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.
Competing Interests: Dr. Chayakrit Krittanawong discloses the following relationships – Journal of the American Heart Association (Early Career Editorial board); The Journal of Scientific Innovation in Medicine (Associate Editor); Member of the American College of Cardiology Solution Set Oversight Committee. Dr. Deepak L. Bhatt discloses the following relationships - Advisory Board: Cardax, Cereno Scientific, Elsevier Practice Update Cardiology, LevelEx, Medscape Cardiology, PhaseBio, PLX Pharma, Regado Biosciences; Board of Directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data Monitoring Committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by 10.13039/100000895St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by 10.13039/100006520Edwards), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by 10.13039/501100002973Daiichi Sankyo), Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by 10.13039/100001003Boehringer Ingelheim; AEGIS-II executive committee funded by 10.13039/100008322CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by 10.13039/501100004914Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Medtelligence/ReachMD (CME steering committees), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by 10.13039/100004326Bayer), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research Funding: Abbott, Afimmune, 10.13039/100014384Amarin, 10.13039/100002429Amgen, 10.13039/100004325AstraZeneca, 10.13039/100004326Bayer, 10.13039/100001003Boehringer Ingelheim, 10.13039/100002491Bristol-Myers Squibb, Cardax, 10.13039/100007560Chiesi, 10.13039/100008322CSL Behring, 10.13039/501100003769Eisai, 10.13039/100009933Ethicon, 10.13039/501100004914Ferring Pharmaceuticals, 10.13039/100005632Forest Laboratories, Fractyl, Idorsia, 10.13039/100010721Ironwood, Ischemix, Lexicon, 10.13039/100004312Lilly, 10.13039/100004374Medtronic, 10.13039/100004319Pfizer, PhaseBio, PLx Pharma, 10.13039/100009857Regeneron, 10.13039/100004337Roche, Sanofi Aventis, Synaptic, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); Site Co-Investigator: Biotronik, Boston Scientific, CSI, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded Research: FlowCo, Merck, Novo Nordisk, Takeda. None of the other authors have any disclosures
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