Uncertainty exists as to what extent common risk factors are involved in the associations of unemployment with major health outcomes and mortality.

A retrospective and prospective observational study.

A large population-based French cohort (CONSTANCES).

99 430 adults at baseline who have been exposed to unemployment during their lifetime and 54 679 of them who were followed for 7 years after baseline.

Testing the mediating roles of several risk factors at baseline in the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates during a 7-year follow-up. Direct and indirect effects were calculated for each risk factor and all together using logistic regression models adjusted for major confounders including sex, age, parental histories of cardiovascular disease and cancer, social position and working conditions.

Estimates (95% CIs) of the direct and indirect effects for smoking are 0.0083 (0.0044 to 0.0122), p

These analyses show that common risk factors such as smoking, alcohol consumption, depressive symptoms, leisure-time physical inactivity and blood triglycerides mediate up to 10% of the associations of lifetime unemployment exposure with cardiovascular disease, cancer and mortality rates when tested separately and approximately 20% when tested all together. This highlights the existence of other major mediating pathways that have yet to be identified.