Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, United States of America.
Department of Sociology and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, United States of America.
Prev Med. 2020 Aug;137:106129. doi: 10.1016/j.ypmed.2020.106129. Epub 2020 May 18.
The recent rise in U.S. midlife mortality has been conceptualized as a "working-class" crisis, defined by increasing mortality among blue-collar and/or unemployed workers and the decline of manual labor; yet research on the topic overwhelmingly focuses on educational attainment as the key socioeconomic determinant of midlife mortality, especially among "despair"-related deaths. The present study addresses this gap by using data on 360,146 adults ages 25-64 from restricted-use National Health Interview Survey-Linked Mortality Files (1997-2015; average follow-up 9.87 years) to estimate associations between individuals' occupation and employment status and alcoholic liver disease, suicide, or accidental poisoning mortality risk, net of confounders. Adults in service, manual labor, and transport occupations exhibited two-to-three times the risk of mortality from accidental poisonings compared to those in managerial/administrative positions. Notably, health professionals exhibited the highest accidental poisoning mortality risks. Relative to managerial/administrative professionals, adults not in the labor force had double the suicide risk and nearly seven times the accidental poisoning risk, net of confounders. Unemployed adults and those having never worked also had elevated risks from accidental poisoning mortality. Critically, the fact that individuals' occupations and employment status are independently associated with midlife mortality due to deaths of despair - especially accidental poisoning - highlights the need for measures of socioeconomic status beyond educational attainment and income in understanding rising midlife mortality. Moreover, policies addressing working-aged mortality must target particular workplace contexts and the consequences of unemployment, both of which affect a large and growing segment of the working-aged U.S. population.
美国中年死亡率的近期上升被认为是一场“工人阶级”危机，其特点是蓝领和/或失业工人的死亡率上升，以及体力劳动的减少；然而，关于这一主题的研究绝大多数都将教育程度作为中年死亡率的关键社会经济决定因素，尤其是在与“绝望”相关的死亡方面。本研究通过使用来自受限使用的国家健康访谈调查-相关死亡率文件（1997-2015 年；平均随访 9.87 年）的 360146 名 25-64 岁成年人的数据来解决这一差距，以估计个体的职业和就业状况与酒精性肝病、自杀或意外中毒死亡率之间的关联，在排除混杂因素后。从事服务、体力劳动和运输职业的成年人因意外中毒而死亡的风险是处于管理/行政职位的成年人的两到三倍。值得注意的是，卫生专业人员表现出最高的意外中毒死亡率风险。与管理/行政专业人员相比，未就业的成年人自杀风险增加一倍，意外中毒风险增加近七倍，在排除混杂因素后。失业成年人和从未工作过的成年人也有较高的意外中毒死亡风险。至关重要的是，个体的职业和就业状况与因绝望而导致的中年死亡率（尤其是意外中毒）独立相关，这突出表明，在理解中年死亡率上升时，除了教育程度和收入之外，还需要衡量社会经济地位的措施。此外，针对工作年龄段成年人死亡率的政策必须针对特定的工作场所环境和失业的后果，这两者都影响到美国工作年龄段人口中一个庞大且不断增长的群体。
