ArticleAmerican journal of industrial medicine2020
Solidarity and disparity: Declining labor union density and changing racial and educational mortality inequities in the United States.
Article in American journal of industrial medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
What it found
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it, 23 citations in OpenAlex.
- A Systematic Review of Evaluated Labor Market Initiatives Addressing Precarious Employment: Findings and Public Health Implications.International journal of social determinants of health and health services · 2025Pooled it
- Heartache in the Heartland: Unraveling the Social Roots of Deaths of Despair in Kentucky.Journal of Appalachian health · 2025Article
- Missing Americans: Early death in the United States-1933-2021.PNAS nexus · 2023Article
- The Future of the United States Overdose Crisis: Challenges and Opportunities.The Milbank quarterly · 2023Article
- Heterogeneity in Disparities in Life Expectancy Across US Metropolitan Areas.Epidemiology (Cambridge, Mass.) · 2022Article
- Labor unions and health: A literature review of pathways and outcomes in the workplace.Preventive medicine reports · 2021Review
- Union Burying Ground: Mortality, Mortality Inequities, and Sinking Labor Union Membership in the United States.Epidemiology (Cambridge, Mass.) · 2021Article
- Perceptions of Diseases of Despair by Members of Rural and Urban High-Prevalence Communities: A Qualitative Study.JAMA network open · 2021Article
- Does the Union Make Us Strong? Labor-Union Membership, Self-Rated Health, and Mental Illness: A Parametric G-Formula Approach.American journal of epidemiology · 2021Article
- Trends in the diagnosis of diseases of despair in the United States, 2009-2018: a retrospective cohort study.BMJ open · 2020Article
- Suicide, overdose and worker exit in a cohort of Michigan autoworkers.Journal of epidemiology and community health · 2020Article
- Economic influences on population health in the United States: Toward policymaking driven by data and evidence.PLoS medicine · 2020Article
Corrections and comments
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Authors and funding
5 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundRecently, United States life expectancy has stagnated or declined for the poor and working class and risen for the middle and upper classes. Declining labor-union density-the percent of workers who are unionized-has precipitated burgeoning income inequity. We examined whether it has also exacerbated racial and educational mortality inequities.
methodsFrom CDC, we obtained state-level all-cause and overdose/suicide mortality overall and by gender, gender-race, and gender-education from 1986-2016. State-level union density and demographic and economic confounders came from the Current Population Survey. State-level policy confounders included the minimum wage, the generosity of Aid to Families with Dependent Children or Temporary Assistance for Needy Families, and the generosity of unemployment insurance. To model the exposure-outcome relationship, we used marginal structural modeling. Using state-level inverse-probability-of-treatment-weighted Poisson models with state and year fixed effects, we estimated 3-year moving average union density's effects on the following year's mortality rates. Then, we tested for gender, gender-race, and gender-education effect-modification. Finally, we estimated how racial and educational all-cause mortality inequities would change if union density increased to 1985 or 1988 levels, respectively.
resultsOverall, a 10% increase in union density was associated with a 17% relative decrease in overdose/suicide mortality (95% confidence interval [CI]: 0.70, 0.98), or 5.7 lives saved per 100 000 person-years (95% CI: -10.7, -0.7). Union density's absolute (lives-saved) effects on overdose/suicide mortality were stronger for men than women, but its relative effects were similar across genders. Union density had little effect on all-cause mortality overall or across subgroups, and modeling suggested union-density increases would not affect mortality inequities.
conclusionsDeclining union density (as operationalized in this study) may not explain all-cause mortality inequities, although increases in union density may reduce overdose/suicide mortality.
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