Gendered precarious employment trajectories and self-reported health outcomes: a retrospective study in France

Background and aim: As precarious employment has been prevalent since the mid-1970s in high-income countries, it emerged as a social determinant of health, with potentially different health consequences for men and women. In France, unemployment and temporary employment have been high since the early 2000s. Our objective was to investigate the gendered influence of precarious employment trajectories on health outcomes in the French context. Methods: We used a retrospective national survey (4445 men, 5371 women) to create patterns of employment trajectories by sex, using multiple correspondence analysis followed by hierarchical ascendant clustering. We considered five dimensions of precariousness: unemployment (%), inactivity (%), frequency of job changes, qualification trend, and versatility of duty. We then explored the associations between the trajectory patterns and four health outcomes (self-perceived health, chronic morbidity, activity limitations and depression) through multivariate logistic regression, taking the most continuous, stable, and skilled trajectories as the reference. Results: Five patterns of employment trajectories were observed in each sex, with some specificities. Highly precarious trajectories concentrated in one cluster in both men (19%) and women (10%) ; they were associated with worse self-perceived health (OR_men=1.34, 95%CI [1.00;1.80] ; OR_women=1.56, 95%CI [1.22;1.99]), and more activity limitations (OR_men=1.52, 95%CI [1.05;2.20] ; OR_women=1.40, 95%CI [1.05;1.88]) as compared to the stable pattern. In women, high precarity was also associated with depression (OR_women=1.37, 95%CI [1.09;1.73]), while those who experienced a sex-specific inactivity pattern (24% of women) or long-lasting low-skill pattern (22%) only reported worse self-perceived health. Men experiencing a sex-specific medium precarity pattern (15%) reported more chronic morbidity and activity limitations than in the stable trajectory. Conclusions: Different patterns of employment trajectories were found in men and women. The precarious patterns were also associated with different adverse health outcomes depending on gender. Ongoing analysis will further address potential mediation through working conditions.