Decomposing Midlife HS-GED Health Disparities: The Role of Employment Histories

Abstract Background The health disparities between high school (HS) diploma holders and GED recipients have been well documented. However, limited research has examined how differential employment histories may contribute the observed HS-GED health disparities. Data This study uses data from the National Longitudinal Survey of Youth 1979 (NLSY79, n = 3,277) to construct the employment histories (age 21-49) and examine eight health outcomes (e.g., self-rated health, functional limitations and depressive symptoms, etc.) observed in the 50+ Health Module. Methods This study employs sequence-based analysis to classify employment histories into typical life course patterns. It then uses multivariate decomposition approach to determine the extent to which the HS-GED health disparities are attributable to differential distribution or differential return of typical employment histories. Results This study identifies six typical employment patterns: (1) gradual withdrawal, (2) incremental integration, (3) prolonged inactive, (4) continuous full-time, (5) part-time dominated, and (6) military to civil work. The decomposition analysis suggests that both differential distribution and differential return between HS and GED groups play a role in explaining the HS-GED disparities, while the relative shares differ across health outcomes. Especially, the differential distribution of “continuous full-time” and “prolonged inactive” employment histories arise to be the main drivers of the HS-GED health disparities. These findings highlight the crucial role of employment histories in shaping HS-GED health disparities and raise the question of why similar employment histories yield discriminatory health returns between these two groups.