Could Working for Yourself Be Good for Your Blood Pressure?

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Can the type of job you have affect your heart health? New research using 20 years of national data suggests it might — especially if you’re self-employed.

In this study, investigators looked at nearly 20,000 working adults in the U.S. and found that people who were self-employed had better outcomes for certain risk factors linked to cardiovascular disease (CVD).

“There is a body of evidence that suggest risk factors for cardiovascular disease may be linked with the structure of employment,” said lead investigator Kimberly D. Narain, M.D., Ph.D., MPH, associated with the Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles (UCLA).

Research shows that people of color and women often work in more stressful jobs with less control and support. These high-strain work environments are linked to poorer heart health. Self-employment, on the other hand, may offer key benefits that protect against CVD.

When people work for themselves, they often have more flexible schedules, which can give them more time to cook healthy meals, exercise and go to the doctor. This independence may also reduce work-related stress and help avoid unhealthy habits like smoking or binge drinking.

For women, especially those balancing work and home responsibilities, self-employment can ease that pressure. It may also protect people from the stress of discrimination, which can harm long-term health. Previous studies have shown that self-employed women, including Black women, reported better physical health, less obesity and fewer cases of high blood pressure. However, those studies relied on self-reported data, which can be inaccurate — especially among people with lower income or who face racial or ethnic bias.

Investigators used National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018 to create the cross-sectional study designed to better understand the link between self-employment status and CVD risk factors. These risk factors included elevated cholesterol, high blood pressure, obesity, smoking status, physical inactivity, binge drinking, poor diet and sleep issues. Importantly, these patterns varied by sex and race/ethnicity. Statistical models also controlled for education, marital status and household poverty-to-income ratio.

Among included participants, the mean age was 45 years, and the proportions of self-employed individuals were 15.5% for nonminority men, 9.8% for minority men, 10.1% for nonminority women and 7.3% for minority women.

For nonminority women, being self-employed was linked to lower rates of obesity, more physical activity and better sleep. Among minority women, self-employment was tied to healthier diets, more physical activity and better sleep. For nonminority men, self-employment was associated with eating better and having lower rates of high blood pressure.

Why might this be happening? The team believes that self-employment may offer some protective benefits through factors like greater flexibility, more autonomy and potentially less workplace stress or discrimination.

While this study found a link between self-employment and better heart health for some groups, it’s important to understand its limitations. Because it’s a snapshot in time (a cross-sectional study), investigators can’t say for sure that self-employment causes better heart health. It’s possible that people who are already healthier — for example, those without chronic conditions like high blood pressure — are more likely to choose self-employment, especially if they want to keep employer-sponsored health insurance.

Additionally, there are also other factors that may play a role, such as personality traits or how people handle stress, which weren’t measured in this study. Additionally, it’s unclear whether people became self-employed by choice or because they had no other option. Those different reasons for being self-employed could affect health outcomes in different ways.

In short, giving workers more flexibility and support may be a powerful tool for protecting long-term health — especially for women.

“This study suggests that work context may provide clues for CVD risk; however, this relationship may differ along racial, ethnic and sex lines,” investigators concluded.

However, they emphasize that more research is needed to fully understand why these patterns emerge and how different work environments impact health.