Jobless workers are at greater risk of being diagnosed with hypertension, and the risks are similar for those who experience long-term joblessness, regardless of their race. However, because Black workers experience disproportionately longer periods of unemployment, the racial health disparities that have been found in prior hypertension research point to structural mechanisms rather than differing biological or psychological responses, University of Illinois Urbana-Champaign scholars say in a new study.
Doctoral candidate Sohee Shin and sociology professor Tim Liao said the findings, published in the journal Social Sciences, show that unequal exposure to prolonged unemployment and labor market discrimination are driving greater incidence of hypertension among Black workers. Although prior studies consistently found links between unemployment and higher hypertension rates among Black workers, the source of the disparities was unclear.
People are also reading…
Shin and Liao’s study used a case-crossover design in which each individual’s health and employment statuses during two four-year intervals called the case and control periods were compared. The case period began four years before diagnosis, and the control period was the four-year interval that preceded it. Shin said this method is particularly effective for investigating how a change in an individual’s circumstances, like becoming unemployed, affects their risk of a specific health event such as a hypertension diagnosis.
“Reporting 45 weeks or more unemployment during the prior year more than doubled individuals’ likelihood of being diagnosed with hypertension compared with their reporting no unemployment, regardless of their race,” said Shin, whose research focuses on how social relationships and institutions shape inequalities in resources, opportunities and well-being. “And even though a higher percentage of Black workers experienced longer duration unemployment of 45-52 weeks compared with their counterparts, we did not find statistically significant differences in hypertension responses among unemployed workers. What this suggests is that the mechanisms linking unemployment to hypertension may operate similarly once individuals are unemployed.”
The finding diverges from the double-jeopardy hypothesis — common to sociology, gerontology and public health research — which holds that people who occupy multiple disadvantaged positions face compounded risks, Liao said.
Shin and Liao used data from the National Longitudinal Surveys of Youth 79, which collected statistics on U.S. residents born between 1957-1964. The data included sociodemographic characteristics along with biomarkers such as hypertension and body mass index, and health behaviors such as alcohol use and physical activity levels.
The analytic sample, which spanned the years 1983-2018, was limited to people age 26 and older who reported physician-diagnosed hypertension. Of the 2,027 people in the study, 803 were Black and 1,224 were non-Black, a group that included Hispanic, white or other races. The researchers tracked participants’ occupations, the number of hours they worked and the cumulative lengths of time that they were unemployed during the previous calendar year. They also controlled for time-invariant effects such as childhood economic hardship and genetics.
The participants’ average age was about 41 years for the Black and non-Black groups. Slightly more than half of the non-Black participants were male compared with about 45% of those who were Black, according to the study. Individuals diagnosed with hypertension before age 30 or after 2012 were excluded from the sample since they were less likely to have entered or were more likely to have already exited the labor force due to schooling or retirement rather than being unemployed, the researchers said.
Workers were categorized into five groups based on their occupation, including managerial and professional; technicians, sales and administrative support; service; farming, fishing, construction, precision production and repair; and transportation.
Those employed in precision craft, production or repair jobs were less likely to be diagnosed with hypertension compared with individuals who worked in managerial or professional occupations. And having health insurance also significantly increased the odds of receiving a diagnosis, which Shin said may have been related to these individuals having greater access to diagnostic screening.
Compared with periods when participants were employed, Shin and Liao found that being out of work for 1-26 weeks reduced individuals’ odds of being diagnosed with high blood pressure, whereas 45-52 weeks of cumulative unemployment increased their likelihood of a diagnosis by 2.2 times. While the odds of developing hypertension were not affected by workers’ weight status, the data indicated that people who were divorced, separated or widowed were at greater risk of hypertension compared with other individuals.
Shin and Liao hypothesized that the lower odds of a hypertension diagnosis associated with a shorter duration of unemployment might indicate that these spells were manageable transitions during which individuals in good health and with greater resilience were able to return to work more quickly. Or an alternate explanation might be that those who were eligible for unemployment benefits — which many states provide for up to 26 weeks — had an additional buffer against work-related physical and emotional stress, Shin and Liao said.
The team also tested formally whether the association between long-term unemployment and hypertension differed between Black and non-Black workers, but the difference was not statistically significant.
“There are several plausible mechanisms that may explain why a significant racial difference did not emerge in the interaction test, but these are all conjectural,” Liao said. “Individuals in poorer health may be more likely to leave the workforce earlier and, if this differs by race, it could attenuate an underlying interaction. Black individuals in the sample also reported lower rates of health-limiting conditions at age 25 compared with other workers, 3.61% versus 4%. However, we could not rule out reverse causation — and health deterioration over time could be associated with later unemployment. In addition, hypertension could be underdiagnosed in those who experience long-term unemployment due to restricted access to health care.”
Despite these limitations, the study provides meaningful insights that have public policy relevance, Liao said. Policies that shorten unemployment duration and promote access to reemployment and unemployment benefits would likely positively affect all workers’ cardiovascular health, regardless of race, he said.
