Downsized older workers at risk for stroke, MI

Need for preventive care strategies

While occupational health professionals are well aware of the increased stress levels associated with employees at risk of job loss through downsizing and other cost-cutting strategies, a new study shows that older employees are specifically at greater risk for life-threatening conditions such as stroke and myocardial infarction (MI).

A recent article in the American Journal of Industrial Medicine indicates that the risk of stroke associated with involuntary job loss in the years preceding retirement is more than double.1 And while the association with MI was not statistically significant, the lead author, William T. Gallo, PhD, an associate research scientist in the department of epidemiology and public health at Yale University School of Medicine in New Haven, CT, says, "The results are nonetheless suggestive of MI — not statistically significant, but very close."

The study, which was funded by The Claude D. Pepper Older Americans Independence Center at Yale and by The National Institute on Aging, analyzed data from the first four years of the Health and Retirement Survey, a nationally representative sample of older individuals in the United States. The sample included 457 workers who experienced job loss, compared with a control group of 3,763 individuals. And while Gallo’s study did not specifically look at retirees, many of whom continue to have some health benefits covered by their employers, the findings suggest the same risks may be true for them as well, he reports.

Implications for occ-med

With the work force steadily aging, the prospect of a growing number of employees being at risk for MI and/or stroke should make occ-med professionals sit up and take notice. While they have no control over who is retained and who is let go, Gallo suggests there are some strategies they might adopt to lower the health risk for these workers.

"In the short term, re-employment is restorative in terms of depression and anxiety; so if possible, you’d want to get these people re-employed as soon as possible," he notes. "Short of that, you could consider preventive strategies such as health education. Clearly, we would want any known risk factor to be made known to people who are about to be unemployed. You also want to make certain providers are aware there is an additional risk factor beyond medical symptoms or conditions."

Specifically, Gallo recommends programs for soon-to-be-dislocated workers that make them aware of the potential health impact of stress associated with coming unemployment.

"On the provider side, those who are treating individuals with classic risk factors should also be asking about their employment status," he adds.

Some companies adopt strategies that enable older employees to continue working in some capacity, either part-time, as teachers or mentors, or even as volunteers. Is this a strategy that would help lower the risks for these workers?

"I think so, but I don’t know that there’s any evidence of that," says Gallo. "The crucial mediating evidence is the severance of workplace social interaction — all the things that give us intrinsic gratification from work. This includes the opportunity to demonstrate your skill, your mastery, your worth, and your value to the organization. The opportunity to volunteer could be somewhat restorative and might decrease your risk."

The bottom line, he notes, is that addressing the greater health risks such employees face "should be in a company’s self-interest."

There also are policy implications, he adds. "[Our findings] probably suggest extended health care plus programs to expand awareness might be important in reducing the risk of something that is debilitating or fatal," he says. "It’s another risk factor [for stroke or MI] that may not be so obvious — yet it has to be considered."


1. Gallo WT, Bradley EH, Falba TA, et al. Involuntary job loss as a risk factor for subsequent myocardial infarction and stroke: Findings from the Health and Retirement Survey. Am J Ind Med 2004; 45:408-416.

[For more information, contact:

William T. Gallo, PhD, Associate Research Scientist, Department of Epidemiology and Public Health, Yale University School of Medicine, One Church St., Seventh Floor, New Haven, CT 06510. Telephone: (203) 764-6729. E-mail:]