Occupational Disparities Research Articles

Challenges with misclassification of American Indian/Alaska Native race and Hispanic ethnicity on death records in North Carolina occupational fatalities surveillance.

As frequently segregated and exploitative environments, workplaces are important sites in driving health and mortality disparities by race and ethnicity. Because many worksites are federally regulated, US workplaces also offer opportunities for effectively intervening to mitigate these disparities. Development of policies for worker safety and equity should be informed by evidence, including results from research studies that use death records and other sources of administrative data. North Carolina has a long history of Black/white disparities in work-related mortality and evidence of such disparities is emerging in Hispanic and American Indian/Alaska Native (AI/AN) worker populations. The size of Hispanic and AI/AN worker populations have increased in North Carolina over the last decade, and North Carolina has the largest AI/AN population in the eastern US. Previous research indicates that misidentification of Hispanic and AI/AN identities on death records can lead to underestimation of race/ethnicity-specific mortality rates. In this commentary, we describe problems and complexities involved in determining AI/AN and Hispanic identities from North Carolina death records. We provide specific examples of misidentification that are likely introducing bias to occupational mortality disparity documentation, and offer recommendations for improved data collection, analysis, and interpretation. Our primary recommendation is to build and maintain relationships with local community leadership, so that improvements in the ascertainment of race and ethnicity are grounded in the lived experience of workers from communities of color.

Occupational disparities in COVID-19 vaccine hesitancy in Japan

BackgroundWe examined occupational disparities in COVID-19 vaccine hesitancy in Japan. MethodsCross-sectional online surveys were conducted among of residents living in Iwate Prefecture from July 2 to 4 and from October 1 to 3 in 2021 (total n=17,914). Intention to get vaccinated for COVID-19 was assessed by self-report questions. We calculated odds ratios for vaccine hesitancy among occupational groups using logistic regression models controlling for covariates and stratified by age and sex groups. ResultsThe overall prevalence of vaccine hesitancy was 5.5% in our sample of working-age adults. Women <40 years were also 1.6 times more likely to be vaccine hesitant, citing concerns about adverse effects on pregnancy or breastfeeding. Among people aged 40–59 years, workers in the service industry, manufacturing industry, and the unemployed were significantly more likely to have perceived vaccine hesitancy regardless of sex. Young service workers viewed themselves as being more vulnerable to risk of infection but less susceptible to getting severe disease, whilst exhibiting low levels of vaccine knowledge. Middle-aged (40–59 years) workers in the manufacturing industry underestimated both vulnerability to infection and disease severity, as well as demonstrated low knowledge of vaccines and practice of preventive measures. ConclusionsWhile complex and heterogeneous reasons for COVID-19 vaccine hesitancy have been cited in Western countries (e.g., mistrust of government, medical mistrust, and conspiracy beliefs), the situation in Japan may be more amenable to educational interventions targeting specific occupations. Policymakers should target interventions for increasing vaccine readiness in high risk occupations.

Experiences of U.S. Nurses Compared With Nonnurses in the First Year of COVID-19: Findings From a National Registry.

Nursing professional organizations and media sources indicated early in the pandemic that the physical and psychological effects of COVID-19 might be distinct and possibly greater in nurses than in other types of healthcare workers (HCWs). Based on survey data collected in Healthcare Worker Exposure Response and Outcomes (HERO), a national registry of U.S. HCWs, this study compared the self-reported experiences of nurses with other HCWs during the first 13 months of the pandemic. Nurse responses were compared to responses of nonnurse HCWs in terms of viral exposure, testing and infection, access to personal protective equipment (PPE), burnout, and well-being. Logistic regression models were used to examine associations between nurse and nonnurse roles for the binary end points of viral testing and test positivity for COVID-19. We also examined differences by race/ethnicity and high-risk versus low-risk practice settings. Of 24,343 HCWs in the registry, one third self-identified as nurses. Nurses were more likely than other HCWs to report exposure to SARS-CoV-2, problems accessing PPE, and decreased personal well-being, including burnout, feeling tired, stress, trouble sleeping, and worry. In adjusted models, nurses were more likely than nonnurse HCWs to report viral testing and test positivity for COVID-19 infection. Nurses in high-risk settings were more likely to report viral exposure and symptoms related to well-being; nurses in low-risk settings were more likely to report viral testing and test positivity. Black or Hispanic nurses were most likely to report test positivity. Differences were identified between nurses and nonnurse HCWs in access to PPE, physical and mental well-being measures, and likelihood of reporting exposure and infection. Among nurses, testing and infection differed based on race and ethnicity, and type of work setting. Our findings suggest further research and policy are needed to elucidate and address social and occupational disparities.

