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Unemployment and COVID-19-related mortality: a historical cohort study of 50,000 COVID-19 patients in Fars, Iran
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Alireza Mirahmadizadeh, Mohammad Taghi Badeleh Shamooshaki, Amineh Dadvar, Mohammad Javad Moradian, Mohammad Aryaie
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Epidemiol Health. 2022;44:e2022032. Published online March 12, 2022
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DOI: https://doi.org/10.4178/epih.e2022032
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Abstract
OBJECTIVES
Previous studies have estimated the risk of death associated with unemployment in the coronavirus disease 2019 (COVID-19) pandemic, but no studies have examined unemployment before COVID-19 infection as a risk factor for COVID-19-related mortality. Thus, this study aimed to investigate COVID-19 mortality among this population.
METHODS Data on 50,038 people aged 25-59 years were collected from 38 agencies in Fars Province, Iran, from February 2020 to July 2021. Follow-up lasted from participants’ diagnosis with COVID-19 based on the results of a reverse transcription-polymerase chain reaction test to participants’ death or the end of the study period. The association between unemployment and COVID-19-related mortality was estimated using the Poisson regression method, and a sensitivity analysis was conducted to calculate the E-value.
RESULTS Unemployment was associated with a 2.41-fold (95% confidence interval [CI], 2.01 to 2.90) higher age-adjusted and sex-adjusted risk of COVID-19-related mortality. The adjusted Poisson regression analysis showed 8.82 (95% CI, 6.42 to 12.11), 2.84 (95% CI, 1.90 to 4.24), and 1.58 (95% CI, 1.24 to 2.01) times higher risks of COVID-19-related mortality among unemployed people aged 25-39 years, 40-49 years, and 50-59 years, respectively, than among their employed counterparts. Unemployment increased the risk of COVID-19 mortality by 3.31 (95% CI, 2.31 to 4.74) and 2.30 (95% CI, 1.86 to 2.84) times in female and male, respectively. The E-value was 3.43, reflecting the minimum strength of confounding required to shift the association between unemployment and COVID-19-related mortality toward the null.
CONCLUSIONS Unemployment prior to COVID-19 infection increased the risk of COVID-19-related mortality. COVID-19-related mortality disproportionately impacted unemployed women and younger unemployed people.
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Summary
Key Message
This study adds new insights to the existing body of work on the topic of unemployment and COVID-19-related mortality. Unemployment prior to COVID-19 infection was found to increase the risk of COVID-19-related mortality, which disproportionately burdened unemployed female and younger unemployed people. It seems older unemployed people and unemployed males may tend to have more financial resources and savings when they lose a job, making younger unemployed people and unemployed female more vulnerable to financial stress, which can lead to deferred care and increase their risk of COVID-19-related mortality.
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Citations
Citations to this article as recorded by  - How do socioeconomic determinants of health affect the likelihood of living with HTLV-1 globally? A systematic review with meta-analysis
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Journal of Preventive Medicine and Public Health.2023; 56(3): 231. CrossRef - The gamma-Maxwell regression for COVID-19 mortality rates of the 50 U.S. largest cities
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