Unequal Exposure, Equal Vulnerability, Unequal Incidence: Unemployment Duration and Hypertension Risk Across Race in the United States

Unemployment is known to deteriorate physical health through income loss and psychological stress; yet it remains unclear whether racial health disparities stem from differential vulnerability to joblessness or unequal exposure to it. Using a case-crossover design on National Longitudinal Survey of Youth (NLSY79) data from 1983 to 2018, this case-crossover study accounts for unobserved, time-invariant heterogeneity to examine how unemployment duration influences hypertension risk across Black and non-Black respondents. Descriptive analyses reveal striking structural inequities: Black respondents experience significantly longer unemployment duration. Conditional logit models show that longer unemployment duration markedly increases the odds of a hypertension diagnosis for all individuals, with interaction models confirming that the health penalty per duration unit does not differ significantly by race. Nevertheless, because vulnerability to joblessness is equal across racial groups, the disproportionate exposure of Black individuals to prolonged unemployment translates directly into a higher cumulative incidence of hypertension. These findings demonstrate that racial health disparities in joblessness are driven by unequal exposure to prolonged unemployment, rooted in labor market discrimination, rather than a differential biological or psychological response. Consequently, structural interventions to reduce unemployment exposure can improve overall population health while simultaneously narrowing racial gaps in cardiovascular disease.