Workplace Stratification and Racial Health Disparities

To what extent is a worker's relative rank within their workplace a determinant of health status, conditional on income? We provide the first US-based evidence on the relationship between relative workplace rank and health status for the near population of workers in one US state. Using a new linkage of commercial all-payer health insurance data to administrative earnings records for workers in Utah from 2013-2015, we quantify the impact of relative workplace rank on health status, the incidence of specific chronic diseases, and racial health disparities. We show that about 70% of SES-health gradient that is commonly interpreted as an income gradient actually operates through relative rank. For an average worker, moving from the 90th to the 10th percentile of within-firm rank holding fixed income, age, location, and health insurance characteristics is associated with a 16.5% increase in morbidity. The racial segregation of jobs in the US leads minority workers to be overrepresented in lower-ranked jobs within firms, which in turn exacerbates racial health disparities.