Association Between Area-level Risk of Job Instability and Workers’ Health: A Multi-level Analysis Using Population-based Survey Data From Japan

Abstract

Background: Precarious job status is negatively related with workers' health. Research has yet to address whether and to what extent the area-level risk of precarious employment is associated with workers' health, independently from their job status. We addressed this issue in the present study. Methods: We estimated multi-level logistic regression models using repeated cross-sectional data comprising 253,048 men and 210,761 women aged 20-59 years who were living in 47 prefectures. This data were obtained from population-based surveys conducted in 2010, 2013, and 2016 in Japan. Results: For male workers, the estimated odds of reporting poor self-rated health, subjective symptoms, and problems in activities of daily living for those residing in the prefectures in the highest tertile of the proportion of precarious employees were 1.10 (95% confidence interval [CI], 1.01-1.18), 1.12 (95% CI, 1.05-1.19), and 1.15 (95% CI, 1.04-1.28) times, respectively, higher than those living in the prefectures in the lowest tertile, even after controlling for individuals' job status and key covariates. The results remained largely similar, despite focusing on the sample with information about household income, which was available from the survey, and controlling for it. In contrast, the results indicated that women's health outcomes were not associated with the prefecture-level proportion of precarious employees. Conclusions: The area-level risk of precarious employment matters for male workers' health independently from their job status, underscoring the importance of policy measures aimed to reduce the adverse impacts of precarious employment on workers' health.