NY24-02: How Workplace Matters for Health: New Evidence on Racial/Ethnic Disparities in Mortality in Urban and Rural America
Abstract/Specific Aims:
Urban-rural mortality disparities emerged in the U.S. in the late 1980s and have increased steadily since then, owing to higher levels of all-cause mortality in rural counties compared to urban counties. At the same time, and despite recent upticks in ‘deaths of despair,’ Non-Hispanic white (hereafter “white”) mortality rates remain lower than those of non-Hispanic Black (hereafter “Black”) and American Indian or Alaska Native (AIAN), while mortality is lower among Latino/as and Asian/Pacific Islanders as a whole than among whites. Recent research has examined these two trends together, finding that rural-urban disparities are especially pronounced for Black and AIAN populations compared to whites.
Prior research has investigated the degree to which place- and race-based mortality disparities are explained by factors such as poverty and education but not the role of work. The U.S.’s comparatively modest social safety net means that work structures access to and use of health-promoting resources like insurance coverage, pensions, and earnings to an unusually high degree. The connections between work and health go even further. On the positive side, prior research finds that higher status jobs are linked to lower mortality and work control is associated with better health. On the negative side, workers in some jobs are exposed to taxing physical labor and hazardous conditions. Job strain, schedule instability, and fear of losing one’s job are associated with higher psychosocial stress.
Positive and negative work attributes are not distributed randomly across jobs nor across workers. Jobs in the U.S. have been increasingly divided into “good” and “bad” jobs, with “good jobs'' offering stable and sufficient wages, job amenities, and job control while “bad jobs'' pay poorly, do not include benefits, have unpredictable work schedules and low job control. Geographic factors matter in who works in “good” jobs, both due to the type of work available in rural vs. urban areas and differences in state-level policies. Race matters because Black, Latino, and AIAN workers are more likely to be working in “bad” jobs, although variation by place and race simultaneously has not been examined. Taken together, the connections between work and health and the unequal distribution of good and bad jobs by place and race suggest that work may explain some degree of existing health disparities.
Work may also condition racial/ethnic mortality disparities in ways that go beyond traditional job characteristics and this may have bearing on rural-urban mortality differentials. Members of marginalized racial/ethnic groups who are greatly outnumbered at work may experience elevated rates of work-based stressors [14-16]. Workers at the same location may garner different receptions in their work environment based on the racial/ethnic composition of the area surrounding the workplace. While no prior work has explored this, previous research has found correlations between health and exposure to segregated spaces throughout the day. Further, because marginalized racial/ethnic groups face greater employment instability and lower chances of being promoted, their current (cross-sectional) work conditions may understate the health impact of their longitudinal careers. Prior work has not examined the degree to which this variation may explain health disparities by both race and place.
The proposed research will examine the degree to which the relative advantages offered by urban workplaces explain both urban-rural and racial mortality disparities. We argue that two processes are likely at play: urban workplaces may offer more positive job attributes with known connections to health, such as higher pay (even relative to cost of living), better health-promoting job amenities, and greater employment stability; and they may be organized in ways that reduce the stress experienced by minoritized workers.
We aim to:
Estimate how workplace characteristics contribute to urban-rural mortality disparities.
Estimate the degree to which workplace characteristics explain racial/ethnic disparities in mortality within urban and rural areas.
Estimate how workplace characteristics explain urban-rural mortality disparities within racial/ethnic groups; and how the distribution of racial groups in urban and rural areas explains racial/ethnic mortality disparities.
