Does persistent precarious employment affect health outcomes among working age adults? A systematic review and meta-analysis

Abstract

ObjectiveTo evaluate the impact of persistent precarious employment (lasting 12+ months) on the health of working age adults, compared with more stable employment. Persistent precarity reflects a shift towards less secure forms of employment and may be particularly important for health.MethodsNine databases were systematically searched to identify quantitative studies that assessed the relationship between persistent precarious employment and health outcomes. Risk of bias (RoB) was assessed using an adaptation of the Effective Public Health Practice Project tool. Narrative synthesis and random effects meta-analysis were conducted. Certainty of evidence was assessed using the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach.ResultsOf 12 940 records screened, 50 studies met the inclusion criteria and 29 were included in meta-analyses. RoB was generally high (n=18). The most reported outcome domain was mental health; with evidence also reported relating to general health, physical health,and health behaviours. Of GRADE assessed outcomes, persistent precarious employment was associated with increased risk of poor self-rated health (OR 1.53, 95% CI 1.09 to 2.14, I2=80%) and mental health symptoms (OR 1.44, 95% CI 1.23 to 1.70, I2=65%). The association with all-cause mortality was imprecisely estimated (OR 1.10, 5% CI 0.91 to 1.33, I2=73%). There was very low GRADE certainty across all outcomes.ConclusionsPersistent precarious employment is associated with poorer health, particularly for outcomes with short time lags, though associations are small and causality is highly uncertain. Further research using more robust methods is needed but given potential health harms of persistent precarious employment, exploration of precautionary labour regulations and employment policies is warranted.

History of Low Hourly Wage and All-Cause Mortality Among Middle-aged Workers

“…Observing higher mortality risk and excess death for the group of employees with sustained low-wage exposure and employment fluctuations aligns with expectations based on prior literature—in particular, findings from studies of precarious employment (often measured using multiple dimensions of poor-quality employment, including instability and low wage), which has been previously shown to be associated with poor physical and mental health outcomes, including mortality . Although the magnitude of association between sustained low-wage exposure and mortality was slightly higher for female than for male workers in this study, observing no evidence of interaction was surprising given that low hourly wage exposure was much higher for female workers (50% had any low-wage exposure vs only 34% of male workers, with 15% vs 4%, respectively, having sustained exposure).…”

“…68 Observing higher mortality risk and excess death for the group of employees with sustained low-wage exposure and employment fluctuations aligns with expectations based on prior literature-in particular, findings from studies of precarious employment (often measured using multiple dimensions of poor-quality employment, including instability and low wage), which has been previously shown to be associated with poor physical and mental health outcomes, [70][71][72][73][74][75][76][77][78] including mortality. 70,74,78,79 Although the magnitude of association between sustained low-wage exposure and mortality was slightly higher for female than for male workers in this study, observing no evidence of interaction was surprising given that low hourly wage exposure was much higher for female workers (50% had any low-wage exposure vs only 34% of male workers, with 15% vs 4%, respectively, having sustained exposure). It could be that male low-wage workers are a higher risk group than female low-wage workers.…”

Precarious work and the covid-19 pandemic: the need for a gender equality focus

“…In 2019, a systematic review and meta-analysis of longitudinal studies found evidence of an association between precarious employment and adverse effects on mental health 17. This was supported by a 2022 systematic review and meta-analysis, which found that persistent precarious employment (for a period of at least 12 months) was associated with poorer mental health and poorer self-rated health 18…”

“…17 This was supported by a 2022 systematic review and meta-analysis, which found that persistent precarious employment (for a period of at least 12 months) was associated with poorer mental health and poorer self-rated health. 18 A 2022 Swedish registry study of over 1.5 million people examined trajectories of precarious employment over five years and found that constant precarious employment (as well as constant borderline precarious employment) was associated with increased risk of stroke and myocardial infarction among men. 19 Constant low or very low income was associated with increased risk of stroke and myocardial infarction in both men and women.…”

Association between precarious employment and the onset of depressive symptoms in men and women: a 13-year longitudinal analysis in Korea (2009–2022)

“…Previous studies have associated PE with various adverse health outcomes, including poor self-rated health (Pulford et al, 2022), cardiovascular diseases (Matilla-Santander et al, 2022) and all-cause mortality (Matilla-Santander et al, 2023). Alongside physical conditions, PE is closely associated with mental health.…”