Precarious employment and self-reported health: a cross-sectional analysis

Abstract

BackgroundAssociations between precarious employment and poorer health outcomes are well documented. However, which components of this multidimensional construct are associated with adverse health is unknown. The primary aim of this study was to examine associations between the different domains of precarious employment and self-reported health. MethodsWe used data from 1016 respondents (634 women and 382) to the COVID-19 Employment and Health in Wales Study, a nationally representative household survey of the so-called working-age population (18–64 years). The study was done on May 25 and June 22, 2020, using a push-to-web approach (letter invitation to an online survey; response rate: 6·9%). Respondents provided details of their main job in February, 2020, including information on their contract type and different domains of employment precariousness as assessed by the Employment Precariousness Scale. These domains were: temporariness (length of time working under temporary arrangements); disempowerment (control over work schedule); vulnerability (perceived treatment at work); wages (pay and ability to afford basic and unexpected expenses); and rights. Health measures were self-reported pre-existing health conditions, general health, and mental wellbeing (calculated with the Short Warwick Edinburgh Mental Wellbeing Score). To examine associations between domains of precarious employment and health, chi-squared analysis and multinomial logistic regression (adjusted for sex, age, deprivation, contract type, and self-reported health) were done. The Health Research Authority approved this study (Integrated Research Application System reference: 282223). FindingsThe domains of precarious employment that showed the strongest associations with poor health, independently of contract type, were high vulnerability precariousness (associated with pre-existing condition: adjusted odds ratio 2·44 [95% CI 1·32–4·49], p=0·004; poor general health: 2·35 [1·23–4·51], p=0·010; low mental wellbeing: 2·74 [1·30–5·75], p=0·008); high wage precariousness (associated with pre-existing condition: 1·66 [1·08–2·57], p=0·022; poor general health: 2·21 [1·33–3·69], p=0·002; low mental wellbeing: 3·16 [1·54–6·45], p=0·002); and moderate wage precariousness (associated with pre-existing condition: 1·68 [1·20–2·36], p=0·003; and low mental wellbeing: 2·25 [1·19–4·29], p=0·013). InterpretationBefore the COVID-19 pandemic, tackling poverty in those in work and perceived fair treatment in the workplace appear to have been important in improving the health of the working-age population of the UK. Longitudinal analyses are required to establish the effect of the pandemic on employment conditions and on whether these domains remain adversely associated with health. FundingNo funding to declare.