Understanding the Association Between County-level Unemployment and Health Stratified by Education and Income in the Southwestern United States

Past research on the relationship between unemployment rates and population health has produced mixed findings. The relationship can be influenced by the kinds of health outcomes observed, time frame, level of geographic aggregation, and other factors. Given these mixed findings, there is a need to add to our knowledge about how unemployment rates and population health are related. There is limited research that examines the association of unemployment rates with both physical and mental health, while simultaneously stratifying populations by income and education levels. Using survey-based self-reported data, this first population-based study examined the association between unemployment rates and physically and mentally unhealthy days in the southwestern United States, by county-level stratification of income (high and low) as well as education (high and low), from 2015 to 2019. After controlling for covariates, associations were modelled using negative binomial regression, with autocorrelative residuals, and were reported as rate ratios (RR). Overall, we found that a 1% rise in unemployment rates was significantly associated with an increase in physically unhealthy days [adjusted RR 1.007; 95% CI, 1.004-1.011, P < 0.001] and mentally unhealthy days [RR 1.006; 95% CI, 1.003-1.009, P  < 0.001]. Upon stratification, a significant risk was found among the high education and high income category [RR 1.035; 95% CI, 1.021-1.049, P  < 0.001], as well as for the high education and low income category [RR 1.026; 95% CI, 1.013-1.040, P  < 0.001]. A better understanding of how unemployment is associated with the health of communities with different education and income levels could help reduce the burden on society through tailored interventions and social policies not only in the United States, but also in other developed nations.