Paying for Work-Family Balance: Assessing the Role of Family-Friendly Job Amenities in Occupational Segregation

Workers in female-dominated occupations earn less, on average, than workers in comparable male-dominated occupations. To explain the gendered occupational wage disparity, com pensating differentials theory focuses on women’s preferences and asserts that women cluster in occupations that pay less in exchange for family-friendly job amenities. On the other hand, the devaluation perspective argues these wage discrepancies are the result of the cultural devaluation of women’s work that leads to both lower wages and a lower likelihood of having job amenities. Using data from the 2017–2018 American Time Use Survey Leave Module, I examine whether workers in female-dominated occupations are indeed more likely to have access to family-friendly job amenities. I focus on workers’ access to three contemporary family-friendly job amenities: paid leave, remote work, and flexible scheduling. I find that workers in female-dominated jobs are no more likely to have access to family-friendly job amenities than workers in male-dominated jobs. Additionally, family-friendly job amenities are associated with higher wages, not the lower wages as compensating differentials posits. These findings suggest that compensating differentials theory cannot explain the clustering of women in lower-paying occupations.

Social stratification in meaningful work: Occupational class disparities in the United Kingdom.

Sociologists have long been interested in the meaning workers derive from their jobs. The issue has garnered increasing academic and policy attention in recent years with the concept of “meaningful work,” yet little is known about how social stratification relates to access to it. This paper addresses this issue by exploring how the meaningfulness of jobs—as rated by their incumbents—is stratified across classes and occupations in a national survey of 14,000 working adults in the United Kingdom. It finds modest differentials between classes, with those in routine and manual occupations reporting the lowest levels of meaningfulness and those in managerial and professional occupations and small employers and own account workers reporting the highest levels. Detailed job attributes (e.g., job complexity and development opportunities) explain much of the differences in meaningfulness between classes and occupations, and much of the overall variance in meaningfulness. The main exception is the specific case of how useful workers perceive their jobs to be for society: A handful of occupations relating to health, social care, and protective services which cut across classes stand out from all other occupations. The paper concludes that the modest stratification between classes and occupations in meaningful work is largely due to disparities in underlying job complexity and development opportunities. The extent to which these aspects of work can be improved, and so meaningfulness, especially in routine and manual occupations, is an open, yet urgent, question.

Why we should monitor disparities in old-age mortality with the modal age at death.

Indicators based a fixed “old” age threshold have been widely used for assessing socioeconomic disparities in mortality at older ages. Interpretation of long-term trends and determinants of these indicators is challenging because mortality above a fixed age that in the past would have reflected old age deaths is today mixing premature and old-age mortality. We propose the modal (i.e., most frequent) age at death, M, an indicator increasingly recognized in aging research, but which has been infrequently used for monitoring mortality disparities at older ages. We use mortality and population exposure data by occupational class over the 1971-2017 period from Finnish register data. The modal age and life expectancy indicators are estimated from mortality rates smoothed with penalized B-splines. Over the 1971-2017 period, occupational class disparities in life expectancy at 65 and 75 widened while disparities in M remained relatively stable. The proportion of the group surviving to the modal age was constant across time and occupational class. In contrast, the proportion surviving to age 65 and 75 has roughly doubled since 1971 and showed strong occupational class differences. Increasing socioeconomic disparities in mortality based on fixed old age thresholds may be a feature of changing selection dynamics in a context of overall declining mortality. Unlike life expectancy at a selected fixed old age, M compares individuals with similar survival chances over time and across occupational classes. This property makes trends and differentials in M easier to interpret in countries where old-age survival has improved significantly.

