Causal effect of shifting from precarious to standard employment on all-cause mortality in Sweden: an emulation of a target trial

Nuria Matilla-Santander, Anthony A Matthews, Virginia Gunn, Carles Muntaner, Bertina Kreshpaj, David H Wegman, Néstor Sánchez-Martínez, Julio C Hernando-Rodriguez, Maria Albin, Rebeka Balogh, Letitia Davis, Theo Bodin

Research output: Contribution to journalArticlepeer-review

12 Downloads (Pure)


Background We aimed at estimating the causal effect of switching from precarious to standard employment on the 6-year and 12-year risk of all-cause mortality among workers aged 20-55 years in Sweden.

Methods We emulated a series of 12 target trials starting every year between 2005 and 2016 using Swedish register data (n=251 273). We classified precariously employed individuals using a multidimensional approach at baseline as (1) remaining in precarious employment (PE) (73.8%) and (2) shifting to standard employment (26.2%). All-cause mortality was measured from 2006 to 2017. We pooled data for all 12 emulated trials and used covariate-adjusted pooled logistic regression to estimate intention-to-treat and per-protocol effects via risk ratios (RRs) and standardised risk curves (the parametric g-formula).

Results Shifting from precarious to standard employment decreases the 12-year risk of death by 20% on the relative scale (RR: 0.82, 95% CI: 0.73; 0.93), regardless of what happens after the initial shift. However, we estimated a 12-year risk reduction of 30% on the relative scale for workers shifting from precarious to standard employment and staying within this employment category for the full 12 years (RR: 0.71, 95% CI: 0.54; 0.95).

Conclusions This study finds that shifting from low to higher-quality employment conditions (ie, stable employment, sufficient income levels and high coverage by collective agreements) decreases the risk of death. Remaining in PE increases the risk of premature mortality. Our results emphasise the necessity of ensuring decent work for the entire working population to accomplish the 2030 Agenda for Sustainable Development.
Original languageEnglish
Pages (from-to)736-743
Number of pages8
JournalJournal of Epidemiology and Community Health
Issue number11
Early online date2023
Publication statusPublished - Nov 2023

Bibliographical note

Funding Information:
The project was funded by FORTE, the Swedish Research Council for Health, Working Life and Welfare (no. 2019-01226).

Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.


Dive into the research topics of 'Causal effect of shifting from precarious to standard employment on all-cause mortality in Sweden: an emulation of a target trial'. Together they form a unique fingerprint.

Cite this