Can self-employment promote better cardiovascular health for women?

A study suggests self-employed women might have heath advantages.

Working for yourself can offer several key perks, including greater flexibility and autonomy that might be lacking in a more traditional work structure. But could self-employment also boost cardiovascular health?

New long-term research suggests it could — among women, at least. Those who were self-employed were less likely to have high blood pressure, diabetes, and obesity, and reported higher amounts of physical activity than women who drew wages or a salary.

“The study brings to light that there may actually be health-related benefits to enabling women to take charge of their employment and the way they choose to work,” says Dr. Emily Lau, a cardiologist at Massachusetts General Hospital who specializes in women’s cardiovascular health. “It’s really timely, since as a society the pandemic confronted us with questions about how we should be thinking about work landscapes and whether traditional work structures offer the best way to move forward.”

Interesting, but not conclusive

The new study, which was published in BMC Women’s Health, drew on data from a large, long-term health and retirement study underway at the University of Michigan. While intriguing, its findings are far from conclusive, Dr. Lau notes. As an observational, cross-sectional analysis, it can’t prove self-employment leads to better health markers because it doesn’t 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 a lot of things,” she explains. “Women who are self-employed are generally older, have higher levels of education, and are more likely to be financially literate. All of those factors are independently associated with better cardiovascular outcomes.”

What did this study on cardiovascular health and work consider?

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

The study analyzed survey data collected between 2016 and 2018 from an ethnically diverse set of 4,624 women who reported being either salaried employees, self-employed, or working for wages. All were over age 50 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 about risk factors for cardiovascular disease, such as high blood pressure, coronary heart disease, or heart failure.

Survey questions centered on health behaviors and self-reported factors affecting risk for cardiovascular disease. One, for example, asked about participants’ habits surrounding alcohol: “In the last three months, on how many days 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 find, and what are its limitations?

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

Results were adjusted for a crucial factor — access to health care — and stood despite more self-employed women indicating they are uninsured. “The study’s biggest strength is its sheer size, and that they’re trying to capture something that’s not been rigorously studied before,” Dr. Lau says. “The researchers should be applauded for trying to answer this really complicated question.”

Self-employment doesn’t always translate into more freedom, which can affect how much time someone can devote to exercise or self-care. “One can imagine that a high-powered consultant working from home has the ability to exercise when she wants to,” Dr. Lau says. “Contrast that with an Uber driver or a contractor who doesn’t have a lot of autonomy over her workplace. Those are very different women; by lumping them together, we can’t understand the drivers or nuances related to cardiovascular health.”

Additionally, the study did not verify answers offered by respondents through independent test results. And those reporting both fair and poor health were lumped into the category of poor health when results were considered. With self-reported outcomes, one person’s poor health could be another person’s idea of fair health, skipping over important differences.

Seize workplace flexibility to optimize health

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

“As the study teases out, there may be potential cardiovascular benefits to not having traditional work settings and places,” Dr. Lau says. “It’s important to figure out what actually contributes to these outcomes, but maybe workplace flexibility and autonomy overall are contributors to better health.”