Occupational disparities in survival from common cancers in Japan: Analysis of Kanagawa cancer registry

BackgroundLittle is known about occupational disparities in survival for common cancer sites in Japan. MethodsUsing data from a population-based cancer registry, we identified 32,870 cancer patients diagnosed during 1992–2011. We followed the patients for 5 years (median follow-up time 5.0 years). For each individual, we classified their longest-held occupation into 5 classes (upper non-manual, lower non-manual, manual, farmer, and others) following the Erikson-Goldthorpe-Portocarero scheme. Poisson regression models were used to estimate overall and site-specific mortality rate ratios (MRRs) and 95% confidence intervals (CI) for each occupational class, adjusted for sex, age, and diagnosis year. Upper non-manual workers served as the reference group. Additionally, using a binary categorization of occupations (manual workers versus non-manual workers), a causal mediation analysis with 4-way decomposition was performed to investigate the potential mediation of the association between occupation and overall mortality by cancer stage. ResultsOverall prognosis was good in this population (5-year overall survival was 81.7%). Compared with upper non-manual workers, both overall and cancer-specific mortality was higher in lower non-manual workers (MRR=1.14, 95% CI 1.05–1.24) and manual workers (MRR=1.40, 95% CI 1.29–1.53). After adjusting for the mediating influence of prognostic factors (stage and treatment), the observed occupational differences were attenuated but remained significant in manual workers: MRR = 1.23 (95% CI 1.08–1.39). Observed occupational disparities tended to be attributable to common cancers, i.e., stomach and lung among men and female breast cancer. Additionally, manual workers had 1.25 times higher odds for advanced stage. In the mediation analysis, the overall proportion explained by mediating effect of cancer stage was 29% (4% due to mediated interaction and 25% due to pure indirect effect). ConclusionWe documented occupational disparities in survival from commonly-occurring cancers in Japan. Occupational differences in cancer stage may explain one-third of the survival disparities.

Occupational disparities in tumor grade and cytosolic HMGB1 expression in renal cell cancer.

ObjectivesWe sought to examine occupational disparities in tumor grade and cytosolic expression of high‐mobility group box‐1 (HMGB1) among renal cell cancer (RCC) patients.MethodsThis retrospective study included 318 RCC patients with complete information on occupation and pathology in Kanagawa Cancer Registry (KCR). Longest‐held occupations were grouped into manual workers (e.g., manufacturing, construction) versus “others.” Odds ratios (OR) and 95% confidence intervals (CI) for high‐grade histology were estimated by logistic regression, adjusted for age and sex. We also examined a sub‐sample of 74 low‐grade RCC inpatients to estimate the OR for positive cytosolic HMGB1 expression in manual workers, adjusting for age, sex, and other available covariates.ResultsHigh‐grade tumors were more prevalent in manual workers compared to other occupations: 23.0% (14/61) versus 10.9% (28/257, p = .01) with an adjusted OR of 2.28 (95% CI, 1.11–4.69). In the sub‐sample of low‐grade RCCs, positive cytosolic HMGB1 expression was more prevalent in manual workers compared to other occupations: 71.4% (10/14) versus 38.3% (23/60, p = .03) with a sex‐ and age‐adjusted OR of 3.76 (95% CI, 1.03–13.7).ConclusionsManual workers are associated with increased risks of high‐grade renal cell tumors and cytosolic HMGB1 expression.

Occupational Disparities in COVID-19 Vaccine Hesitancy in Japan

Occupational Disparities in COVID-19 Vaccine Hesitancy in Japan

Occupational Characteristics in the Outbreak of the COVID-19 Delta Variant in Nanjing, China: Rethinking the Occupational Health and Safety Vulnerability of Essential Workers.

