Health Disparities
The forgotten middle at work: examining labor sector-specific declines in health and well-being across middle income strata Agata Foryciarz* Agata Foryciarz Foryciarz Foryciarz Foryciarz Stanford University
Despite overall increases of life expectancy in the United States, many health metrics and health disparities continue worsening. US middle-aged adults in the lower middle class, known as the “forgotten middle,” are experiencing particularly steep declines in physical, mental and functional health, compared to those in other income groups. These declines have been observed concurrently with a number of changes in the US labor market, including declining union density and the rise of precarious employment. We hypothesize that health declines experienced by the lower middle class may be concentrated in a subset of sectors and occupations most affected by those labor market shifts, such as manufacturing, food and service sectors, and less pronounced in the public sector, where union density is declining less rapidly. In this study, we will examine sector-specific declines in health and well-being of the middle-aged population across the income distribution over the last decade. While prior work has examined how health metrics vary by industry and occupation, to our knowledge the trends across time for middle income groups have not previously been characterized.
We leverage the Behavioral Risk Factor Surveillance System dataset, a cross-sectional, state-level, nationally representative survey of health and health behaviors, which includes data on occupation and industry. We focus on individuals aged 40-74, observed in the period 2013-2024 in the 8 states which collected data for each year (MT, IL, NH, MS, MN, MA, LA and ND) (n=444,109, 32,966-45,693 in any given year). Using linear regression, we estimate changes in measures of physical, mental and functional well-being by industry category, stratified by household-size adjusted income and age groups, in line with prior work. We will characterize the identified trends in the context of sector-specific changes. These results will support work that identifies causal drivers of declining health among the forgotten middle.