Unemployment and cancer: a literature review.

With a tenth of the labour force involuntarily out of work, unemployment has become an important element among the socioeconomic determinants of health in the rich countries. Unemployed men have an excess cancer mortality of close to 25% compared with that of all men in the labour force. The available data from various countries indicate that this excess risk is found both in periods when the unemployment rate is about 1% and in periods when it is about 10%. Furthermore, it persists long after the start of unemployment and it does not disappear when social class, smoking, alcohol intake, and previous sick days are controlled for. The excess cancer mortality comes mainly from lung cancer, and the increased risk of lung cancer does not disappear when social class and number of previous sick days are controlled for. Unemployment does not increase smoking, but unemployed men have a slightly higher smoking prevalence before unemployment. However, as the excess lung cancer risk among unemployed men remains after controlling for social class, it seems unlikely that it can be explained only by differences in smoking prior to unemployment.