The risk of contracting COVID-19 varies by occupation. Clarifying the occupational disparity in the infection risk is crucial to the prevention and control of the epidemic in the workplace. In late July, some new cases of COVID-19 were confirmed among cleaners working in Lukou International Airport in Nanjing, China. The infected cases rapidly increased and spread to many domestic cities in the following days. The present study traces the brief reports of epidemiological investigations among the confirmed cases released by the Nanjing government from 20 July to 2 August, and offers a descriptive analysis on the occupational distribution of these cases. Cleaners and other staff working in the airport were found to make up more than 40% of all cases. The overwhelming majority of the cleaner cases were confirmed in the first 7 days. The present study statistically ascertains that the airport cleaners were the initial sufferers and transmitters in this outbreak. They experienced occupational health and safety vulnerability on both individual and contextual levels, including workplace hazards, workplace safety policies, and lack of awareness and empowerment. Effective protection for essential workers and the strict surveillance of occupational health in the workplace is urgently needed.

Socioeconomic, Psychosocial, and Clinical Factors Associated With Employment in Women With HIV in the United States: A Correlational Study.

Employment is a social determinant of health, and women living with HIV (WLWH) are often underemployed. This correlational study examined the socioeconomic, psychosocial, and clinical factors associated with employment among WLWH (n = 1,357) and women at risk for HIV (n = 560). Descriptive and inferential statistics were used to evaluate factors associated with employment status. Employment was associated (p ≤ .05) with better socioeconomic status and quality of life (QOL), less tobacco and substance use, and better physical, psychological, and cognitive health. Among WLWH, employment was associated (p ≤ .05) with improved adherence to HIV care visits and HIV RNA viral suppression. Using multivariable regression modeling, differences were found between WLWH and women at risk for HIV. Among WLWH, household income, QOL, education, and time providing childcare remained associated with employment in adjusted multivariable analyses (R2 = .272, p < .001). A better understanding of the psychosocial and structural factors affecting employment is needed to reduce occupational disparities among WLWH.

Occupational Characteristics and Management Measures of Sporadic COVID-19 Outbreaks From June 2020 to January 2021 in China: The Importance of Tracking Down "Patient Zero".

There are occupational disparities in the risk of contracting COVID-19. Occupational characteristics and work addresses play key roles in tracking down “patient zero.” The present descriptive analysis for occupational characteristics and management measures of sporadic COVID-19 outbreaks from June to December 2020 in China offers important new information to the international community at this stage of the pandemic. These data suggest that Chinese measures including tracking down “patient zero,” launching mass COVID-19 testing in the SARS-CoV-2-positive areas, designating a new high- or medium-risk area, locking down the corresponding community or neighborhood in response to new COVID-19 cases, and basing individual methods of protection on science are effective in reducing the transmission of the highly contagious SARS-CoV-2 across China.

Understanding the Role of Work in Mortality: Making the Best Use of Available US Death Certificate Occupation Data and Opportunities for Improvements.

Occupational disparities in mortality are a concern in public health. Understanding these disparities is important for identifying high-risk occupations for intervention and occupational factors that may be contributing to high risk for primary prevention. Using data from death certificates is a useful strategy for tracking occupational disparities in mortality. There are a number of challenges associated with working with this data. This paper describes how to access death certificate data, code occupational information from these death certificates, calculate mortality rates by occupation, and combine death certificate data with data from other sources. Limitations of existing death certificate occupation data are described along with recommendations about how to improve the collection of occupation information for death certificates. Finally, a proposal for the development of a national occupational mortality surveillance system is presented.

Gender-Stratified Labor Market, Heterosexual Marriage Expectation, and LGBQ Young Adults’ Career Plans in Contemporary Japan

Previous U.S. studies showed that many lesbian, gay, bisexual, and queer (LGBQ) young adults hold optimistic views about their occupational careers, despite their risk for facing labor market disadvantages as LGBQ workers. The present study uses Japan as a comparison case and illustrates how young LGBQ people plan their careers in a different national context. Analysis of in-depth interviews shows that many LGBQ young adults in Japan anticipate financial insecurity and consequently prioritize stability over pursuit of personal interests in their career planning. Their career concerns vary by gender and represent their responses to high levels of occupational gender segregation and earnings inequality as well as strong social expectations for heterosexual marriage and gendered division of household responsibilities. Overall, the study endorses ongoing efforts to understand occupational and economic disparities across sexuality groups from global perspectives by paying close attention to macro conditions.

