State Institute of Health, Bavarian Health and Food Safety Authority, Erlangen, Germany.
Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany.
Work. 2023;75(4):1179-1198. doi: 10.3233/WOR-220145.
A stringent systematic review of population-based observational studies focusing on the physical health of self-employed individuals as a basis for the development of targeted prevention strategies is lacking.
We aimed to systematically evaluate all the studies of good quality that compared the occurrence of chronic physical disorders in self-employed individuals with that of employees.
We searched three major medical databases (MEDLINE, Web of Science, Embase) following the Cochrane guidelines. The quality of the studies was rated based on the slightly modified validated assessment tool that was developed by Hoy et al.RESULTS:We included 16 population-based studies of good quality, with data from 15,369,964 participants in total. The two longitudinal evaluations of Swedish national registers with the longest follow-up periods showed increased cardiovascular mortality and incidence estimates of cardiovascular disease in self-employed individuals compared with those of white-collar (i.e., nonmanual) employees but decreased risk estimates compared with those of blue-collar (i.e., manual) workers. The results of the shorter cohort studies were heterogeneous. In cross-sectional studies, prevalence estimates for musculoskeletal, respiratory and malignant diseases were higher among self-employed individuals than among employees.
The long-term cardiovascular disease risk and mortality of self-employed individuals seemed to be higher than those of white-collar employees but lower than those of blue-collar employees. As a basis for targeted prevention strategies, further longitudinal studies in different settings are required to better understand the development of physical health disorders for specific self-employment categories such as sole proprietors, small entrepreneurs, family businesses and others.
目前缺乏以人群为基础的观察性研究的严格系统评价，这些研究主要关注个体的身体健康，为制定有针对性的预防策略提供依据。
我们旨在系统评估所有高质量的研究，这些研究比较了个体经营与雇佣员工的慢性身体障碍的发生情况。
我们按照 Cochrane 指南，在三大医学数据库（MEDLINE、Web of Science、Embase）中进行了检索。研究质量根据由 Hoy 等人制定的经过略微修改的验证评估工具进行了评估。
我们纳入了 16 项高质量的基于人群的研究，总共有 15369964 名参与者的数据。两项具有最长随访期的瑞典国家登记纵向评估显示，与白领（即非体力劳动者）员工相比，个体经营的个体发生心血管疾病的心血管死亡率和发生率估计值增加，但与蓝领（即体力劳动者）工人相比，风险估计值降低。较短队列研究的结果存在异质性。在横断面研究中，个体经营的个体患肌肉骨骼、呼吸和恶性疾病的患病率高于雇佣员工。
个体经营的个体的长期心血管疾病风险和死亡率似乎高于白领员工，但低于蓝领员工。作为有针对性的预防策略的基础，需要在不同环境中进行进一步的纵向研究，以更好地了解特定个体经营类别的身体健康障碍的发展情况，如独资经营者、小企业家、家族企业等。
