Social
Following the power: social-class inequities in mortality from accidental poisonings, suicide, and chronic liver disease Jerzy Eisenberg-Guyot* Jerzy Eisenberg-Guyot Audrey Renson
Introduction: Hazardous working conditions fuel inequities in accidental-poisoning, suicide, and chronic-liver-disease mortality. Relational social-class theories suggest such hazards flow from power imbalances between workers, managers, and employers, social classes demarcated by power over property and labor. However, to our knowledge, no US studies using relational measures have analyzed social-class inequities in mortality from these causes. We addressed this gap.
Methods: We used the Mortality Disparities in American Communities dataset, which links the 2008 American Community Survey to the National Death Index through December 31, 2019. We classified respondents ages >18 as incorporated business owners (IBOs), unincorporated business owners (UBOs), managers, workers, or not in the labor force (NLFs) based on their employment, occupational, and business-ownership status. Then, using inverse-probability-weighted Aalen-Johansen survival curves, we estimated class inequities in mortality risks from the causes of interest, adjusted for age and gender. We also ran analyses subdividing workers by occupation and employment status, and by gender, race/ethnicity, and education.
Results: Our sample included 2,304,500 respondents and 132,000 deaths from all causes, 10,870 of which were from the focal causes. NLFs, UBOs, and workers had, respectively, 900 (95% CI: 800, 1000), 100 (95% CI: 0, 200), and 100 (95% CI: 0, 200) per 100,000 greater 12-year risks of mortality from the causes of interest than IBOs. Estimates remained largely unchanged after more thorough sociodemographic adjustment. Risks were especially elevated among unemployed, blue-collar, and service workers. Finally, inequities were similar within racialized groups, but were greater among men and the less-educated.
Discussion: We estimated class inequities in mortality from accidental poisonings, suicide, and chronic liver disease, aligning with theories linking the exploitation of labor to health inequities.