Employment quality and mortality in Canada

BACKGROUND: Research has shown that workers in non-standard (eg, temporary and part-time) employment experience poorer health outcomes than their permanent, full-time counterparts. However, previous studies have overlooked important differences in the quality of non-standard employment. To address this gap, we examined associations between a diverse typology of employment quality and mortality in Canada. METHODS: The 2006 Canadian Health and Environment Cohort (n=2 805 550) was linked to death records from 2006 to 2019. Employment quality was assessed according to an empirical typology describing five distinct employment arrangements: standard (secure and gainful), portfolio (demanding but gainful), marginal (limited hours and earnings), intermittent (sporadic and unstable) and precarious (insecure and low paying). Poisson regression models estimated covariate-adjusted associations between employment quality, all-cause and cause-specific (cancer, cardiovascular and unintentional injury) mortality, by sex/gender. RESULTS: We observed a graded association between employment quality and mortality. Mortality rates were lowest among workers in standard and portfolio employment. Mortality rates were highest among workers in precarious employment, with workers in marginal and intermittent employment occupying intermediate positions along the risk gradient. Associations varied by sex/gender, with larger absolute and relative mortality inequalities among men. CONCLUSIONS: Our findings reinforce the need to move away from a binary view of jobs as either 'standard' or 'precarious', encouraging a more nuanced understanding of contemporary employment arrangements and their health-related consequences. Policy interventions that promote access to high-quality jobs and protect workers exposed to precarious employment may yield substantial improvements in population health, including longevity.