Employment history indicators and mortality in a nested case-control study from the Spanish WORKing life social security (WORKss) cohort

Employment has transitioned from stable to more flexible schemes. Little is known about the effects of dynamic working lives and mortality. We examined the association of employment, unemployment and inactivity on mortality among workers born in 1926–1988, in a nested case-control study of workers from the Spanish WORKss cohort. Cases were all deaths that occurred during 2004–2013 and controls were living persons, matched for sex and age at the time the case occurred. We had information on employment from 1981 to 2013. Logistic regression was used to measure the associations between the 3 employment history indicators separately by sex. There were 53,989 cases and an equal number of controls (n = 107,978). More than 16 years employed showed a protective effect against mortality in women (OR = 0.88, 95%CI: 0.81, 0.94) and men (OR = 0.76, 95%CI: 0.70, 0.79). The number of spells and time in unemployment and inactivity were significantly related to mortality in men, but not women. Sensitivity analyses by labor relationship showed stronger associations of unemployment (OR = 1.42, 95%CI: 1.13, 1.78) and inactivity (OR = 1.34; 95%CI: 1.09, 1.65) for temporary workers. Employment gaps are detrimental to health and have worse effects if the gaps occur without unemployment benefits or after temporary contracts. These results may drive improvement of labor and social policies that protect workers against the potential negative effects of dynamic work lives.就业模式已从稳定转向更灵活的用工形式。目前学界对动态职业生涯与死亡率之间的关联尚知之甚少。本研究依托西班牙WORKss队列中的劳动者群体开展巢式病例对照研究（nested case-control study），旨在探讨1926至1988年出生的劳动者的就业、失业及非劳动状态与死亡率的关联。病例为2004至2013年期间的所有死亡病例，对照为同期存活个体，按病例发生时的性别与年龄进行匹配。研究获取了1981至2013年的就业相关数据。采用Logistic回归分别按性别分析3项就业史指标与死亡率的关联。本研究共纳入53989例病例与等量对照（总样本量n=107978）。累计就业时长超过16年时，对女性与男性均展现出死亡率保护效应（女性：OR=0.88，95%CI：0.81, 0.94；男性：OR=0.76，95%CI：0.70, 0.79）。失业与非劳动状态的持续时段数及时长均与男性死亡率显著相关，但该关联未在女性群体中观察到。按用工关系开展的敏感性分析显示，临时用工群体的失业（OR=1.42，95%CI：1.13, 1.78）与非劳动状态（OR=1.34，95%CI：1.09, 1.65）与死亡率的关联更强。就业中断对健康存在不利影响，若该中断未领取失业救济金或发生于临时用工合同期间，则其健康损害效应更为显著。本研究结果可为推动完善劳动与社会政策提供依据，以保护劳动者免受动态职业生涯带来的潜在负面影响。