Employment quality and suicide, drug poisoning, and alcohol-attributable mortality

Suicide, drug poisoning, and alcohol-attributable mortality (SDAM) - often labelled 'deaths of despair' - are increasing among working-aged individuals in many high-income countries. We examined the association between employment quality and SDAM in Canada. Census records from the 2006 Canadian Census Health and Environment Cohort (n=2,805,550) were linked to mortality data from 2006-2019. Latent class analysis identified five employment quality types: standard (secure and rewarding), portfolio (rewarding but demanding), marginal (limited hours and earnings), intermittent (sporadic and unstable), and precarious (insecure and unrewarding). Poisson regression models estimated sex/gender-stratified associations between employment quality type and suicide, drug poisoning, and alcohol-attributable deaths separately. We observed a consistent mortality gradient across employment quality groups, with lower-quality employment - and precarious employment in particular - associated with increased rates of SDAM relative to higher-quality (i.e., standard) employment. For example, precarious employment was associated with a more than threefold rate of drug poisoning deaths among women (RR: 3.58, 95% CI: 3.21-4.00) and a more than twofold rate of alcohol-attributable death among men (RR: 2.22, 95% CI: 2.07-2.38). Employment quality is an important determinant of SDAM, with varying associations by sex/gender. Improvements in employment conditions may help to reduce the burden of premature mortality attributable to suicide and substance use