Skip to main content
Log in

Self-Employment, Working Hours, and Hypertension by Race/Ethnicity in the USA

  • Published:
Journal of Racial and Ethnic Health Disparities Aims and scope Submit manuscript

Abstract

There is a large literature on work-related characteristics and hypertension, but studies on self-employment, longer working hours, and hypertension are mixed. Assessments of self-employment should be extended to account for people with part-time self-employment (i.e., employees also earning income from self-employment). The aim of this study was to determine the association of different types of self-employment with hypertension among adults by race/ethnicity and to assess whether longer working hours moderated these associations. Using data from the 2007–2018 National Health and Nutrition Examination Survey, measured hypertension (blood pressure ≥ 140/90 mm Hg) was assessed and employment categories included employees, part-time self-employment (i.e., employee with self-employment income), or full-time self-employment. Modified Poisson regressions and multiplicative interaction terms were used. Having full-time self-employment was associated with lower relative risk (RR) of hypertension compared to employees among Black (RR = 0.77, 95% confidence interval (CI) = 0.61–0.96) and White men (RR = 0.77, 0.65–0.93) compared to employees. Full-time self-employment was associated with higher risk of hypertension (RR = 1.36, 95% CI = 1.01–1.82) compared to employees among Hispanic women, while part-time self-employment was associated with lower risk (RR = 0.69, 95% CI = 0.48–0.98). Among White women, part-time self-employment was associated with higher relative risk of hypertension (RR = 1.27, 95% CI = 1.05–1.53) compared to employees. There were significant interactions between employment categories and longer working hours among Hispanic women as well as Black women and men. The results suggest that self-employment categories and longer working hours impact hypertension by race/ethnicity and sex. Because the number of full-time and part-time self-employed adults has increased, the health of this particular subgroup of workers should be further addressed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data Availability

Data for this study is from the National Health and Nutrition Examination Survey (NHANES), a publicly available dataset from the National Center for Health Statistics.

Code Availability

Codebooks and variable descriptions are found online on the NHANES website.

References 

  1. Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon-Moran D. Hypertension prevalence and control among adults: United States, 2015–2016. 2017. Contract No.: NCHS Data Brief No. 289. Available from: https://www.cdc.gov/nchs/data/databriefs/db289.pdf.

  2. Aggarwal R, Chiu N, Wadhera RK, Moran AE, Raber I, Shen C, et al. Racial/ethnic disparities in hypertension prevalence, awareness, treatment, cand control in the United States, 2013 to 2018. Hypertension. 2021;78:1719–26.

    Article  CAS  PubMed  Google Scholar 

  3. Commodore-Mensah Y, Turkson-Ocran RA, Foti K, Cooper LA, Himmelfarb CD. Associations Between social determinants and hypertension, stage 2 hypertension, and Controlled blood pressure among men and women in the United States. Am J Hypertens. 2020;34(7):707–17.

    Article  Google Scholar 

  4. Kaur H, Luckhaupt SE, Li J, Alterman T, Calvert GM. Workplace psychosocial factors associated with hypertension in the U.S. Workforce: a cross-sectional study based on the 2010 National Health Interview Survey. Am J Ind Med. 2014;57(9):1011–21.

    Article  PubMed  Google Scholar 

  5. Yamasaki F, Schwartz JE, Gerber LM, Warren K, Pickering TG. Impact of shift work and race/ethnicity on the diurnal rhythm of blood pressure and catecholamines. Hypertension. 1998;32(3):417–23.

    Article  CAS  PubMed  Google Scholar 

  6. Slopen N, Glynn RJ, Buring JE, Lewis TT, Williams DR, Albert MA. Job strain, job insecurity, and incident cardiovascular disease in the women’s health study: results from a 10-year prospective study. Plos One. 2012;7(7):e40512.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Virtanen M, Kivimaki M. Long working hours and risk of cardiovascular disease. Curr Cardiol Rep. 2018;20(11):123–9.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Virtanen M, Hansson LM, Goldberg M, Zins M, Stenholm S, Vahtera J, et al. Long working hours, anthropometry, lung function, blood pressure and blood-based biomarkers: cross-sectional findings from the CONSTANCES study. J Epidemiol Community Health. 2019;73(2):130–5.

    Article  PubMed  Google Scholar 

  9. Kudo T, Belzer MH. Excessive work hours and hypertension: evidence from the NIOSH survey data. Saf Sci. 2020;129:104813.

    Article  Google Scholar 

  10. Trudel X, Brisson C, Gilbert-Ouimet M, Vezina M, Talbot D, Milot A. Long working hours and the prevalence of masked and sustained hypertension. Hypertension. 2020;75(2):532–8.

    Article  CAS  PubMed  Google Scholar 

  11. Yang H, Schnall PL, Jauregui M, Su TC, Baker D. Work hours and self-reported hypertension among working people in California. Hypertension. 2006;48(4):744–50.

    Article  CAS  PubMed  Google Scholar 

  12. Curtis AB, James SA, Raghunathan TE, Alcser KH. Job strain and blood pressure in African Americans: The Pitt County Study. Am J Public Health. 1997;87(8):1297–302.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Gilbert-Ouimet M, Trudel X, Talbot D, Vezina M, Milot A, Brisson C. Long working hours associated with elevated ambulatory blood pressure among female and male white-collar workers over a 2.5-year follow-up. J Hum Hypertens. 2022;36(2):207–17.

