Living in an unhealthy neighbourhood impacts individual employment status

Background 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), divided in tertiles. 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.
Findings Poorest nHealth and nDisease tertiles were associated with higher risks of unemployment and work disability, both cross-sectionally (odds ratios (OR)s for nHealth: 2·22 (95% CI: 2·06─2·39) and 1·98 (95% CI: 1·81─2·16)) and longitudinally (hazard ratios (HR)s for nHealth: 1·27 (95% CI: 1.22─1.32) and 1·59 (95% CI: 1·45─1·74)). Associations for nDisease were weaker but statistically significant. iHealth and iDisease moderated the associations but stratified analyses yielded inconclusive results.
Interpretation Neighbourhood health promotion may have societal and economic benefits by extending individual’s working lives.
Funding None.