A cross-sectional analysis of the association between self-employment, racial and ethnic minority status, sex and cardiovascular disease risk factors among a nationally representative sample.

Abstract

Background: There is a body of evidence that suggest risk factors for cardiovascular disease (CVD) may be linked with self-employment status. Work context varies across race, ethnicity and sex. The objective is to examine the association of self-employment status and CVD risk factors across racial and ethnic minority status as well as sex.

Methods: For this observational study, National Health and Nutrition Examination Survey (NHANES) data (1999-2018), a cross-sectional study design, and stratified logistic regression models were used to explore the association between self-employment status (a dichotomous variable) and CVD risk factors (dichotomized measures of elevated cholesterol, hypertension, glucose intolerance, obesity, poor diet, physical inactivity, smoking, binge drinking, sub-optimal sleep duration and poor mental health) across combined racial and ethnic minority status and sex groups, among working, non-pregnant adults(ages 30-62). Statistical models controlled for age, education, marital status, household poverty-to-income ratio, and the number of months working at current job. The coefficient estimates were expressed as predictive margins.

Results: The study sample was comprised of 19,395 working adults. Among non-minority women, self-employment was negatively associated with obesity (% diff = -7.4%; p = 0.008), physical inactivity % diff = -7.0%; p = 0.017), and poor sleep duration (% diff = -9.4%; p = 0.004). Among minority women, self-employment was negatively associated with poor diet (% diff = -6.7%; p = 0.024), physical inactivity (% diff =-7.3%; p = 0.013) and poor sleep duration (% diff = -8.1%; p = 0.017). Among non-minority men, self-employment was negatively associated with poor diet (% diff = -6.5%; p = 0.008) and hypertension (% diff = -5.7%; p = 0.013).

Conclusions: This study suggests that there may be a relationship between work context and CVD risk factors that varies across race, ethnicity and sex; however, further research is needed to characterize this relationship. Specifically, exploring how autonomy, flexibility, social support and discrimination exposure varies across self-employment status in diverse demographic groups may be important for illuminating the relationship between work and cardiovascular health.