Unemployment appears to increase the risk of having a stroke in middle-age men and women, according to a Japanese study.

Compared with continuously employed middle-aged Japanese participants, those experiencing at least one period of unemployment had increased risks of developing and dying from ischemic (clot) stroke or hemorrhagic (bleed) stroke. Reemployed men, but not women, also had increased risks of stroke and continuously unemployed men and women had higher risks of stroke mortality.

Japanese workers are part of a “life-term employment system” in which male employees devote themselves to a stable job.

“If they lose that job, they are likely to be reemployed in unsatisfactory, lower positions,” said Ehab. S. Eshak, M.D., MSc., Ph.D., lead study author and visiting associate professor at Osaka University’s medical school in Japan.

Researchers analyzed the long-term impacts of changes in employment among 21,902 Japanese men and 19,826 women, ages 40-59, over 15 years. During that time, 973 men had a stroke and 275 died because of it, while 460 women had a stroke and 131 died because of it.

The results may not apply to other countries because of cultural differences, including Japan’s unique labor market.

“The main implication is that job security during the most productive work ages could help reduce stroke risk,” said Hiroyasu Iso, M.D., Ph.D., M.P.H, an Osaka University professor. “Those who do suffer a job loss need help in rejoining the labor market in an appropriate career.”

The study, published in the American Heart Association journal Stroke, didn’t distinguish between people who left a job on their own or were fired.