Lingering Impact of Starting Working Life During a Recession: Health Outcomes of Survivors of the "Employment Ice Age" (1993-2004) in Japan

A growing amount of evidence demonstrates the adverse impacts of economic downturns on population health. However, the extent to which the macroeconomic conditions at labor market entry affect health outcomes in later life remains relatively understudied. This study focused on the health outcomes of the cohort who entered the labor market during the "employment ice age" (EIA; 1993-2004) in Japan, when young people had difficulty finding jobs after graduating from college or high school. We used repeated cross-sectional data (N = 3,054,782; 1,500,618 men and 1,554,164 women) obtained from an 11-wave population-based nationwide survey conducted every 3 years from 1986 through 2016. We considered three health outcomes: being in hospital, subjective symptoms, and self-rated health (SRH). We employed two types of statistical analyses: an age-period-cohort (APC) analysis, which controlled for age and period (wave) effects, and a difference-in-differences (DiD) analysis, in which the EIA experience was regarded as a treatment. The APC analysis confirmed the relative disadvantage of the EIA cohort for all three outcomes; for instance, the odds ratio of poor SRH for the EIA cohort was 1.29 (95% confidence interval [CI], 1.21-1.38) for men and 1.25 (95% CI, 1.17-1.34) for women. The DiD analysis confirmed the robustness of these results, especially for men. The results underscored the lingering impact of the macroeconomic conditions at labor market entry on health outcomes in later life in Japan.