A live community growing together: Communal occupation of a senior center welcoming Spanish-speaking elders

ABSTRACT The percentage of Latinx immigrants over the age of 65 in the United States is expected to more than double within the next 30 years. These elders face particular health and occupational disparities emerging from a transaction of individual and sociocultural factors that warrants attention by both service providers and researchers. This study employed an ethnographic approach including interviews, observations, document review, and group mapping activities. It sought to explore a county senior center as it evolves toward greater inclusion of Spanish-speaking members who are increasingly agentic in their community occupations despite facing initial constraints. John Dewey’s philosophy is employed alongside critical theoretical perspectives to illuminate the juxtaposition of individual vulnerability and agency interwoven with structural elements. The communal growth experienced by the senior center and the Spanish-speaking elders is characterized by social relationships that transform, and are transformed by, shared occupation. For occupational scientists, the results offer an expanded understanding of communal occupation and its influence on community change, in this case focused on a marginalized population integrating into dominant cultural spaces and practices.

Occupational disparities in survival in Korean women with cancer: a nationwide registry linkage study.

ObjectivesWe sought to examine occupational disparities in survival among Korean women diagnosed with cancer.DesignPopulation-based, registry-linkage study.SettingSouth Korea.ParticipantsOur study population comprised female workers registered in the Korean national employment insurance programme during 1995–2000 and diagnosed with cancer between 1995 and 2008. A total of 61 110 women with cancer diagnoses was included in analysis. The occupation was categorised into four groups: (1) managers, professionals and technical workers, (2) clerks, (3) service/sales workers and (4) blue-collar workers.Primary and secondary outcome measureStudy population were linked to the national death registry until 2009. HRs for mortality adjusting for age and year of diagnosis were calculated in the study sample and subgroups with 10 specific cancer sites including thyroid, breast, stomach, cervix, colon or lung cancer using managers, professionals and technical workers as the reference.ResultsWomen in service/sales (HR 1.25, 95% CI 1.15 to 1.35) and blue-collar occupations (HR 1.34, 95% CI 1.25 to 1.44) had poorer survival for all cancer sites combined, while blue-collar workers showed poorer survival for lung (HR 1.41, 95% CI 1.14 to 1.77), breast (HR 1.28, 95% CI 1.06 to 1.54), cervical cancer (HR 1.42, 95% CI 1.02 to 2.06) and non-Hodgkin’s lymphoma (HR 1.69, 95% CI 1.09 to 2.77) compared with women in professional and managerial positions.ConclusionWe found substantial and significant inequalities in overall survival by the occupational group among Korean women with cancer, even in the context of universal access to cancer screening and treatment.

Cardiovascular Health Risk Behaviors by Occupation in the NYC Labor Force.

We explored associations between occupation and cardiovascular disease (CVD) risk behaviors including: attempted weight loss, physical activity, smoking, and restaurant meal and sugary beverage consumption. We used NYC Health and Nutrition Examination Survey 2013 to 2014 data, and coded free-text, occupational question responses using 2010 US Census Bureau Classification. CVD risk behaviors were compared across occupational categories, using regression to adjust for demographics. There were health behavior differences across occupational categories. Construction/transportation/maintenance workers smoked more and were less likely than management to attempt weight loss, service workers were less likely to eat restaurant-prepared meals, sales/office workers were less likely to be physically active (all P < 0.05). Adjusting for demographics, differences in health behaviors were reduced, but remained present. Knowledge of occupational disparities may aid chronic disease prevention by identifying populations for targeted interventions.

