Objective Chronic obstructive pulmonary disease (COPD) is a respiratory disorder, and – after tobacco smoking – occupational exposures are among the most important risk factors. Precarious employment (PE) has been linked to a range of adverse mental and physical health outcomes; however, evidence regarding its potential association with COPD remains limited. PE may contribute to COPD risk through both greater exposure to occupational hazards and health-related behaviors, particularly smoking. This study aimed to examine whether PE is associated with COPD in the Swedish working population and assess whether these associations differ by gender.

Methods A nationwide register-based cohort of 1 984 081 working-age individuals in Sweden was followed for 14 years (2003–2017). PE was operationalized multidimensionally: contractual employment insecurity, temporariness, multiple jobholding, income level, and coverage by collective bargaining agreements. Cumulative incidence of COPD (2004–2017) was identified through register-based diagnoses. Risk ratios (RR) were estimated using generalized linear models with a log link function, adjusting for sociodemographic factors, occupational exposures, and smoking where available.

Results PE was associated with a graded increase in COPD risk, ranging from substandard employment [adjusted RR (RR_adj) 1.18, 95% confidence interval (CI) 1.14–1.22] to PE (RR_adj 1.39, 95% CI 1.31–1.47). Among the dimensions of PE, low income was the strongest contributor (RR 1.44, 95% CI 1.39–1.50), while unstable employment had a modest effect (RR 1.16, 95% CI 1.12–1.20).

Conclusion PE is associated with elevated risk of COPD in the Swedish workforce. These findings emphasize the role of employment conditions as a social determinant of respiratory health.

Key terms chronic obstructive pulmonary disease; COPD; job exposure matrix; longitudinal; precarious employment; register-based research; register-based study; Sweden; working population

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