk only for other diseases, compared women who were employed. CONCLUSION: Unemployment is an important risk factor for mortality in Taiwan. The long-term impact of unemployment on mortality in Taiwan remains to be explored.