Social
Following the power: social class inequities in cause-specific mortality in the United States Jerzy Eisenberg-Guyot* Jerzy Eisenberg-Guyot Audrey Renson
Introduction: Socioeconomic and racial health inequities in the US are vast, with sinking life expectancy propelled by excess mortality among poor and racially minoritized people. Hazardous working conditions, like low wages and poor job control, fuel the inequities. Underused relational theories suggest such hazards flow from structural power imbalances between workers, managers, and employers: social classes divisible by managerial authority and business ownership. However, while studies using relational theories have documented inequities in all-cause mortality in the US, none have investigated cause-specific mortality. We addressed this gap.
Methods: Our sample included respondents ages 18-64 to the 1986-2018 National Health Interview Survey with mortality follow-up through 2019 (n=1,067,193). Using data on business ownership, occupation, and employment status, we classified respondents as incorporated business owners (IBOs), unincorporated business owners (UBOs), managers, workers, and not in the labor force (NLF). Next, we used an inverse-probability-weighted Aalen Johansen estimator to estimate class inequities in mortality from 10 underlying causes, account for competing risks. In-progress analyses will test class-year, class-race, and class-gender interaction.
Results: We estimated considerable class inequities (Figure 1), with NLFs and workers, which are the largest classes across gender-races and disproportionately consist of women and people color, tending to be at greatest mortality risk. For example, the 34-year cancer-mortality risk among NLFs, workers, and UBOs was, respectively, 9.5% (95% CI: 9.2%, 9.8%), 8.0% (95% CI: 7.8%, 8.3%), and 8.2% (95% CI: 7.8%, 8.7%), greater than the risk among managers (7.0%; 95% CI: 6.7%, 7.4%) and IBOs (6.8%; 95% CI: 6.1%, 7.5%).
Discussion: We estimated large inequities in cause-specific mortality in the US, highlighting the urgency of building power among workers and other marginalized groups to promote public health.
