INTRODUCTION: Hazardous working conditions fuel inequities in accidental-poisoning, suicide, and chronic-liver-disease mortality. Relational theories suggest such hazards flow from power imbalances between workers, managers, and employers – social classes demarcated by power over property and labor. However, to our knowledge, no US studies using relational measures have analyzed class inequities in the cause-specific mortality.
METHODS: We used the Mortality Disparities in American Communities dataset, which links the 2008 American Community Survey to the National Death Index through December 31, 2019. We classified respondents as incorporated business owners, unincorporated business owners, managers, workers, or not in the labor force based on their employment, occupational, and business-ownership status. Then, using an inverse-probability-weighted Aalen-Johansen estimator, we estimated risk differences in the cause-specific mortality across classes at the end of follow-up, including by sex, race/ethnicity, and education.
RESULTS: Our sample included 2,304,500 respondents and 10,870 accidental-poisoning, suicide, and chronic-liver-disease deaths. Compared to incorporated business owners, those not in the labor force, workers, and unincorporated business owners had, respectively, 8.9 (95 % CI: 8.0, 9.7), 0.9 (95 % CI: 0.4, 1.5), and 1.1 (95 % CI: 0.3, 1.9) greater 12-year age- and sex-adjusted risks of the cause-specific mortality per 1000. Managers’ risks resembled incorporated business owners’. Inequities largely persisted after thorough sociodemographic adjustment. Among workers, risks were elevated among the unemployed and those with blue-collar or service occupations. Finally, inequities were greater among men and less-educated respondents than among women and more-educated respondents.
DISCUSSION: We estimated considerable class inequities in the cause-specific mortality, adding to research connecting class relations to mortality inequities and worsening population health.
Following the power: Social-class inequities in mortality from accidental poisonings, suicide, and chronic liver disease in the United States
Social Science and Medicine, 392, 118991. doi: 10.1016/j.socscimed.2026.118991.