Job Loss and Early-onset Dementia Risk in Middle-aged Adults: A Longitudinal Study

Abstract

Background: Early-onset dementia poses a significant public health challenge, particularly due to its profound impact on working-age individuals (under 65 years). This study investigated the association between job loss and early-onset dementia in middle-aged adults in Republic of Korea. Methods: Using National Health Insurance Service data in the Republic of Korea, we analyzed participants aged 45-54 years who were employed by private companies and who underwent health checkups between 2009 and 2010. Early job loss was defined as involuntary unemployment within two years of the 2011 index date. The primary outcome was incident dementia, identified using both International Classification of Diseases-10 (ICD-10) codes and antidementia medication use. Adjusted hazard ratios (HRs) were calculated using Cox proportional hazards models. Subgroup analyses were conducted by age, household income, residential region, company size, and industrial sector. Results: Among 1,130,665 participants (mean age 49.2 +/- 2.82 years, follow-up of 14.02 years), earlyonset dementia occurred in 3,748 individuals. Of these, 580 cases were from the job loss group (n = 98,504) and 3,168 cases were from the remaining employed group (n = 1,032,161). Job loss was significantly associated with an increased risk of early-onset dementia in both males (adjusted HR: 1.75; 95% confidence interval, 1.57-1.95) and females (adjusted HR: 1.51; 95% confidence interval, 1.27-1.78). Subgroup analyses identified a higher dementia risk among low-income individuals, particularly in males under 50, females over 50, and those employed in the primary industrial sector. Conclusion: Job loss was significantly associated with an increased risk of early-onset dementia, particularly among males, after adjusting for multiple demographic, socioeconomic, and health-related covariates. (c) 2025 Occupational Safety and Health Research Institute. Published by Elsevier B.V. on behalf of Institute, Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).