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

Pulford, A., Thapa, A., Thomson, R. , Guilding, A., Green, M. , Leyland, A. H. , Popham, F. and Katikireddi, S. V. (2022) Does persistent precarious employment affect health outcomes among working age adults? A systematic review and meta-analysis. Journal of Epidemiology and Community Health, 76(11), pp. 909-917. (doi: 10.1136/jech-2022-219292) (PMID:36137738) (PMCID:PMC9554022)

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Objective: To 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. Methods: Nine 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. Results: Of 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. Conclusions: Persistent 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.

Item Type:Articles
Additional Information:Funding: AP, RMT, AG, MJG, AL and SVK acknowledge funding from the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). SVK acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02).
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Pulford, Andrew and Popham, Dr Frank and Leyland, Professor Alastair and Guilding, Annette and Green, Dr Michael and Thomson, Dr Rachel
Authors: Pulford, A., Thapa, A., Thomson, R., Guilding, A., Green, M., Leyland, A. H., Popham, F., and Katikireddi, S. V.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Journal of Epidemiology and Community Health
Publisher:BMJ Publishing Group
ISSN (Online):1470-2738
Published Online:22 September 2022
Copyright Holders:Copyright © Author(s) (or their employer(s)) 2022
First Published:First published in Journal of Epidemiology and Community Health 76(11): 909-917
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
3048230011Complexity in healthSharon SimpsonMedical Research Council (MRC)MC_UU_00022/1HW - MRC/CSO Social and Public Health Sciences Unit
3048230071Inequalities in healthAlastair LeylandOffice of the Chief Scientific Adviser (CSO)SPHSU17HW - MRC/CSO Social and Public Health Sciences Unit
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02SHW - Public Health