Trajectories of precarious employment and the risk of myocardial infarction and stroke among middle-aged workers in Sweden: A register-based cohort study

Abstract

Background: The aim is to identify trajectories of precarious employment (PE) over time in Sweden to examine associations of these with the subsequent risk of myocardial infarction (MI) and stroke.

Methods: This is a nation-wide register-based cohort study of 1,583,957 individuals aged 40 to 61 years old residing in Sweden between 2003-2007. Trajectories of PE as a multidimensional construct and single PE components (contractual employment relationship, temporariness, income levels, multiple job holding, probability of coverage by collective agreements) were identified for 2003-2007 by means of group-based model trajectories. Risk Ratios (RR) for MI and stroke according to PE trajectories were calculated by means of generalized linear models with binomial family.

Findings: Adjusted estimates showed that constant PE and borderline PE trajectories increased the risk of MI (RR: 1·08, CI95%:1·05-1·11 and RR:1·13, CI95%: 1·07-1·20 respectively) and stroke (RR:1·14, CI95%: 1·10-1·18 and HR:1·24, CI95%: 1·16-1·33 respectively) among men. A higher risk of stroke in men was found for the following unidimensional trajectories: former agency employees (RR:1·32, CI95%:1·04-1·68); moving from high to a low probability of having collective agreements (RR: 1·10, CI95%:1·01-1·20). Having constant low or very low income was associated to an increased risk of MI and Stroke for both men and women.

Interpretation: The study findings provide evidence that PE increases the risk of stroke and possibly MI. It highlights the importance of being covered by collective bargaining agreements, being directly employed and having sufficient income levels over time.

Funding: The Swedish Research Council for Health, Working Life and Welfare, no. 2019-01226.

Keywords: Cardiovascular; Collective bargaining agreements; Group-based model trajectories; Income; Multiple job holding; Temporary agency work; Unstable employment.

Figure 1

Trajectories of precarious and non-precarious employment (2003-2007) in middle aged workers in Sweden (n= 1,583,957). Note: PE (PE score). An individual is in precarious employment when the total score is < -3. The three trajectories corresponding to non-precarious employment are merged for the analysis into one trajectory “constant non precarious employment”.

Figure 2

Trajectories of components of precarious employment (2003-2007) in middle aged workers in Sweden (n= 1,583,957). Note: 2A. CIN (Contractual relation insecurity) score (0 = directly employed, 1= temporary agency employed), 2B Temporariness score (0 = stable employment, 1= unstable employment), 2C. Multiple job holding score (0 = non multiple job holder, -1= multiple job holder, -2= multiple job holder in multiple sectors), the two trajectories corresponding to non-multiple job holding are merged for the analysis into “constant non-multiple job holding”, 2D. Income levels score (-2= income <60% of the median, -1= income 60-80% of the median, 0= income 81-120% of the median, 1= income 121-199% of the median, 2= income >200% of the median), 2E. CBA (probability of coverage by collective agreements) score (-2 = less than 70%, -1= from 71 to 90%, 0= more than 90%).