Association Between Self-Reported Health Status and Employment By Industry and Occupation in the 2013 Wisconsin Behavioral Risk Factor Surveillance System (BRFSS)

BACKGROUND:  Workplace has the potential to influence health behaviors and outcomes, making employment information a valuable addition to public health surveys. The industry and occupation (I/O) module was included for the first time on the Wisconsin Behavioral Risk Factor Surveillance System (BRFSS) survey in 2013. In this analysis, we examined the health status of Wisconsin’s employed population to identify industries and occupations at higher risk of fair/poor health in Wisconsin. Specifically, we sought to 1) characterize the demographics of Wisconsin’s employed population; 2) estimate population prevalence of fair/poor health by I/O; 2) examine the association of fair/poor health with employment by I/O and demographic and health factors.

METHODS:  Coded industry (2002 North American Industry Classification System) and occupation (2000 Standard Occupation Classification System and 2002 Census Occupation) responses from BRFSS were categorized into 11 major industry and 10 major occupation groups for analysis. Distributions of industry and occupation groups from the BRFSS were compared to those from the U.S. Census Bureau’s American Community Survey (ACS) for representativeness. Descriptive analyses characterized the employed population by demographic factors. Weighted population prevalence and adjusted prevalence odds ratios (OR) of fair/poor health by I/O and nonoccupational risk factors were estimated.

RESULTS:  Out of 6,589 Wisconsin residents who participated in the BRFSS in 2013, 3,581 had been employed within the last year and 80% provided I/O responses that could be coded. Distributions of I/O within the BRFSS and ACS were similar. Among the employed population, prevalence of fair/poor health was 8.8% (95% CI 7.1-10.5) and highest among Other Services industries (13.2%), particularly among the subcategory of Accommodation and Food Services (22.1%). Highest prevalence by occupation included Office/Administrative Support (13.1%) and Service occupations (12.4%), most notably among Building/Grounds Maintenance workers (21.7%). In multivariate analyses, factors related to fair/poor health included: older age, male gender, depression, occupation group (all P<0.05), lower education and obesity (P<0.001). While industry group was not significantly associated with health status, employment in Office/Administrative Support occupations was associated with a significantly elevated adjusted OR (4.7, 95% CI 1.9-11.8).

CONCLUSIONS:  Findings indicate that Service industries and occupations and Office/Administrative Support occupations consistently reported higher prevalence of adverse health indicators. Inclusion of employment questions on the WI BRFSS provides the opportunity to study the potential impact of work on a person’s health, highlight areas of disease disparity and improve targeting of specific industries and occupations for workplace prevention and wellness programs.