Association between job insecurity and cardiovascular diseases in workers with type 2 diabetes mellitus

Abstract

Objective This study analyzes the association between job insecurity, measured by cumulative unemployment, and the risk of cardiovascular disease (CVD) among middle-aged workers with type 2 diabetes mellitus. Methods We utilized data from the National Health Insurance Service of Korea, focusing on patients with type 2 diabetes, aged 40-50 who were continuously employed in 2009-2010. Job insecurity was defined by cumulative unemployment in 2012-2016 and categorized as stable, partially stable, or unstable. Participants were followed until December 2023, with incident CVD as the primary outcome. Cox regression models estimated sex-stratified hazard ratios (HR) with 95% confidence intervals (CI), with additional subgroup and sensitivity analyses. Results Among 128 704 participants (107 071 males and 21 633 females; median age 51 years), CVD occurred among 6.1% of males and 3.9% of females. Job insecurity was associated with an increased risk of CVD [males: HR 1.12 (95% CI 1.05-1.19) for partially stable, HR 1.25 (95% CI 1.16-1.34) for unstable; females: HR 1.00 (95% CI 0.85-1.19) for partially stable, HR 1.33 (95% CI 1.13-1.57) for unstable]. Subgroup analyses showed particularly elevated risks among low-income males and high-income females. By age, males aged 40-49 in the partially stable and unstable groups had increased CVD risks, while those aged 50-59 had the highest risk in the unstable group. Among females, significant associations appeared only in the 40-49 age group. Conclusions Among middle-aged workers with type 2 diabetes, prolonged job insecurity was significantly associated with an increased risk of CVD.