Unemployment and self-rated health: neighborhood influence.

This work contributes to the study of the relationship between health, work and context by investigating the interaction between them in Brazil, a country with great social inequalities. It investigates whether unemployment and socioeconomic characteristics of the neighborhoods in which people live are associated with poor self-rated health after adjustment for individual sociodemographic characteristics, behavioral risk factors and health status. Moreover, it tests whether living in an area of socioeconomic deprivation modifies the association between unemployment and self-rated health. The study involved participants whose ages ranged from 15 up to 64 years, and who lived in four Brazilian cities included in the National Household Survey on Risk Behaviors and Reported Morbidity from Non-Communicable Diseases, carried out by the Ministry of Health in 2002/2003. Data from the 2000 Brazilian Population Census were used to calculate two neighborhood socioeconomic indicators: the proportion of householders with low income, a compositional variable of individual level characteristics, and residing in slums, a contextual variable not captured by individual properties. Logistic regression analysis was estimated by Generalized Estimating Equations. Of the 6426 participants, 20.6% reported poor self-rated health. Unemployment as well as residing in slums or in low income household areas were significantly associated with poor self-rated health. The magnitudes of these associations were attenuated after adjustment for sociodemographic characteristics, behavioral risk factors and other health status indicators. However, the association between unemployment and poor self-rated health was not modified by neighborhood socioeconomic indicators. Results confirm the association between unemployment and poor self-rated health, regardless of the personal or contextual characteristics studied here. Similarly, they show a clear independent association between self-rated health and neighborhood context. Even so, they do not show that the neighborhood contexts investigated modify the associations between unemployment and poor self-rated health.