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NIOSH Study Examines Relationship between Employment Status, Healthcare Access, and Health Outcomes

November 18, 2021
NIOSH Update:

Contact: Stephanie Stevens,, 202.245.0641

NIOSH Study Examines Relationship between Employment Status, Healthcare Access, and Health Outcomes

A new study from the National Institute for Occupational Safety and Health (NIOSH) found healthcare access and other health-related needs in the United States differ by employment status. Researchers evaluated these needs among people who were employed for wages, self-employed, short-term unemployed (less than a year), long-term unemployed (a year or more), or unable to work. Healthcare access was most problematic among the short-term unemployed. The prevalence of adverse health outcomes increased with length of unemployment status and was highest among respondents unable to work. The studyexternal icon was published online November 8, 2021 in the American Journal of Industrial Medicine.

“In the U.S. healthcare system, healthcare access is closely linked to work, with the majority of working-age adults having employer-sponsored insurance,” said Sharon Silver, epidemiologist and lead author of the study. “While people with very low incomes and a subset of those unable to work are eligible for public benefits, the short-term unemployed may have difficulty accessing both employer-sponsored and public benefits.”

NIOSH researchers used the 2018-2019 Behavioral Risk Factor Surveillance System data, which includes self-reported information on a variety of topics, including employment and health, from 278,424 respondents aged 25-54 in the United States who met the study definition. Researchers assessed healthcare access and use, health-related behaviors, and health outcomes by employment status.

Short-term unemployed respondents were most likely to face challenges accessing healthcare. Researchers found this group was least likely to have health insurance or a personal healthcare provider. Nearly one in three short-term unemployed respondents reported needing to see a doctor in the past year but were unable to because of costs. Self-employed individuals had gaps in healthcare use and were least likely to have had a routine check-up within the last year.

Respondents who were unemployed were more likely to report adverse health outcomes than those employed and self-employed. Prevalences of fair or poor self-rated health, poor physical and mental health, obesity, and 10 chronic health conditions increased from the short-term unemployed to the long-term unemployed and were highest among those unable to work. More than half of the respondents who were unable to work reported having fair or poor general health, poor physical health, or diagnosed depression. Additionally, almost half of those unable to work had obesity, and more than 40% reported poor mental health, hypertension, and high cholesterol.

“Employment is a social determinant of health and a health equity issue, particularly given the link between employment and healthcare access. Our research shows that unemployed individuals and those unable to work face increased challenges when it comes to healthcare access and health outcomes,” said Silver. “Addressing access to affordable healthcare and other resources is key to preventing health declines that may hinder re-employment, particularly among the short-term unemployed.”

NIOSH is the federal institute that conducts research and makes recommendations for preventing work-related injuries, illnesses, and deaths. Find more information about NIOSH at

Page last reviewed: November 18, 2021