Elsevier

Public Health

Volume 124, Issue 3, March 2010, Pages 174-179
Public Health

Original Research
Employment status and self-rated health in north-western China

https://doi.org/10.1016/j.puhe.2010.02.001Get rights and content

Summary

Objective

Despite a growing economy, unemployment remains a severe socio-economic problem in China. This study aimed to examine whether risk of self-rated poor health is related to employment status, and if any such relationship varies across sociodemographic groups.

Study design

A cross-sectional analysis in a random sample survey conducted in three north-western Chinese cities in 2005.

Methods

Subjects were 7796 adults aged 20–59 years who reported being either employed or unemployed but actively seeking work. Multinomial generalized estimating equation models were performed for ordered logistic regression to estimate the relative risk of self-reporting poor health on an ordinal five-point scale with regard to employment status.

Results

Unemployment was associated with self-rated poor health (odds ratio 1.4, 95% confidence interval 1.25–1.55). This association was stronger for people who resided in Xining, were older, frequently consumed alcohol and possessed a strong social network. Likelihood of self-rated poor health increased with duration of unemployment up to 5 years, but then decreased.

Conclusion

This study found that unemployment is detrimental to health, and that the relationship is modified by certain personality characteristics and social factors. An optimal strategy would incorporate such heterogeneity into Chinese programmes aimed at alleviating poor health among the unemployed.

Introduction

Globalization, competitive markets and rapid technological change have precipitated rising unemployment in many nations, including China. Restructuring at Chinese state-owned firms prompted lay-offs of 45 million workers between 1995 and 2002.1 The registered urban unemployment rate increased from 2.9% to 4% during the same period.

Unemployment is one of the most stressful life events an adult can experience. It may produce financial strain, depress social status, fracture social relations, promote risky behaviours and diminish self-esteem. All of these effects can be detrimental to health. Epidemiological research shows a positive association between unemployment and adverse health outcomes,2, 3 including all-cause mortality,4, 5, 6, 7, 8, 9 and morbidity from depression, stroke, diabetes and chronic lung disease.10, 11, 12 In addition, there is an apparent dose–response relationship. Longer-term unemployment appears to be more deleterious to health than short-term unemployment.13 However, few studies have examined how the relationship between unemployment and health varies across different sociodemographic factors, such as age, gender, familial roles and social network strength. Moreover, results are conflicting.4, 14, 15

Self-rated health is commonly used as a health outcome in social epidemiological studies. This subjective health assessment reflects an integrated perception of personal health, which covers its biological, psychological and social dimensions.16 Studies have demonstrated that self-rated health correlates highly with objective health assessments and health status indices, including measures of physical and functional health16, 17, 18 and utilization of healthcare services.19 Thus, subjective assessments of general health could potentially be even more sensitive than external measures in monitoring population health.

Data were accessed from a large cross-sectional survey conducted in three north-western Chinese cities to evaluate the association between employment status and self-rated heath. The survey addressed a range of topics including social protection, employment and healthcare utilization. The aim of the present study was to evaluate whether the risk of self-rated poor health is related to employment status, and if any such relationship varies across sociodemographic groups.

Section snippets

Study design

The data used in this study derive from the Chinese Urban Social Protection Survey, which was conducted in 2005 by the Provincial Civil Affairs Sector and the School of Social Development and Public Policy at Beijing Normal University. Three-stage cluster sampling was used to select households for survey in three north-western Chinese cities (Lanzhou, Baiyin in Gansu province, and Xining in Qinghai province). In the first two stages, probability proportional to size sampling was used to select

Results

Table 1 shows the sociodemographic characteristics of subjects, differentiating employment status. Compared with employed adults, unemployed adults were more likely to be from Lanzhou, less likely to be from Xining, more likely to be younger, female, Han ethnicity, unmarried, less educated, from a Dibao family, low BMI, non-smoker, low consumption of alcohol, physically inactive, experience material deprivation, and possess a weak social network.

Baiyin residents were more likely to self-report

Discussion

Unemployment was associated with self-rated poor health. This association was stronger for certain sociodemographic groups, including people who resided in Xining, were older, frequently consumed alcohol and had a strong social network. There was evidence of a dose–response relationship between self-rated poor health and duration of unemployment, but the association was attenuated beyond a 5-year window.

The positive association between unemployment and adverse health outcomes has been supported

Ethical approval

Approved by the institutional ethics committee. Subjects gave informed consent for the work.

Funding

The Provincial Civil Affairs Sector supported the study design and data collection.

Competing interests

None declared.

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