Associations Between Employment and Health Outcomes: A Systematic Review of Reviews

The subject of employment as a determinant of health has received considerable attention from researchers. To our knowledge, a comprehensive synthesis of evidence on the health effects of employment has not been completed in almost 20 years. This systematic review aimed to provide an up-to-date summary of the associations between employment status and any measurable domain of health.

We searched Ovid MEDLINE, Embase, CINAHL Plus with Full Text, and APA PsycINFO. We included peer-reviewed, full-text systematic reviews or overviews published in English between January 2012 and November 2024. Two reviewers independently screened resultant publications and extracted data from those found eligible for the review.

Our search yielded 1862 reviews and meta-analyses, 49 of which were eligible for synthesis. Employment status was associated with several health domains including general health and wellbeing, mental health, alcohol and substance use disorders, cardiovascular health, systemic inflammation, sleep quality, cognitive functioning, and mortality.

Being employed was almost universally associated with favourable physical and mental health outcomes, with evidence to suggest re-employment may facilitate improvements in health after a period of unemployment. Socioeconomic status was a notable factor which affected health outcomes for both employed and unemployed people, illustrative of social gradients in health. Insecure or low-quality work demonstrated the potential to override identified health benefits of work. Heterogeneity in the operationalization of employment across publications, and the influence of survivorship bias on health outcomes highlights a task for future research to establish causality in the relationship between employment status and health.