Employment quality and suicide, drug poisoning, and alcohol-attributable mortality

Suicide, drug poisoning, and alcohol-attributable mortality (SDAM)-often labeled "deaths of despair"-are increasing among working-aged individuals in many high-income countries. We examined the association between employment quality and SDAM in Canada. Census records from the 2006 Canadian Census Health and Environment Cohort (n = 2 805 550) were linked to mortality data from 2006 to 2019. Latent class analysis identified 5 employment quality types: standard (secure and rewarding), portfolio (rewarding but demanding), marginal (limited hours and earnings), intermittent (sporadic and unstable), and precarious (insecure and unrewarding). Poisson regression models estimated sex/gender-stratified associations between employment quality type and SDAM separately. We observed a consistent mortality gradient across employment quality groups, with lower-quality employment-and precarious employment in particular-associated with increased rates of SDAM relative to higher-quality (ie, standard) employment. For example, precarious employment was associated with a more than 3-fold rate of drug poisoning deaths among women (rate ratio [RR] = 3.58; 95% CI, 3.21-4.00) and a more than 2-fold rate of alcohol-attributable death among men (RR = 2.22; 95% CI, 2.07-2.38). Employment quality is an important determinant of SDAM, with varying associations by sex/gender. Improvements in employment conditions may help reduce the burden of premature deaths attributable to suicide and substance use.