Objective Monitoring of occupational health inequities is central to establishing effective public policies. The Central America Working Conditions Survey (ECCTS, by its Spanish acronym) was conducted in 2011 and 2018. This study analyzes changes, between these two periods, in the health inequality gap of workers in the six Spanish-speaking Central American countries, by gender, age, education level, occupation, and geographic area.

Methods The ECCTS is a cross-sectional survey of a nationally representative sample of workers (12,024 in 2011 and 9,030 in 2018), age ≥18 years, in formal or informal employment. We calculated the prevalence of poor self-perceived health (SPH) and its 95% confidence interval by country, age, education level, occupational category, and geographic area; differences between 2011 and 2018 were measured using chi-square statistics. We also measured absolute and relative population attributable risks, the Kuznets ratio and weighted Keppel index as inequality measures. All analyses were stratified by sex.

Results Overall, the health of the population in this region improved. Poor SPH decreased from 32% to 29% in women, and from 33% to 30% in men. The health inequalities gap among occupational groups remains wide. In women, the gap increased by occupation and geographic area, and decreased by education level. Among men, we found no statistically significant changes in the gap. Inequality between countries increased, evidenced by an increase in the Keppel index from 22% to 39% in women and from 20% to 29% in men.

Conclusion A general improvement in the health status was observed, but there was no progress in closing the health gap among occupational groups, and the gap between countries grew significantly. This study is the first to benchmark surveillance information that may contribute to developing, implementing and evaluating public policies. It could also serve as an initial stimulus to create strong national and regional occupational monitoring systems.