Silva-Peñaherrera, Michael, 1984-López Ruiz, María, 1982-Merino Salazar, Pamela Alexandra, 1978-Gómez García, Antonio RamónBenavides, Fernando G. (Fernando García)2021-10-082021-10-082021Silva-Peñaherrera M, López-Ruiz M, Merino-Salazar P, Gomez Garcia AR, Benavides FG. Association between informal employment and mortality rate by welfare regime in Latin America and the Caribbean: an ecological study. BMJ Open. 2021;11(8):e044920. DOI: 10.1136/bmjopen-2020-0449202044-6055http://hdl.handle.net/10230/48591Objective: We aimed to estimate the association between informal employment and mortality in Latin America and the Caribbean (LAC) by comparing welfare state regimes. Design: Ecological study using time-series cross-sectional analysis of countries. Informality was estimated from household surveys by the Center for Distributive, Labor and Social Studies in collaboration with the World Bank, and the adult mortality rates for 2000-2016 were obtained from the WHO databases. Countries were grouped by welfare state regimes: state productivist, state protectionist and familialist. We calculated the compound annual growth rate for each country and performed linear regression between the informality and the adult mortality rates stratified by sex and welfare state regime. Setting: Seventeen countries from LAC with available data on informality and adult mortality rates for 2000-2016. Primary outcome measure: The association between informality and mortality by welfare state regime. Results: Between 2000 and 2016, mortality rates decreased an average 1.3% per year and informal employment rates 0.5% per year. We found a significant positive association between informality and mortality rates (women: R2=0.48; men: R2=0.36). The association was stronger among the state regime countries (women: R2=0.58; men: R2=0.77), with no significant association among the familialist countries. Conclusion: Informal employment negatively impacts population health, which is modified by welfare state regimes. Addressing informal employment could be an effective way to improve population health in LAC. However, linkage with public health and labour market agendas will be necessary.application/pdfeng© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.info:eu-repo/semantics/articlehttp://dx.doi.org/10.1136/bmjopen-2020-044920Health & safetyHealth policyOccupational & industrial medicinePublic healthinfo:eu-repo/semantics/openAccess