Self-employed women show fewer risk factors for heart disease

Self-employed women show fewer risk factors for heart disease

New research finds that self-employed women have fewer risk factors for cardiovascular disease (CVD) compared to non-self-employed women, suggesting that the work environment may play a role in the development of risk factors that can lead to heart attacks.

While the results also showed some positive associations between health outcomes and self-employment among white men, the researchers found that women had the most favorable CVD risk profile associated with self-employment, possibly because they are more likely than men to experience stress and time demands related to balancing responsibilities at work and home.

In contrast, self-employed men of color did not have the same health benefits.

The study is one of the few to use measures from laboratory tests and physical measures, rather than relying on self-reported measures, to examine the relationship between independence and heart disease risk factors, said lead author Dr. Kimberly Narain, assistant professor in residency of medicine, in the Department of General Internal Medicine and Health Services Research at the Medical School of Medicine. It is also the only study to consider differences between gender and racial/ethnic minority status.

“There is a relationship between self-employment and risk factors for heart disease, and this relationship appears to be stronger in women compared to mensaid Narain, who is also director of health services and health optimization research at the Iris Cantor-Ucla Women's Health Center.It is essential to increase our understanding of how the work environment gets under our skin so we can find ways to ensure everyone has access to a healthy work environment. “

The study will be published in the peer-reviewed journalBMC public health.

Previous studies have shown links between the structure of employment and the risk of cardiovascular disease. Some have found better health outcomes among people in leadership positions compared to those in clerical or administrative positions, which are often held by women and people of color. Others have found ties between work controls and health benefits. For example, high-stakes jobs with higher psychological demands and less autonomy have been linked to hypertension and CVD.

However, many of these studies have relied largely on self-reported measures, which are not fully reliable due to factors such as recall bias.

For this study, researchers used data from 19,400 working adults in the National Health and Nutrition Examination Survey (NHANES). They analyzed the association between self-employment and CVD risk factors, including elevated cholesterol levels, high blood pressure, glucose intolerance, obesity, poor diet, physical inactivity, smoking, binge drinking, suboptimal sleep duration and poor mental health. They examined these questions across gender, race, and ethnicity, and in some contexts used biological and physical measures that are more reliable than self-reported measures.

They found a number of negative associations—that is, lower rates of specific CVD risk factors—between self-employment and health outcomes. These are among the most important findings.

Among white women, self-employment was associated with:

• 7.4 percentage point decrease in obesity

• 7.0 percentage point drop in physical inactivity

• 9.4 percentage point decrease in poor sleep duration

Among women of color it was associated with:

• 6.7 percentage point decrease in poor nutrition

• 7.3 percentage point drop in physical inactivity

• 8.1 percentage point decrease in poor sleep duration

And for white men, self-employment was associated with:

• 6.5 percentage point decrease in poor nutrition

• 5.7 percentage point reduction in high blood pressure

The researchers did not find the same benefits among self-employed minority men, perhaps because they are generally in companies with high barriers to entry and failure rates, and they may also struggle with lower financial capital and less access to mentorship that could better prepare them to maintain a successful business, the researchers wrote.

Due to the cross-sectional nature of the study, the researchers cannot make causal claims from their findings. Other study limitations include the possibility that unmeasured characteristics such as personality traits and coping mechanisms may influence individuals' choice of self-employment and the development of CVD risk factors. The researchers also couldn't distinguish between people who were forced into them because of job losses or other circumstances.

Study co-authors are Daniela Markovic and Dr. Jose Escarce of UCLA.

The research was funded by the Leichtman-Levine Tem Mentorship in Women's Health Research at the Iris Cantor-Ucla Women's Health Center and the Tides Foundation (TFR15-00194).

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