Unemployment and mortality: a comparative study of Germany and the United States

Am J Public Health. 2012 Aug;102(8):1542-50. doi: 10.2105/AJPH.2011.300475. Epub 2012 Jun 14.


Objectives: We examined the relationship between unemployment and mortality in Germany, a coordinated market economy, and the United States, a liberal market economy.

Methods: We followed 2 working-age cohorts from the German Socio-economic Panel and the US Panel Study of Income Dynamics from 1984 to 2005. We defined unemployment as unemployed at the time of survey. We used discrete-time survival analysis, adjusting for potential confounders.

Results: There was an unemployment-mortality association among Americans (relative risk [RR]=2.4; 95% confidence interval [CI]=1.7, 3.4), but not among Germans (RR=1.4; 95% CI=1.0, 2.0). In education-stratified models, there was an association among minimum-skilled (RR=2.6; 95% CI=1.4, 4.7) and medium-skilled (RR=2.4; 95% CI=1.5, 3.8) Americans, but not among minimum- and medium-skilled Germans. There was no association among high-skilled Americans, but an association among high-skilled Germans (RR=3.0; 95% CI=1.3, 7.0), although this was limited to those educated in East Germany. Minimum- and medium-skilled unemployed Americans had the highest absolute risks of dying.

Conclusions: The higher risk of dying for minimum- and medium-skilled unemployed Americans, not found among Germans, suggests that the unemployment-mortality relationship may be mediated by the institutional and economic environment.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cohort Studies
  • Data Collection
  • Economics
  • Female
  • Germany
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Mortality*
  • Risk
  • Unemployment / statistics & numerical data*
  • United States
  • Young Adult