Transitions Between Forms of Employment Quality and Associations With Self‐Rated Health and Mental Health in the United States, 2008–2022

INTRODUCTION: A growing body of research is focused on the association between employment quality (EQ) and health, yet few studies have explored how transitions between types of EQ impact health in the United States (U.S.). Moreover, unemployed individuals are frequently omitted from EQ studies. The objective of this study was to assess how transitions between different EQ states, including unemployment, are associated with health in the U.S. METHODS: Using U.S. Medical Expenditure Panel Survey data from 2008 to 2022 (n = 71,957; weighted n = 126,312,273), this study identified five unique EQ types for men: 1. Salaried-Intensive; 2. Standard Employment Relationship (SER)-like; 3. Standard but Economically Vulnerable; 4. Precarious; and 5. Unemployed, and four for women: 1. SER-like, Union; 2. SER-like, non-Union; 3. Precarious; and 4. Unemployed. The probability of transitioning between each EQ type was measured using latent transition analysis (LTA). The probability of reporting poor/fair self-rated health (SRH) and self-rated mental health (SRMH) within each EQ transition was measured descriptively and associations of poor/fair SRH or SRMH with each EQ type were measured using generalized estimating equations. RESULTS: Respondents transitioning to or from low-EQ arrangements (e.g., precarious employment or unemployment) reported poor/fair SRH and SRMH more frequently relative to high-EQ (e.g., SER-like) types. LTA results suggested some respondents cycled between precarious employment and unemployment, potentially compounding the effects of employment instability on health. CONCLUSION: Improving employment conditions, particularly for those caught in cycles of precarious employment and unemployment, may be an avenue for improving population health in the U.S.