Causally-informative analyses of the effect of job displacement on all-cause and specific-cause mortality from the 1990s Finnish recession until 2020: A population registry study of private sector employees

BACKGROUND: Job loss is related to morbidity and mortality, but generation of causal evidence is challenging due to confounding factors. Finland suffered a severe economic recession in the early 1990s with unemployment reaching almost 25%, with many job losses due to mass layoff or company closure. Such job displacements are assumed to be exogenous to the individual and create a natural experiment for causal inference. METHODS AND FINDINGS: We evaluate the causal relationship between job displacement and mortality using register data from Finland between 1988 and 2020 (N = 590,823 individuals [43.3 % female] aged 25-55 and securely employed by the private sector at baseline, N = 93,199 total deaths by 2020). Job displacement is associated with increased risk of all-cause mortality even after accounting for sex, age, marital status, and education (HR = 1.09 [1.07, 1.11]). Risks of death by suicide, violence, alcohol, accidents, and disease are higher for displaced individuals at all follow-up periods examined. Risks of death from cancer and ischaemic heart disease are higher for displaced individuals only in later follow up periods. CONCLUSIONS: Our analyses support the causal influence of job displacement on all-cause and specific-cause mortality, even up to 30 years after the recession; this risk varies by cause of death and by length of follow-up. Future work should evaluate stress and substance use as potential pathways from job displacement to mortality.