In Canada and other high-income countries, rates of suicide, drug poisoning, and alcohol-attributable mortality—sometimes referred to as “deaths of despair”—have increased over time. Recent studies suggest that rising deaths of despair may in part be related to broader socioeconomic conditions, including the trend in the labour market towards increasingly precarious employment.
Based on that insight, a new Institute for Work & Health (IWH) study investigated whether job quality—measured in terms of employment stability, hours and wages—is linked to these causes of deaths. The study, led jointly by Dr. Faraz Vahid Shahidi, IWH scientist, and University of Toronto PhD candidate Alessandra Andreacchi, is freely available in the American Journal of Epidemiology (doi:10.1093/aje/kwaf018).
We know from previous research that low-quality, precarious employment—what some people might call ‘bad jobs’—can have an impact on our health,
says Andreacchi. Our findings show that this type of employment is also a risk factor for suicide, drug poisoning, and alcohol-attributable deaths.
The study examined death rates across five groups of study participants, sorted by differing levels of job quality (see sidebar). People in the category with the highest job quality—labelled “standard” employment—had full-time hours, year-round employment and good pay. Those in the category with the lowest job quality— labelled “precarious” employment—had the lowest hours, stability and earnings. Between these two groups were categories that the researchers labelled "portfolio”, “marginal” and “intermittent” employment.
Compared to those in standard employment, women in precarious jobs had 2.4 times the risk of suicide, 3.6 times the risk of fatal drug poisoning and 1.8 times the risk of alcohol-attributable deaths.
Men in the precarious employment group had 1.7 times the risk of suicide, 2.7 times the risk of fatal drug poisoning and 2.2 times the risk of alcohol-attributable death.
The study also found a gradient across the five groups. That means that as job quality declined, the risk of death from suicide, drug poisoning and alcohol-attributable causes increased. Those in the highest quality, standard jobs had the lowest risks, those in intermediary quality categories (“portfolio”, “intermittent” and “marginal”) had higher risks, and those in the lowest quality, precarious jobs had the highest risks (see sidebar for descriptions of each category and their associated risks).
It is well understood that some jobs don’t allow people to meet their basic needs in life, which can in turn affect their health,
says Shahidi. That’s why we knew we would pick up on some kind of signal. What we didn’t realize was just how strong of a signal we would pick up.
How the study was done
The researchers drew on data from a group of 2.8 million working-aged Canadians who completed the long-form census in 2006 and whose census data were linked to death records between census day in 2006 and the end of 2019.
To sort the respondents by the quality of their employment, the researchers used three indicators: hours (number worked in the previous week), employment stability (weeks employed in the previous year), and earnings (income from wages, salaries or tips). They then used a statistical technique called latent class analysis to identify groups of respondents with similar employment conditions. From the results of this analysis, they grouped respondents into one of five categories of job quality.
Next, the researchers examined the relationship between job quality and risk of deaths related to suicide, drug poisoning, or alcohol-attributed causes. These analyses also included information on race, sex/gender, age, immigrant status, marital status, household size, region of Canada, rurality and education.
Differences in risk between men and women and different age groups
There were nuances in the findings when it came to men and women. While suicide and drug poisoning mortality were more strongly linked to low job quality among women, alcohol-attributable mortality was more strongly linked to low job quality among men. Women are more likely to have to balance multiple, competing demands at work and at home,
says Andreacchi, Gender-based pressures in the labour market may explain why we are seeing these differences in how strongly job quality is linked to suicide and substance use-related deaths.
The researchers also found some age-related differences in these patterns. For example, precarious employment was more strongly associated with these causes of deaths among those between 45 to 64 years of age than those between 18 to 44 years old. To the researchers, this implied that health impacts of low-quality employment may accumulate over time.
This study expands on research concerning the link between employment and health, but it reminds us that the quality of one’s work matters, and not just whether one has a job,
says Shahidi. Our study highlights the continuing need for policies to focus on ensuring that the jobs we create are of good quality.