Faraz Vahid Shahidi

Introduction: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide, and work stress is recognized as a potential contributor to increased CVD risk among workers. While meeting the moderate-to-vigorous-intensity physical activity (PA) recommendation is widely promoted for CVD prevention, evidence suggests that physical work demands may not yield the same protective effects. This study assessed work stress, physical work demands, meeting the PA recommendation, and their independent and effect modification associations with CVD risk. Methods: Data from 5 cycles of the Canadian Health Measures Survey (2007 to 2017) were linked to CVD hospitalization and mortality records through 2019 (N = 9,860). Covariate-adjusted Cox proportional hazard models estimated independent and stratified associations between (i) self-reported work stress, (ii) physical work demands derived from occupational titles, and (iii) meeting the PA recommendation (≥150 min per week of accelerometer-measured moderate-to-vigorous intensity PA) and CVD events. Results: In covariate-adjusted models, work stress was not significantly associated with CVD risk (hazard ratio [HR] for high versus low work stress = 1.08, 95% CI: 0.64 to 1.80). In stratified models, workers with low physical work demands and stationary occupations and moderate and high work stress did not have a statistically significant increased CVD risk compared with those with low stress (moderate stress: HR = 1.36, 95% CI: 0.53 to 3.44; high stress: HR = 1.34, 95% CI: 0.37 to 4.83). In contrast, among workers in high physical work demand occupations, stressful work conditions were generally associated with lower CVD risk, with substantial uncertainty around the effect estimates (moderate stress: HR = 0.41, 95% CI: 0.17 to 0.95; high stress: HR = 0.46, 95% CI: 0.06 to 3.69). Meeting the PA recommendation was also associated with lower CVD risk across levels of work stress, including among those reporting moderate or high stress; however, these associations were not statistically significant. Conclusion: Associations between work stress and CVD risk varied by physical work demands, with higher stress linked to greater risk in low physical work demands and stationary occupations. Meeting the PA recommendation showed a consistent trend toward lower CVD risk across levels of work stress. Overall, the findings suggest potential heterogeneity in the relationship between work stress and CVD according to physical work demands rather than demonstrating a protective effect. Further research with greater statistical power is needed to improve precision and clarify the underlying mechanisms.

Against the backdrop of a severe drug toxicity crisis, this study examined socioeconomic inequities in drug poisoning mortality among working-age adults in

Background Research has shown that workers in non-standard (eg, temporary and part-time) employment experience poorer health outcomes than their permanent, full-time counterparts. However, previous studies have overlooked important differences in the quality of non-standard employment. To address this gap, we examined associations between a diverse typology of employment quality and mortality in Canada. Methods The 2006 Canadian Health and Environment Cohort (n=2 805 550) was linked to death records from 2006 to 2019. Employment quality was assessed according to an empirical typology describing five distinct employment arrangements: standard (secure and gainful), portfolio (demanding but gainful), marginal (limited hours and earnings), intermittent (sporadic and unstable) and precarious (insecure and low paying). Poisson regression models estimated covariate-adjusted associations between employment quality, all-cause and cause-specific (cancer, cardiovascular and unintentional injury) mortality, by sex/gender. Results We observed a graded association between employment quality and mortality. Mortality rates were lowest among workers in standard and portfolio employment. Mortality rates were highest among workers in precarious employment, with workers in marginal and intermittent employment occupying intermediate positions along the risk gradient. Associations varied by sex/gender, with larger absolute and relative mortality inequalities among men. Conclusions Our findings reinforce the need to move away from a binary view of jobs as either ‘standard’ or ‘precarious’, encouraging a more nuanced understanding of contemporary employment arrangements and their health-related consequences. Policy interventions that promote access to high-quality jobs and protect workers exposed to precarious employment may yield substantial improvements in population health, including longevity.

Objectives To examine the association between precarious employment and risk of occupational injury or illness in Ontario, Canada. Methods We combined accepted lost-time compensation claims from the Workplace Safety and Insurance Board with labour force statistics to estimate injury and illness rates between January 2016 and December 2019. Precarious employment was imputed using a job exposure matrix and operationalised in terms of temporary employment, low wages, irregular hours, involuntary part-time employment and a multidimensional measure of ‘low’, ‘medium’, ‘high’ and ‘very high’ probabilities of exposure to precarious employment. Negative binomial regression models examined exposure to precarious employment in relation to risk of occupational injury or illness. Results After adjusting for age, sex and year, all indicators of precarious employment were associated with increased risk of injury or illness. Workers with ‘high’ and ‘very’ high’ exposure to precarious employment presented a nearly threefold risk of injury or illness (rate ratio (RR): 2.81, 95% CI 2.73 to 2.89; RR: 2.82, 95% CI 2.74 to 2.90). Further adjustment for physical demands and workplace hazards attenuated associations, though a statistically and substantively significant exposure–outcome relationship persisted for workers with ‘high’ and ‘very high’ exposures to precarious employment (RR: 1.65, 95% CI 1.58 to 1.72; RR: 2.00, 95% CI 1.92 to 2.08). Conclusions Workers exposed to precarious employment are more likely to sustain a lost-time injury or illness in Ontario, Canada. Workplace health and safety strategies should consider the role of precarious employment as an occupational hazard and a marker of work injury risk.

Objective To examine the association between precarious employment and risk of work-related COVID-19 infection in Ontario, Canada. Methods We combined data from an administrative census of workers’ compensation claims with corresponding labour force statistics to estimate rates of work-related COVID-19 infection between April 2020 and April 2022. Precarious employment was imputed using a job exposure matrix capturing temporary employment, low wages, irregular hours, involuntary part-time employment and a multidimensional indicator of ‘low’, ‘medium’, ‘high’ and ‘very high’ overall exposure to precarious employment. We used negative binomial regression models to quantify associations between precarious employment and accepted compensation claims for COVID-19. Results We observed a monotonic association between precarious employment and work-related COVID-19 claims. Workers with ‘very high’ exposure to precarious employment presented a nearly fivefold claim risk in models controlling for age, sex and pandemic wave (rate ratio (RR): 4.90, 95% CI 4.07 to 5.89). Further controlling for occupational exposures (public facing work, working in close proximity to others, indoor work) somewhat attenuated observed associations. After accounting for these factors, workers with ‘very high’ exposure to precarious employment were still nearly four times as likely to file a successful claim for COVID-19 (RR: 3.78, 95% CI 3.28 to 4.36). Conclusions During the first 2 years of the pandemic, precariously employed workers were more likely to acquire a work-related COVID-19 infection resulting in a successful lost-time compensation claim. Strategies aiming to promote an equitable and sustained recovery from the pandemic should consider and address the notable risks associated with precarious employment.