Precarious employment and occupational injuries in Sweden

Abstract: Nowadays, employment arrangements come under many different forms, often difficult to trace in the statistics due to a lack of standard definitions and measurements. Precarious Employment (PE) is a multidimensional construct constituted by several elements of low-quality employment conditions, and increasing evidence has associated this construct with an array of unfavorable mental and physical health outcomes. However, there is still a lack of a commonly recognized definition of PE, which results in methodological challenges when measuring this multifaceted concept. Furthermore, while PE has been associated with a range of health outcomes, little is known in Sweden regarding under-reporting levels of Occupational Injuries (OIs) among precarious workers and, ultimately, how PE is associated with OIs. Therefore, the overarching aim of this thesis was to advance the development of PE as an occupational exposure and investigate its relation to under-reporting levels of OIs and risks of OIs among the precarious and non-precarious working population in Sweden. In Study I, a systematic review of definitions and operationalizations was carried out in the literature. A total of 63 full-text articles were included in the study, and thematic analysis was performed to identify the core characteristics of PE. Three dimensions were identified: employment insecurity, income inadequacy, and lack of rights and protection. The dimensions were further represented by a total of nine items. Dimensions and items identified in the review facilitated guidance and the operationalization of the Swedish Register-based Operationalization of Precarious Employment (SWE-ROPE) in Study II. SWE-ROPE was operationalized in 2014 in the Swedish working population (n. 4,349,322) following a typological and summative scale approach. As a result of latent class analysis (LCA), the typological approach identified six employment types in which one PE-type emerged and was associated with female gender, low education, foreign background, and young age. The summative scale resulted in a score ranging between -10 and +2 with approximately 80% of individuals in PER-type having a score of -4. In Study III, PE was measured as a summative scale, and OIs were stratified according to injury severity (no health care, outpatient care, in-patient care). Swedish registries were used to perform capture-recapture methods and estimate under-reporting levels of OIs among precarious and non-precarious workers in Sweden in 2013. Higher levels of under-reporting of OIs were seen among precarious workers (22.6%, 95%CI 21.3% to 23.8%) compared to the other groups. Also, under-reporting of OIs decreased as injury severity increased and was higher among all occupations in the precarious group. Study IV aimed to investigate PE as a risk factor for OIs in Sweden between 2006-2014, employing multivariate logistic regression models. The study was set as a prospective register-based study that included employed workers aged 18-65. PE was measured as a summative scale and by looking at each specific PE dimension, while OIs were dichotomized as having or not having an OI during the year. Precarious workers were not found at higher risks of OIs compared to non-precarious workers (OR<1). While male workers employed by an agency, workers in multiple jobs/sectors, and women in the low-income groups were at higher risks of OIs. In conclusion, this thesis contributed to the methodological advancement of PE as an occupational exposure in Sweden through the work performed in Study I-II. It further shed light on its relationship with under-reporting levels and risks of OIs in the Swedish labor market. In Study III highest under-reporting levels were found among precarious workers compared to non-precarious workers, and in Study IV, increased risks of OIs were found among multiple-job holders, workers employed by an agency, and individuals with poor income. To date, research practice and policy have based the quantification of workplace hazards on the standard employment relationship (SER). However, today´s segmented labor market structure could intensify existing hazards or create new ones. Thus, conventional approaches to research, interventions, and policies may no longer be adequate. By increasing the understanding between PE and OIs, it may be possible to develop programs and policies to increase workers´ protection in the labor market. Organizations may also develop targeted health and safety programs to address root causes of OIs. Quantifying and monitoring the possible impact of a new exposure such as PE to known occupational risk factors becomes fundamental if we want to avoid reinforcing prevailing inequalities in our society.