Vanderleyden Julie, Peckham Trevor, Balogh Rebeka, De Moortel Deborah
Brussels Institute for Social and Population Studies (BRISPO), Vrije Universiteit Brussel, Brussels, Belgium.
Hazardous Waste Management Program, King County, Seattle, Washington, USA.
Am J Ind Med. 2025 Feb;68(2):140-159. doi: 10.1002/ajim.23684. Epub 2024 Dec 15.
The typological approach of the employment quality (EQ) framework offers a comprehensive lens for assessing the heterogeneity of employment experiences while concurrently acknowledging associated health risk factors. EQ incorporates multiple employment characteristics-such as working hours, wages and benefits, and union representation, among others-where standard employment relationship (SER)-like (or high EQ) features are distinguished from nonstandard features (low EQ). Low EQ features are known to relate negatively to health outcomes. Addressing limitations from previous cross-sectional studies, we contribute to longitudinal research on the link between EQ and self-rated general health in the United States. Our objectives are: (1) to investigate the association between baseline EQ and poor self-rated general health 3 years later; and (2) to examine the relation between poor self-rated health and: (a) transitioning from low EQ to SER-like employment (the scarring hypothesis); (b) transitioning from SER-like employment to low EQ (the initial-impact hypothesis); and (c) consistent low EQ status (for example, the dose-response hypothesis).
Using the American Working Conditions Survey (AWCS), baseline and follow-up data on employees' self-rated health was collected (N = 1109). An EQ typology with five categories was created via latent class cluster analysis: SER-like, Instrumental, Precarious Unsustainable, Portfolio; and Precarious Intensive employment. Each EQ segment represents a unique combination of EQ features, with SER-like and Portfolio employment reflecting overall high EQ, while Instrumental, Precarious Unsustainable, and Precarious Intensive reflect varieties of low EQ constellations. We used lagged Poisson regression to link baseline EQ to follow-up self-rated health and Poisson regression to analyze multiple EQ paths between baseline and follow-up and their association with health.
Precarious Unsustainable and Instrumental employment at baseline associated significantly with poor self-rated general health at follow-up. Transitioning from SER-like employment to a low-EQ segment was linked to an increased risk of poor self-rated general health, confirming the initial-impact hypothesis. No evidence was found for the scarring hypothesis. Consistent Instrumental and Precarious Unsustainable employment were both associated with poorer health, underlining the importance of the dose-response effect.
Enhancing EQ is crucial for public health, particularly in the context of limited welfare provisions in the United States. Policy and legislative measures to improve EQ can promote better health outcomes and reduce health disparities within the working population.
就业质量（EQ）框架的类型学方法为评估就业经历的异质性提供了一个全面的视角，同时承认相关的健康风险因素。就业质量包含多种就业特征，如工作时间、工资和福利以及工会代表等，其中类似标准就业关系（SER）（或高就业质量）的特征与非标准特征（低就业质量）有所区别。已知低就业质量特征与健康结果呈负相关。为解决以往横断面研究的局限性，我们为美国就业质量与自评总体健康之间的联系开展纵向研究做出贡献。我们的目标是：（1）调查基线就业质量与3年后自评总体健康状况不佳之间的关联；（2）研究自评健康状况不佳与以下情况之间的关系：（a）从低就业质量转变为类似标准就业关系的就业（疤痕假说）；（b）从类似标准就业关系的就业转变为低就业质量（初始影响假说）；以及（c）持续的低就业质量状态（例如，剂量反应假说）。
利用美国工作条件调查（AWCS），收集了员工自评健康的基线和随访数据（N = 1109）。通过潜在类别聚类分析创建了一个包含五个类别的就业质量类型学：类似标准就业关系、工具性、不稳定不可持续、组合型；以及不稳定高强度就业。每个就业质量类别代表就业质量特征的独特组合，类似标准就业关系和组合型就业反映总体高就业质量，而工具性就业、不稳定不可持续就业和不稳定高强度就业反映各种低就业质量组合。我们使用滞后泊松回归将基线就业质量与随访时的自评健康联系起来，并使用泊松回归分析基线和随访之间的多种就业质量路径及其与健康的关联。
基线时的不稳定不可持续就业和工具性就业与随访时自评总体健康状况不佳显著相关。从类似标准就业关系的就业转变为低就业质量类别与自评总体健康状况不佳的风险增加有关，证实了初始影响假说。未发现支持疤痕假说的证据。持续的工具性就业和不稳定不可持续就业都与较差的健康状况相关，强调了剂量反应效应的重要性。
提高就业质量对公众健康至关重要，尤其是在美国福利 provision 有限的背景下。改善就业质量的政策和立法措施可以促进更好的健康结果，并减少劳动人口中的健康差距。
