Workplace hazards and health among informally employed domestic workers in 14 cities, United States, 2011-2012: using four approaches to characterize workers’ patterns of exposures

Abstract

ABSTRACTObjectivesWe characterized informally employed US domestic workers’ (DWers) exposure to patterns of workplace hazards, as well as singular hazards, and examined associations with DWers’ work-related and general health.MethodsWe analyzed cross-sectional data from the sole nationwide survey of informally employed US DWers with work-related hazards data, conducted in 14 cities (2011-2012; N=2,086). We characterized DWers’ exposures using four approaches: single exposures (n=19 hazards), composite exposure to hazards selected a priori, classification trees, and latent class analysis. We used city fixed effects regression to estimate the risk ratio (RR) of work-related back injury, work-related illness, and fair-to-poor self-rated health associated with exposure as defined by each approach.ResultsAcross all four approaches—net of individual, household, and occupational characteristics and city fixed effects—exposure to workplace hazards was associated with increased risk of the three health outcomes. For work-related back injury, the estimated RR associated with heavy lifting (the single hazard with the largest RR), exposure to all three hazards selected a priori (did heavy lifting, climbed to clean, worked long hours) versus none, exposure to the two hazards identified by classification trees (heavy lifting, verbally abused) versus “No heavy lifting,” and membership in the most-versus least-exposed latent class were, respectively, 3.4 (95% confidence interval [CI] 2.7 to 4.1); 6.5 (95% CI 4.8 to 8.7); 4.4 (95% CI 3.6 to 5.3), and 6.6 (95% CI 4.6 to 9.4).ConclusionsMeasures of joint work-related exposures were more strongly associated than single exposures with informally employed US DWers’ health profiles.KEY MESSAGESWhat is already known on this topicInformally employed domestic workers in the US and internationally are frequently exposed to physical and social hazards at work, but only two studies have quantitatively assessed these workers’ exposures to joint patterns of hazards, and neither examined such patterns in relation to health.What this study addsWe characterized informally employed US domestic workers’ exposure to 19 single hazards and to combinations of these hazards, using three distinct approaches: composite exposure to hazards selected a priori, classification trees, and latent class analysis. Across all approaches to defining exposure, domestic workers exposed to worse joint patterns of workplace hazards, as well as to certain single hazards, experienced greater risk of work-related back injury, work-related illness, and fair-to-poor self-rated health.How this study might affect research, practice, or policyResults underscore the importance of conceptualizing and operationalizing measures that capture domestic workers’ patterns of exposures. Moreover, results support the use of a latent class approach for identifying potential subgroups of workers unduly burdened and—across multiple health metrics—harmed by employer practices.