American Journal of Epidemiology Advance Access published online on November 15, 2007
American Journal of Epidemiology, doi:10.1093/aje/kwm328
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Mortality Patterns following Downsizing at Pan American World Airways
1 Department of Occupational and Environmental Health, Rollins School of Public Health, Emory University, Atlanta, GA
2 Industrywide Studies Branch, Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, OH
Correspondence to Dr. Kyle Steenland, 1518 Clifton Road, Rollins School of Public Health, Emory University, Atlanta, GA 30322 (e-mail: nsteenl{at}sph.emory.edu).
Received for publication June 26, 2007. Accepted for publication October 10, 2007.
There are only a small number of studies on the health effects of involuntary unemployment (e.g., downsizing), and results are contradictory. The authors studied the mortality through 2002 of 13,370 Pan American World Airways employees who were born before 1940 and whose records were available after the company's bankruptcy in 1991. The cohort was divided into those who left work voluntarily (55%), involuntarily (39%), and because of illness (6%). The mean year of first employment was 1963, the mean year of last employment was 1987, and the mean age at leaving the company was 55 years. Of those who left involuntarily, 56% left at the time of bankruptcy in December 1991 or later. Twenty-two percent of the cohort died during follow-up, which began at the time of leaving the company. Standardized mortality ratios relative to the US population for all causes for those who left voluntarily, involuntarily, and because of illness were 0.72 (95% confidence interval (CI): 0.69, 0.76), 0.69 (95% CI: 0.65, 0.74), and 2.40 (95% CI: 2.22, 2.60), respectively. Ischemic heart disease mortality showed a similar pattern. Internal analyses comparing involuntary to voluntary leavers after adjusting for age, race, sex, calendar time, and education yielded all-cause and ischemic heart disease rate ratios of 0.96 (95% CI: 0.87, 1.07) and 1.11 (95% CI: 0.93, 1.35), respectively. Subanalyses of those who left involuntarily at age 
60 years, or those who left involuntarily at the time of bankruptcy, did not indicate any excess mortality (all-cause standardized mortality ratios = 0.69 and 0.64, respectively). These data do not indicate that mortality among those who left involuntarily was higher than for those who left voluntarily. Both groups showed a strong healthy worker effect.
healthy worker effect; heart diseases; mortality; personnel downsizing; unemployment
Abbreviations: CI, confidence interval; Pan Am, Pan American World Airways