Background The ageing workforce in China not only brings a great burden to the pension system but also poses a considerable challenge to the healthcare system. This study aims to investigate the association between employment status and general health status measured by self-rated health (SRH) among Chinese middle-aged and older workers.

Methods Individual-level data came from the national baseline wave of China Health and Retirement Longitudinal Study (2011-2012). The analytical sample consisted of 14,445 baseline participants aged 45 years and over. Multivariate logistics regression models were estimated to investigate the association between employment status and SRH. Multiple imputation by chained equations was performed to deal with missing data in covariates. A sensitivity analysis was performed to investigate whether the association between employment status and SRH is modified by excluding participants without valid information on employment status. A complete case analysis was performed to be able to compare the results from imputed data analysis and complete case analysis. To account for the complex survey design, all the results were adjusted for baseline individual weights.

Results Controlling for age, sex, education, household wealth, marital status, region, and health behaviours, non-agricultural self-employed workers, retirees, and agricultural workers (employed, self-employed, or retired) have higher odds of reporting poor and very poor SRH compared with non-agricultural employed workers. The association is modified by residence type (urban, migrant, and rural). Among urban residents, non-agricultural self-employed workers and retirees have 1.92 (95% CI, 1.11-3.33) and 2.33 (95% CI, 1.56-3.50) times higher odds of poor SRH, compared with non-agricultural employed workers, respectively. Among rural residents, agricultural employed, self-employed, and retired workers have 1.44 (95% CI, 1.01-2.05), 2.19 (95% CI, 1.77-2.72), and 4.68 (95% CI, 3.67-5.96) times higher odds of poor SRH compared with non-agricultural employed workers, respectively. Results from sensitivity analysis and complete case analysis are in consistent with the main results.

Conclusion There is some evidence for an urban-rural difference in the association between employment status and SRH among Chinese middle-aged and older workers. Non-agricultural employed workers reported better health status than other working groups.