Can self-employment benefit women's cardiovascular health?

A study suggests that self-employed women could have health benefits.

Working for yourself can offer several important benefits, including greater flexibility and autonomy that may be lacking in a more traditional work structure. But could self-employment also promote cardiovascular health?

New long-term research suggests this is possible – at least in women. Self-employed women were less likely to have high blood pressure, diabetes and obesity and reported higher levels of physical activity than women who received wages or salaries.

“The study shows that allowing women to take control of their employment and the way they work could actually have health benefits,” says Dr. Emily Lau, a cardiologist at Massachusetts General Hospital who specializes in cardiovascular disease in women's health. “It is really timely as the pandemic has confronted us as a society with questions about how we should think about work landscapes and whether traditional work structures offer the best way to move forward.”

Interesting, but not conclusive

The new study published inBMC Women's Health, based on data from a large, long-term health and retirement study underway at the University of Michigan. Although the results are fascinating, they are anything but conclusive, says Dr. Lau firmly. As an observational, cross-sectional analysis, it cannot prove that self-employment leads to better health markers because it does not provide the scientific rigor of a randomized, controlled trial that directly compares the effects of an intervention among randomly assigned study participants.

“Self-employment can be an indicator of many things,” she explains. "Self-employed women are generally older, have higher levels of education, and are more likely to be financially literate. All of these factors are independently associated with better cardiovascular outcomes."

What was considered in this study about cardiovascular health and work?

Cardiovascular disease contributes to heart attacks, strokes and other serious health problems. It affects nearly half of women in the United States.

The study analyzed survey data collected between 2016 and 2018 from an ethnically diverse group of 4,624 women who reported working either employed, self-employed or for pay. All were over 50 years old and about 16% of participants were self-employed, while the rest worked for someone else.

Researchers examined the possible relationships between work structure and participants' self-reported responses to cardiovascular disease risk factors such as high blood pressure, coronary artery disease or heart failure.

Survey questions focused on health behaviors and self-reported factors that influence cardiovascular disease risk. For example, one asked about participants' drinking habits: "On how many days in the last three months have you had four or more drinks on one occasion?" Another asked: “Would you say your health is excellent, very good, good, fair or poor?”

What did the study show and what are its limitations?

The study found that women who were self-employed reported a 34% lower risk of obesity; 43% lower chance of high blood pressure; and 30% lower chance of diabetes compared to those who work for a salary or wage. Meanwhile, self-employed women appeared to have a lower body mass index (BMI) and were more physically active, with 80% saying they exercise at least twice a week, compared to 72% of other participants.

The results were adjusted for one key factor - access to health care - and remained despite more self-employed women reporting they were uninsured. “The biggest strength of the study is its sheer size and that it's trying to capture something that hasn't been thoroughly studied before,” says Dr. Lau. “The researchers should be applauded for trying to answer this really complicated question.”

Self-employment doesn't always mean more freedom, which can affect how much time someone can devote to exercise or self-care. “You can imagine that a high-performing consultant who works from home has the opportunity to train when she wants,” says Dr. Lau. "Compare that to an Uber driver or a contractor who doesn't have a lot of autonomy over their job. These are very different women; if we lump them together, we can't understand the drivers or nuances related to cardiovascular health."

Furthermore, the study did not verify the answers offered by respondents through independent test results. And those who reported both good and poor health were placed in the poor health category when the results were taken into account. For self-reported outcomes, one person's poor health could be another person's idea of ​​good health, skipping important differences.

Use workplace flexibility to optimize health

Fortunately, we don't necessarily have to be self-employed to reap the cardiovascular benefits suggested by the study. The workplace flexibility that some employees are enjoying due to the pandemic offers similar conditions to optimize health.

“As the study highlights, there may be potential cardiovascular benefits from not having traditional work environments and locations,” says Dr. Lau. "It's important to find out what actually contributes to these outcomes, but perhaps flexibility and autonomy in the workplace contribute to better health overall."