Scottish Longitudinal Study
Development & Support Unit

Current Projects

Project Title:

Mortality rates by occupation within the UK

Project Number:

2013_015

Researchers:

S Vittal Katikireddi (SPHSU)
Alastair Leyland (SPHSU)
David Stuckler (Oxford University)
Martin McKee (LSHTM)
Kevin Ralston (University of Edinburgh)

Start Date:

8 April 2014

Summary:

Aim:

To describe the standardised mortality rates by occupation and employment conditions in the UK

Objectives:

  1. To calculate standardised mortality rates by occupation amongst those of working age (defined as 20-59 years at the time of the census) by sex in Scotland and the rest of the UK for the time periods 1991-2000 and 2001-2010.
  2. To calculate comparable standardised mortality rates for different government office regions across the UK to allow geographical comparisons to be made
  3. To investigate the causes of excess mortality in occupations with the greatest mortality rates
  4. To compare the mortality among different types of employment status (e.g., part-time, full-time, self-employed)

Background:

The relationship between occupation and population health is complex, but understanding their interrelationships is a policy priority (1). It is widely accepted that being in employment is associated with health benefits (2). However, there is a lack of detailed understanding about the relative mortality risks of specific occupations and whether health-related benefits of employment occur across all occupations.

Previous research has quantified the relative importance of specific causes of death by occupation by analysing unlinked death certificates (3-5). Such work helps identify the need for occupational health interventions to target those exposed to specific hazards within particular jobs. Existing studies do not allow denominators for the population at risk and therefore proportional mortality ratios, rather than mortality rates, have been calculated (which do not allow comparison between occupations) (6).

Recent changes in the labour market may have made employment less secure, with increased under-employment (i.e. working fewer hours than an individual would like) (7, 8). The extent of these changes and their health impacts may vary in response to changing macro-economic circumstances (9). While pathways to health effects have been theorised, further empirical research is needed (8, 10). It also remains unclear if recent labour market changes have reduced the potential health benefits of employment compared to unemployment. SLS data could contribute to investigating some of these issues. For example, individuals working less than full-time with no dependents, potentially differentiated by occupation/social class, could be studied to research effects of under-employment. Similarly, potential indicators of employment security (such as being self-employed with no employees) could be investigated.

Scotland is known to experience worse health than the rest of the UK, often referred to as the ‘Scottish effect’ (11). Previous research suggests this adverse mortality profile cannot be explained by social class differences (12, 13). It remains unknown whether the increased mortality risks are experienced across all occupations or if these risks are confined to those most deprived.

Our research will provide contributions to a number of areas of policy relevance: first, characterisation of mortality risks allows identification of occupations at greatest overall mortality risk, thereby facilitating appropriate prevention responses; second, determining the association of job security with mortality will help establish the existence of potential public health consequences of ongoing labour market changes; and finally, studying the geographical patterning of mortality risk by occupation will allow a more detailed understanding of the causes of the ‘Scottish effect’.

References:

1. Black CM. Working for a healthier tomorrow: Dame Carol Black's review of the health of Britain's working age population: TSO Shop; 2008.

2. Waddell G, Burton AK. Is work good for your health and well-being?: TSO Shop; 2006.

3. Coggon D, Harris EC, Brown T, Rice S, Palmer KT. Occupational mortality in England and Wales, 1991–2000: Office for National Statistics; 2009.

4. Coggon D, Harris EC, Brown T, Rice S, Palmer KT. Work-related mortality in England and Wales, 1979-2000. Occup Environ Med. 2010 Dec;67(12):816-22.

5. Coggon D, Harris EC, Brown T, Rice S, Palmer KT. Occupation and mortality related to alcohol, drugs and sexual habits. Occupational Medicine. 2010 August 1, 2010;60(5):348-53.

6. Rothman KJ, Greenland S, Lash TL. Modern Epidemiology. 3rd ed. London: Lippincott Williams & Wilkins; 2008.

7. Standing G. The precariat: The new dangerous class: A&C Black; 2011.

8. Kim I-H, Muntaner C, Vahid Shahidi F, Vives A, Vanroelen C, Benach J. Welfare states, flexible employment, and health: A critical review. Health Policy. 2012;104(2):99-127.

9. Stuckler D, Basu S. The Body Economic: Why Austerity Kills: Basic Books; 2013.

10. Virtanen M, Nyberg ST, Batty GD, Jokela M, Heikkilä K, Fransson EI, et al. Perceived job insecurity as a risk factor for incident coronary heart disease: systematic review and meta-analysis. BMJ: British Medical Journal. 2013;347.

11. McCartney G, Walsh D, Whyte B, Collins C. Has Scotland always been the ‘sick man’ of Europe? An observational study from 1855 to 2006. The European Journal of Public Health. 2011 October 22, 2011.

12. Walsh D, Bendel N, Jones R, Hanlon P. It's not ‘just deprivation’: Why do equally deprived UK cities experience different health outcomes? Public health. 2010;124(9):487-95.

13. McCartney G, Collins C, Walsh D, Batty D. Accounting for Scotland's excess mortality: towards a synthesis. Glasgow: Glasgow Centre for Population Health. 2011:1-87.

14. Jackson A, Davies C, Leyland A. Do differences in the administrative structure of populations confound comparisons of geographic health inequalities? BMC Medical Research Methodology. 2010;10(1):74.

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