Abstract A116: Occupational disparities in women’s employment after cancer

Abstract Background: Due to advances in early diagnosis and treatment, the population of working-age cancer survivor population has grown. However, few studies have examined long-term (10+ years) employment outcomes after treatment. We evaluated the impact of cancer on employment outcomes among women enrolled in the Health and Retirement Study (HRS), a nationally representative panel of non-institutionalized adults aged 51 and older in the United States Methods: Data came from nine waves of the HRS (1998-2014) (n = 7,088; Observations = 26,355). We conducted two sets of analyses: The first set of analyses examined the impact of cancer on employment status and the second set of analyses examined the impact of cancer on the number of work hours for women who were working full time (≥ 35 hours per typical work week) at baseline. For the analysis of employment status, we used a random intercept logistic regression in a multi-level growth curve framework to analyze change over time in likelihood of employment. For the analysis of hours of work per week, we used a mixed-effects coefficient regression to assess work hours trajectories in relation to cancer. Results: There were 7,088 working-age (51-64 years) women in the study sample. Approximately 7% (n=483) of the sample were cancer survivors, with a mean number of years since diagnosis of 9 years. After controlling for sociodemographic and health factors, women who were 6-10 year cancer survivors had a 2.3 times greater likelihood of being employed over time than women without a history of cancer; however, if these women had professional jobs, they were less likely to work over time (OR = 0.4) than professional women without a history of cancer. Long-term (10+ year) cancer survivors in professional occupations tended to work less hours per week at baseline (-4.1 hours) and over time (-2.4 hours) than professional women who without a history of cancer. Conclusions: Professional women may be vulnerable to job loss after cancer treatment. Identifying factors associated with continued employment for women will be key to developing strategies to promoting quality survivorship in the growing cancer survivor population. Citation Format: Christine Ekenga, Eunsun Kwon, BoRin Kim, Sojung Park. Occupational disparities in women’s employment after cancer [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A116.

Occupational inequality in health expectancy in Denmark.

Background: The pension age in Denmark is adjusted in line with projected increasing life expectancy without taking health differentials between occupational groups into account. The purpose was to study occupational disparities in partial life expectancy and health expectancy between the ages of 50 and 75. Methods: Register data on occupation and mortality were combined with data from the Danish part of Survey of Health, Ageing and Retirement in Europe in 2010-2014 (N=3179). Expected lifetime without and with activity limitations and without and with long-term illness was estimated by Sullivan's method and comparisons made between four occupational groups. Results: We found clear differences between occupational groups. Expected lifetime without activity limitations between the ages of 50 and 75 was about 4.5 years longer for men and women in high skilled white-collar occupations than for men and women in low skilled blue-collar occupations. Men in high skilled blue-collar and low skilled white-collar occupations could expect 2.3 and 3.8 years shorter lifetimes without activity limitations, respectively, than men in high skilled white-collar occupations. For women in low skilled white-collar occupations, lifetime without activity limitations was 2.6 years shorter than for women in high skilled white-collar occupations. Due to few observations, no results were obtained for women in the high skilled blue-collar group. The social gradient was also significant when health was measured by years without long-term illness. Conclusions: The results support implementation of a flexible pension scheme to take into account the health differentials between occupational groups.

Inter-regional occupational disparities in Indian manufacturing sector with regards to socioeconomic labour attributes

ABSTRACTFavouritism and discrimination reduce labour force diversification while driving unequal growth. The incidence of these practices increases the probability of securing employment for some people irrespective of their individual capabilities, leading to non-inclusive growth. In India, employment in certain sectors is determined by the personal, familial, social, cultural, and demographic traits of individuals. This study attempts to analyse how the socio-economic attributes of individuals affect their employability in a particular sector or kind of work, with a special focus on the Indian manufacturing sector. The study utilises unit-level data from the fourth (2013–14) and fifth (2015–16) rounds of the annual Employment and Unemployment Surveys (EUS) by the Government of India. Logistic regression analysis was undertaken to analyse employment probabilities in the manufacturing sector. We found that location and caste are more important than education and gender in determining an individual’s probability of gaining employment in the Indian manufacturing sector. The overall results from the model show that all the selected independent variables have a significant impact on the probability of getting jobs in the manufacturing sector.