Living in an unhealthy neighbourhood impacts individual employment status

Objectives: Individual characteristics including poor health are well-known to affect labour market participation. However, less is known on the role of health at the residential neighbourhood level. This study examines cross-sectional and longitudinal associations between neighbourhood health and employment status and the moderating role of individual health in the association between neighbourhood health and employment status. 

Methods: Individual level data from the Lifelines Cohort Study (n = 137,921) was matched with full-population neighbourhood health data and registry data from Statistics Netherlands on employment status with up to 14 years of follow-up. Neighbourhood health indicators included the proportion of individuals in poor self-reported health (nHealth) and with a chronic disease (nDisease) within neighbourhoods, divided in tertiles (T1, T2, T3). Individual health included dichotomized measures of self-reported poor health (iHealth) and the presence of a chronic disease (iDisease). Employment status comprised the categories employed, unemployed, work disabled, economically inactive and early retired. Logistic and cause-specific Cox regression analyses, including interaction terms between iHealth and nHealth, were used to examine the associations with employment status. 

Results: Poorest nHealth and nDisease tertiles were associated with higher risks of unemployment and work disability. Cross-sectional odds ratios (OR)s for nHealth T3 were: 2.22 (95% CI: 2.06─2.39) for unemployment and 1.98 (95% CI: 1.81─2.16) for work disability. Longitudinal hazard ratios (HR)s for nHealth T3 were: 1.27 (95% CI: 1.22─1.32) for unemployment and 1.59 (95% CI: 1.45─1.74) for work disability. Associations for nDisease were weaker but statistically significant. iHealth and iDisease moderated the associations but stratified analyses yielded inconclusive results. 

Conclusions: Neighbourhood health promotion may have societal and economic benefits by extending individual’s working lives.