The first to have a heart attack was George Kull Jr., 56, a millwright who worked for three decades at the steel mills in Lackawanna, N.Y. Three weeks after learning that his plant was closing, he suddenly collapsed at home.
Less than two hours later, he was pronounced dead.
A few weeks after that, a co-worker, Bob Smith, 42, a forklift operator with four young children, started having chest pains. He learned at the doctor’s office that he was having a heart attack. Surgeons inserted three stents, saving his life.
Less than a month later, Don Turner, 55, a crane operator who had started at the mills as a teenager, was found by his wife, Darlene, slumped on a love seat, stricken by a fatal heart attack.
It is impossible to say exactly why these men, all in relatively good health, had heart attacks within weeks of one another. But interviews with friends and relatives of Mr. Kull and Mr. Turner, and with Mr. Smith, suggest that the trauma of losing their jobs might have played a role.
“He was really, really worried,” George Kull III said of his father. “With his age, he didn’t know where he would get another job, or if he would get another job.”
A growing body of research suggests that layoffs can have profound health consequences. One 2006 study by a group of epidemiologists at Yale found that layoffs more than doubled the risk of heart attack and stroke among older workers. Another paper, published last year by Kate W. Strully, a sociology professor at the State University of New York at Albany, found that a person who lost a job had an 83 percent greater chance of developing a stress-related health problem, like diabetes, arthritis or psychiatric issues.
In perhaps the most sobering finding, a study published last year found that layoffs can affect life expectancy. The paper, by Till von Wachter, a Columbia University economist, and Daniel G. Sullivan, director of research at the Federal Reserve Bank of Chicago, examined death records and earnings data in Pennsylvania during the recession of the early 1980s and concluded that death rates among high-seniority male workers jumped by 50 percent to 100 percent in the year after a job loss, depending on the worker’s age. Even 20 years later, deaths were 10 percent to 15 percent higher. That meant a worker who lost his job at age 40 had his life expectancy cut by a year to a year and half.
Additional investigation is still needed to understand the exact connection between job loss and poor health, according to scientists. The focus is mostly on the direct and indirect effects of stress. Acute stress can cause biochemical changes that trigger heart attacks, for example. Job loss and chronic stress can also lead to lifestyle changes that damage health.
Studies have, for instance, tied job loss to increased smoking and greater chances of former smokers relapsing. Some laid-off workers might start drinking more or exercising less. Increased prevalence of depression has been tied to both job loss and the development of heart disease.
“We’re just at the very beginning of studying pathways,” said William T. Gallo, a professor of epidemiology and biostatistics at Hunter College in New York. “We want to find out how we can intervene so we can lessen the effects of job loss, or eliminate them.”
The anxiety among the 260 workers at the ArcelorMittal steel plant in Lackawanna, just south of Buffalo, actually began months, even years, before the company announced in mid-December 2008 that it was closing. Bethlehem Steel, the previous owner, had shut the main steel mill in 1985. After it shuttered the coke ovens across the street from the galvanizing mill in 2001, two workers committed suicide.
Bethlehem went bankrupt in 2003, passing the galvanizing operation on to International Steel Group, which merged with ArcelorMittal in 2005. Workers had been fighting to preserve their jobs ever since.
Even before the plant finally closed last April, Anthony Fortunato, president of Local 2604 of the United Steelworkers of America, counted at least a half-dozen workers who had coronary problems dating to 2006.
A 2009 study led by Sarah A. Burgard, a professor of sociology and epidemiology at the University of Michigan, found that “persistent perceived job insecurity” was itself a powerful predictor of poor health and might even be more damaging than actual job loss.
Nevertheless, it was not until after company officials announced that the Lackawanna plant was closing that any of the workers actually died from a heart attack.
The news of the closing hit Mr. Kull hard, according to his family. He had always been a drinker, but now he was drinking almost every night and seemed depressed.
“He was going out and trying to forget about all of this stuff,” his son said.
Mr. Kull, who was 5-foot-8 and a stocky 200 pounds, had a history of high blood pressure but had passed his company physical the year before, including a stress test. On Dec. 28, 2008, he sat down to watch a Buffalo Bills game and have a few drinks. He got up to make dinner but collapsed on the sofa.
Weeks later, his co-worker, Mr. Smith, thought he might have pulled a muscle while raking snow off the roof when he started having chest pains in bed. It did not cross his mind, he said, that he might be having a heart attack. He had no problems with his blood pressure, his cholesterol was low and he was in decent shape, often playing hockey with his boys on their backyard rink.
But his wife, Kim, watched as he tossed and turned at night, fretting about whether he would find a job that paid as much as his position at the mills. When he was still feeling uncomfortable the next day, she made him see a doctor.
“I think the stress just got to him,” she said.
Mr. Turner’s wife, Darlene, noticed that he was smoking more after he learned about the plant closing. He was up to more than two packs a day, from a little over a pack. She also saw that he seemed to be laboring more when he exerted himself.
About the same time, they found out that her hours had been cut at her accounting job, to just one day a week. Still, he kept his worries to himself. At his funeral she learned from colleagues that he had been asking for Tums at work.
“My husband was the type of person that just kept everything inside,” Mrs. Turner said.
She came home on Feb. 13, 2009, and found her husband sitting on the love seat, his hat and gloves still on.
At first she thought he had fallen asleep.