Self-employment and cardiovascular risk in the US general population

Background: Studies on self-employment and cardiovascular risk are very limited. We examined the relationship between self-employment and cardiovascular risk among the general population in the United States from 1999 to 2016. Methods: Using the National Health and Nutrition Examination Survey (NHANES), we identified all patients with hypertension (HTN), hyperlipidemia (HLD), diabetes mellitus (DM), stroke, heart failure (HF), and coronary artery disease (CAD) between 1999 and 2016. Type of job was defined based on the participant's response to the survey question as "an employee of a private company, business, or individual for wages, salary, or commission" or "self-employed in own business, professional practice or farm". Multivariable logistic regression analyses were performed to adjust for confounders. Results: Of 30,103 patients, 2835 (9.4%) were self-employed in their own business, professional practice, or farm and 27,268 (90.6%) were employed by a private company, business, or government. After adjusting for age, race, sex, BMI, marital status, educational level, health insurance status, smoking status, sleep duration and lipid profiles, self-employed individuals had a higher prevalence of HTN (OR: 1.12; 95% confidence interval [CI] 1.05-1.20), HLD (OR: 1.10; 95% CI 1.07-1.31), stroke (OR: 1.45; 95% CI 1.27-1.67), HF (OR: 1.17; 95% CI 1.03-1.32), and CAD (OR: 1.26; 95% CI 1.13-1.35) (all P v< 0.05). Conclusions: Self-employment may be associated with greater cardiovascular risk in the US general population. Further prospective studies are urgently needed to establish the optimal preventive strategy to reduce cardiovascular risk in self-employed individuals.