Young men seem to be more at risk than young women, long term study suggests

Experiencing the sort of job insecurity in early adulthood that is often linked to the gig economy, is linked to a heightened risk of a serious alcohol-related illness in later life, suggest the findings of a long term study published online in Occupational & Environmental Medicine.

And men who find themselves in this position as young adults seem to be more at risk than young women, the findings indicate.

The prevalence of ‘precarious employment’, which describes non-standard or temporary work that is often poorly paid, insecure, and unprotected, has increased in recent years, explain the researchers. But few studies have looked at its potential consequences on mental health and vulnerability to alcohol misuse, they add.

To explore these issues further, the researchers drew on 339, 403 participants from the Swedish Work, Illness, and Labour Market Participation (SWIP) group, all of whom were born between 1973 and 1976, and whose data were linked to several nationwide registers for 16–65 year old Swedish residents in 2005.

Information on employment status was collected between 1992 and 2006 when the participants were aged between 19 and 30, and 3 years after they had graduated from the highest level of education attended—school or university.

Their employment status was categorised into 5 mutually exclusive groups: precarious employment; long term unemployment (at least 180 days); substandard employment; standard employment; and other, to include self-employment, not registered as employed, or student.

Information on subsequent ill health, requiring inpatient care, was obtained from the National Hospital Discharge Register, specifically mental and behavioural disorders due to alcohol; alcoholic liver disease; and toxic effects of alcohol.

Most participants were in substandard (107,395; 32%) or standard (133,141; just over 39%) employment. Only 42,232 (12.5%) were experiencing precarious employment: they tended to be male and to have lower levels of educational attainment than those in standard employment.

In all, 6713 (2%) participants required inpatient care at least once for alcohol-related illness during a maximum monitoring period of 28 years. Two thirds of them (4448) were men.

Compared with young adults in standard employment, those in precarious employment were almost twice as likely to have an alcohol-related illness, while the long term unemployed were almost three times as likely to do so.

After taking into consideration several potentially influential factors, including previous mental health and alcohol-related health problems, those in precarious employment were 43% more likely to have an alcohol related illness than those in standard employment.

Similarly, the long term unemployed were almost twice as likely to have an alcohol related illness, while those in substandard employment were 15% more likely to do so.

When stratified by sex, the association between precarious employment and alcohol-related Illness was stronger among men: 50% heightened risk vs 32% heightened risk for women.

This is an observational study, and as such, no firm conclusions can be drawn about cause and effect. And the researchers acknowledge that as Swedish registers have limited coverage of educational attainment outside of Sweden, many people would have been excluded from the study, which might limit the wider applicability of the findings.

And important dimensions of precarious employment, including rights and working hours, aren’t captured in employment registry data in Sweden.

Despite these caveats, the findings echo and amplify those of previous studies, point out the researchers. “A potential explanation for our findings could be that young adulthood is a particularly sensitive period in life concerning the initiation and formation of health-related behaviours, such as alcohol use,” they suggest.

“Subsequently, young adults in precarious employment might use alcohol as a coping strategy for stress and form a habit of consuming larger quantities of alcohol compared with individuals in [standard employment] of the same age.”

Referring to the even higher risk of alcohol related illness among those who were long term unemployed as young adults, the researchers write: “To escape unemployment, several young people take the first job offered, which is generally more precarious with less security, lower wages and longer hours.

“The results of the current study suggest that this decision appears to be marginally more beneficial compared with remaining unemployed, which adds to the discussion of whether any job is really better than no job at all,” they conclude.


Research: Precarious employment in young adulthood and later alcohol-related morbidity: a register-based cohort study doi: 10.1136/oemed-2023-109315

Journal: Occupational & Environmental Medicine

External funding: Swedish Research Council for Health, Working Life and Welfare (FORTE)

Link to Academy of Medical Sciences Press releases labelling system

Externally peer reviewed?Yes

Evidence type: Observational

Subjects: People