title: Informal employment and health status in Central America.
abstract: BACKGROUND
  Informal employment is assumed to be an important but seldom studied social determinant of health, affecting a large number of workers around the world. Although informal employment arrangements constitute a permanent, structural pillar of many labor markets in low- and middle-income countries, studies about its relationship with health status are still scarce. In Central America more than 60% of non-agricultural workers have informal employment. Therefore, we aimed to assess differences in self-perceived and mental health status of Central Americans with different patterns of informal and formal employment.
  
  
  METHODS
  Employment profiles were created by combining employment relations (employees, self-employed, employers), social security coverage (yes/no) and type of contract--only for employees--(written, oral, none), in a cross-sectional study of 8,823 non-agricultural workers based on the I Central American Survey of Working Conditions and Health of 2011. Using logistic regression models, adjusted odds ratios (aOR) by country, age and occupation, of poor self-perceived and mental health were calculated by sex. Different models were first fitted separately for the three dimensions of employment conditions, then for employment profiles as independent variables.
  
  
  RESULTS
  Poor self-perceived health was reported by 34% of women and 27% of men, and 30% of women and 26% of men reported poor mental health. Lack of social security coverage was associated with poor self-perceived health (women, aOR: 1.38, 95% CI: 1.13-1.67; men, aOR: 1.36, 95% CI: 1.13-1.63). Almost all employment profiles with no social security coverage were significantly associated with poor self-perceived and poor mental health in both sexes.
  
  
  CONCLUSIONS
  Our results show that informal employment is a significant factor in social health inequalities among Central American workers, which could be diminished by policies aimed at increasing social security coverage.
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. maria.lopez@upf.edu.|Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain. maria.lopez@upf.edu.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. maria.lopez@upf.edu.|Facultad Latinoamericana de Ciencias Sociales, Salamanca, Spain. maria.lopez@upf.edu.
authors.forename: María
authors.initials: M
authors.lastname: López-Ruiz
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. lartazco@aspb.cat.|Agència de Salut Pública de Barcelona, Barcelona, Spain. lartazco@aspb.cat.|Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain. lartazco@aspb.cat.
authors.forename: Lucía
authors.initials: L
authors.lastname: Artazcoz
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. jmiguel.martinez@upf.edu.|Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain. jmiguel.martinez@upf.edu.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. jmiguel.martinez@upf.edu.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Martínez
authors.affiliation: Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain. marianela.rojasgarbanzo@gmail.com.|Programa Salud, Trabajo y Ambiente en América Central (SALTRA), Universidad Nacional, Heredia, Costa Rica. marianela.rojasgarbanzo@gmail.com.
authors.forename: Marianela
authors.initials: M
authors.lastname: Rojas
authors.affiliation: CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain. fernando.benavides@upf.edu.|Center for Research in Occupational Health, Universitat Pompeu Fabra, Barcelona, Spain. fernando.benavides@upf.edu.|IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. fernando.benavides@upf.edu.
authors.forename: Fernando G
authors.initials: FG
authors.lastname: Benavides
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002489:Central America / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004651:Employment / Q000523:psychology* / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D009790:Occupations / Q000706:statistics & numerical data; D016017:Odds Ratio; D012649:Self Concept; D012737:Sex Factors; D012943:Social Security / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D055815:Young Adult