Precarious employment and its impact on chronic obstructive pulmonary disease in the Swedish working population – a longitudinal register-based study
5 affiliations
- 1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden .
- 2School of Nursing, Cape Breton University, Nova Scotia, Canada .
- 3Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark .
- 4Center for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden .
- 5Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden .
Abstract
Objective: Chronic obstructive pulmonary disease (COPD) is a respiratory disorder, and – after tobacco smoking – occupational exposures are among the most important risk factors. Precarious employment (PE) has been linked to a range of adverse mental and physical health outcomes; however, evidence regarding its potential association with COPD remains limited. PE may contribute to COPD risk through both greater exposure to occupational hazards and health-related behaviors, particularly smoking. This study aimed to examine whether PE is associated with COPD in the Swedish working population and assess whether these associations differ by gender.
Methods: A nationwide register-based cohort of 1 984 081 working-age individuals in Sweden was followed for 14 years (2003–2017). PE was operationalized multidimensionally: contractual employment insecurity, temporariness, multiple jobholding, income level, and coverage by collective bargaining agreements. Cumulative incidence of COPD (2004–2017) was identified through register-based diagnoses. Risk ratios (RR) were estimated using generalized linear models with a log link function, adjusting for sociodemographic factors, occupational exposures, and smoking where available.
Results: PE was associated with a graded increase in COPD risk, ranging from substandard employment [adjusted RR (RRadj) 1.18, 95% confidence interval (CI) 1.14–1.22] to PE (RRadj 1.39, 95% CI 1.31–1.47). Among the dimensions of PE, low income was the strongest contributor (RR 1.44, 95% CI 1.39–1.50), while unstable employment had a modest effect (RR 1.16, 95% CI 1.12–1.20).
Conclusion: PE is associated with elevated risk of COPD in the Swedish workforce. These findings emphasize the role of employment conditions as a social determinant of respiratory health.
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BibTeX
@article{lundh2026precarious,
title = {{Precarious employment and its impact on chronic obstructive pulmonary disease in the Swedish working population – a longitudinal register-based study}},
author = {Filippa Lundh and Virginia Gunn and Bertina Kreshpaj and Signild Kvart and Theo Bodin and Maria Albin and Jenny Selander and Sandra Ekström and Pernilla Wiebert and Nuria Matilla-Santander},
journal = {Scandinavian Journal of Work, Environment \& Health},
year = {2026},
month = nov,
doi = {10.5271/sjweh.4319},
url = {https://doi.org/10.5271/sjweh.4319},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Precarious employment and its impact on chronic obstructive pulmonary disease in the Swedish working population – a longitudinal register-based study
AU - Filippa Lundh
AU - Virginia Gunn
AU - Bertina Kreshpaj
AU - Signild Kvart
AU - Theo Bodin
AU - Maria Albin
AU - Jenny Selander
AU - Sandra Ekström
AU - Pernilla Wiebert
AU - Nuria Matilla-Santander
PY - 2026
DA - 2026/11/01
JO - Scandinavian Journal of Work, Environment & Health
DO - 10.5271/sjweh.4319
UR - https://doi.org/10.5271/sjweh.4319
AB - Objective: Chronic obstructive pulmonary disease (COPD) is a respiratory disorder, and – after tobacco smoking – occupational exposures are among the most important risk factors. Precarious employment (PE) has been linked to a range of adverse mental and physical health outcomes; however, evidence regarding its potential association with COPD remains limited. PE may contribute to COPD risk through both greater exposure to occupational hazards and health-related behaviors, particularly smoking. This study aimed to examine whether PE is associated with COPD in the Swedish working population and assess whether these associations differ by gender. Methods: A nationwide register-based cohort of 1 984 081 working-age individuals in Sweden was followed for 14 years (2003–2017). PE was operationalized multidimensionally: contractual employment insecurity, temporariness, multiple jobholding, income level, and coverage by collective bargaining agreements. Cumulative incidence of COPD (2004–2017) was identified through register-based diagnoses. Risk ratios (RR) were estimated using generalized linear models with a log link function, adjusting for sociodemographic factors, occupational exposures, and smoking where available. Results: PE was associated with a graded increase in COPD risk, ranging from substandard employment [adjusted RR (RRadj) 1.18, 95% confidence interval (CI) 1.14–1.22] to PE (RRadj 1.39, 95% CI 1.31–1.47). Among the dimensions of PE, low income was the strongest contributor (RR 1.44, 95% CI 1.39–1.50), while unstable employment had a modest effect (RR 1.16, 95% CI 1.12–1.20). Conclusion: PE is associated with elevated risk of COPD in the Swedish workforce. These findings emphasize the role of employment conditions as a social determinant of respiratory health.
SN - 0355-3140
SN - 1795-990X
ER -