Workers Facing Greater Economic Hardship More Likely to Report Poor Health

The prevalence of fair or poor health among occupational groups generally increased with the prevalence of high economic hardship, according to a study published last Thursday in the CDC’s Morbidity and Mortality Weekly Report, highlighting persistent gaps in worker health and employment sustainability.1

Economic hardship, defined as the inability to afford basic needs, such as food, clothing, and health care, adversely affects health.2 Building on past findings, the researchers stressed that understanding how economic hardship is distributed across sociodemographic and occupational groups can help identify where resources are most needed to support worker health.1

To explore this further, they conducted an analysis using 2022-2023 Behavioral Risk Factor Surveillance System (BRFSS) data, focusing on US adults who were either currently employed or recently unemployed within the past 12 months.

US workers facing high economic hardship, especially those in lower-wage occupations, were significantly more likely to report fair or poor health, underscoring persistent disparities in worker well-being. | Image Credit: elenabsl - stock.adobe.com

The BRFSS core survey collects information on sociodemographic characteristics, health conditions, behaviors, and health-related service use. Optional modules, including the Industry and Occupation module and the 2022 and 2023 Social Determinants of Health/Health Equity module, provide additional data.

The Industry and Occupation module classifies respondents’ job types into 22 standard occupational groups, while the Social Determinants of Health/Health Equity module addresses economic hardship factors like employment instability, food insecurity, housing insecurity, utility insecurity, lack of reliable transportation, and reliance on food stamps or Supplemental Nutrition Assistance Program benefits.

Two additional economic hardship indicators, the lack of health insurance and cost-related barriers to medical care, were measured within the BRFSS core survey. Respondents reporting at least 4 of the 8 hardship indicators were considered to be experiencing high economic hardship.

Among 165,060 eligible respondents, 6.9% experienced economic hardship. The most frequently reported issues included job loss or reduction in work hours (16.5%), housing insecurity (12.2%), food insecurity (12.1%), and cost preventing needed medical visits (11.8%). In contrast, lack of reliable transportation was the least commonly reported (6.7%).

High economic hardship was more prevalent among individuals who were recently unemployed, aged 18 to 49 years, female, had a high school education or less, identified as Hispanic or non-Hispanic Black, and earned under $50,000 annually.

By occupation, the highest rates of economic hardship were seen in farming, fishing, and forestry (18.5%); building and grounds cleaning and maintenance (18.2%); and food preparation and serving (16.0%). Conversely, legal occupations had the lowest prevalence (1.2%).

Overall, 12.5% of respondents reported fair or poor health. Similar to individuals with high economic hardships, those with fair or poor health were Hispanic, had lower educational attainment, or had lower incomes.

Across occupational groups, rates of fair or poor health generally rose with increasing economic hardship. Except for the construction and extraction group, this pattern was statistically significant across all occupations experiencing high levels of economic hardship compared with all workers combined.

Lastly, the researchers acknowledged their study’s limitations, including that BRFSS data are self-reported and subject to recall and social desirability biases. Also, results were based on data from respondents in 36 states and the US Virgin Islands that administered 1 or both optional modules, limiting national generalizability.

Despite their limitations, the researchers expressed confidence in their findings and emphasized their relevance for policymaking.

“Given associations between unmet economic needs and health, these findings can be used by policymakers to identify groups of workers with disproportionate economic hardships and develop strategies to enhance economic security and health for all workers,” the authors wrote.

References

1. Silver SR, Li J, Shockey TM. Economic hardship and health within sociodemographic and occupational groups — Behavioral Risk Factor Surveillance System, United States, 2022–2023. MMWR. 2025;74(19):326-333. doi:10.15585/mmwr.mm7419a3
2. Friedline T, Chen Z, Morrow S. Families' financial stress & well-being: the importance of the economy and economic environments. J Fam Econ Issues. 2021;42(suppl 1):34-51. doi:10.1007/s10834-020-09694-9