Contribution of Occupational Risk Factors to Lifespan Inequalities across Socio-Occupational Groups in France

Abstract

Background and aim: Occupational risk factors can mediate the effect of socioeconomic status on mortality; however, the reduction in social disparities in mortality that could be achieved by modifying employment and working conditions has been under-studied. Our aim was to quantify the role of occupational risk factors (lack of job control, job insecurity, and unemployment; and in men only: occupational physical activity (OPA)) in producing socio-occupational inequalities in lifespan among the French population. Methods: We reviewed the literature on 75 occupational risk factors and selected four of them with a robust all-cause mortality effect size. We used the Health and Career Path survey (SIP-2006) to estimate differential exposures in each French socio-occupational group (SOG) by sex. Then, using the life tables published by The French Institute of Statistics and Economic Studies and developing a method based on population attributable fractions, we estimated loss in life expectancy attributed to workplace exposures by SOG and sex. Results: Based on life expectancy estimated at age 35 and depending on SOG, from one to three years of life lost for men, and from 0.6 to two years for women are attributed to a combination of high OPA, low job control, job insecurity, and unemployment compared to those who had low OPA, high job control, no concerns about job loss and were employed. The difference in life expectancy at age 35 between senior executives and manual workers would have been reduced from 6.3 to 4.4 years for men and from 3.2 to 2.2 years for women if socio-occupational exposures had been set at the theoretical minimum level for the four risk factors. Conclusions: Our results, although based on a limited number of workplace factors due to large data gaps, show that improving employment and working conditions would substantially lessen social inequalities in life expectancies.