Black Americans’ Diminished Health Returns of Employment During COVID-19 Pandemic

Document Type : Original Article


1 National Center for Health Insurance Research, Tehran, Iran

2 Marginalization-Related Diminished Returns (MDRs) Center, Los Angeles, California, USA

3 Marginalization-Related Diminished Returns (MDRs) Center, Los Angeles, CA, USA

4 Department of Urban Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA

5 Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA



Introduction: Employment is a major social determinant of health (SDoH) and core socioeconomic status (SES) indicator. This study used a nationally representative sample of American adults to test the association between employment and self-rated health (SRH) overall and by race.
Methods: Using data from the Health Information National Trends Survey (HINTS 2020) Cycle 4, this analysis included 1403 individuals including 1109 (79%) non-Latinx White and 294 (21%) non-Latinx Black participants. The dependent variable was SRH, the independent variable was employment, and age, sex, marital status, education, and income were the covariates. Race was the moderator.
Results: Employment was associated with better SRH overall. A significant statistical interaction reflected racial differences in the effect of employment (above and beyond education and income) on SRH by race. The protective health effects of employment on SRH were weaker for non-Latinx Black than non-Latinx White individuals.
Conclusion: The association between employment and SRH varies across racial groups, and this difference can also be seen during the COVID-19 pandemic. Diminished health returns of SES indicators such as employment in non-Latinx Black individuals compared to nonLatinx White people may reflect some additional health risk for middle-class non-Latinx Black communities in the US. Sustainability of marginalization-related diminished returns (MDRs), defined as weaker effects of social determinants and resources such as employment on health outcomes for marginalized than privileged social groups, is another risk for underserved populations during pandemics. These MDRs that reflect systemic inequalities may hinder our efforts to secure equality during pandemics.