    Article  CAS  PubMed  Google Scholar 

  14. Puig A, Baggs A, Mixon K, Park YM, Kim BY, Lee SM. Relationship between job burnout and personal wellness in mental health professionals. J Employ Couns. 2012;49(3):98–109.

    Article  Google Scholar 

  15. Schult TM, Mohr DC, Osatuke K. Examining burnout profiles in relation to health and well-being in the Veterans Health Administration employee population. Stress Health. 2018;34(4):490–9.

    Article  PubMed  Google Scholar 

  16. Sesemann E, Didericksen K, Lamson A, Schoemann AM, Das B. Healthcare employees’ social networks, burnout, and health. Fam Syst Health. 2021;39(1):38–54.

    Article  PubMed  Google Scholar 

  17. Stone KW, Kintziger KW, Jagger MA, Horney JA. Public health workforce burnout in the COVID-19 response in the US. Int J Environ Res Public Health. 2021;18(8):4369.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Zinchenko YP, Pervichko EI, Ostroumova OD. Burnout syndrome in patients with workplace hypertension. Ration Pharmacother Cardiol. 2016;12(6):675–80.

    Article  Google Scholar 

  19. Rivera AS, Akanbi M, O’Dwyer LC, McHugh M. Shift work and long work hours and their association with chronic health conditions: a systematic review of systematic reviews with meta-analyses. Plos One. 2020;15(4):e0231037.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Guner U. Is there a relationship between working hours and hypertension? Evidence from the United States. Work-a J Prev Assess Rehabil. 2019;62(2):279–85.

    Google Scholar 

  21. Albright CL, Winkleby MA, Ragland DR, Fisher J, Syme SL. Job strain and prevalence of hypertension in a biracial population of urban bus drivers. Am J Public Health. 1992;82(7):984–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Croson DC, Minniti M. Slipping the surly bonds: the value of autonomy in self-employment. J Econ Psychol. 2012;33(2):355–65.

    Article  Google Scholar 

  23. Hessels J, Rietveld CA, van der Zwan P. Self-employment and work-related stress: the mediating role of job control and job demand. J Bus Ventur. 2017;32(2):178–96.

    Article  Google Scholar 

  24. Kara A, Petrescu M. Self-employment and its relationship to subjective well-being. Int Rev Entrep. 2018;16(1):115–40.

    Google Scholar 

  25. Stephan U, Tavares SM, Carvalho H, Ramalho JJS, Santos SC, van Veldhoven M. Self-employment and eudaimonic well-being: energized by meaning, enabled by societal legitimacy. J Busi Ventur. 2020;35(6):106047.

    Article  Google Scholar 

  26. Nikolaev B, Boudreaux CJ, Wood M. Entrepreneurship and subjective well-being: the mediating role of psychological functioning. Entrep Theory Pract. 2020;44(3):557–86.

    Article  Google Scholar 

  27. Nikolova M. Switching to self-employment can be good for your health. J Bus Ventur. 2019;34(4):664–91.

    Article  Google Scholar 

  28. Berrill J, Cassells D, O’Hagan-Luff M, van Stel A. The relationship between financial distress and well-being: exploring the role of self-employment. Int Small Busi J-Res Entrep. 2021;39(4):330–49.

    Article  Google Scholar 

  29. Narain KDC, Jeffers KS. Exploring the relationship between self-employment and health among blacks. Health Equity. 2020;4(1):1–8.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Hessels J, Rietveld CA, van der Zwan P. The relation between health and earnings in self-employment. Front Psychol. 2020;11:801.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Krittanawong C, Kumar A, Wang Z, Baber U, Bhatt DL. Self-employment and cardiovascular risk in the US general population. Int J Cardiol Hypertens. 2020;6:100035.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Stephan U, Roesler U. Health of entrepreneurs versus employees in a national representative sample. J Occup Organ Psychol. 2010;83(3):717–38.

    Article  Google Scholar 

  33. Rietveld CA, van Kippersluis H, Thurik AR. Self-employment and health: barriers or benefits? Health Econ. 2015;24(10):1302–13.

    Article  PubMed  Google Scholar 

  34. Dzodzomenyo S, Narain KDC. Exploring the relationship between self-employment and women’s cardiovascular health. BMC Womens Health. 2022;22(1):1–8.

    Article  Google Scholar 

  35. Scott J, Edwards K, Stanczyk A. Moonlighting to the side hustle: the effect of working an extra job on household poverty for households with less formal education. Fam Soc J Contemp Soc Serv. 2020;101(3):324–39.

    Google Scholar 

  36. Sessions H, Nahrgang JD, Vaulont MJ, Williams R, Bartels AL. Do the hustle! empowerment from side-hustles and its effects on full-time work performance. Acad Manag J. 2021;64(1):235–64.

    Article  Google Scholar 

  37. Bennett GG, Merritt MM, Sollers JJ, Edwards CL, Whitfield KE, Brandon DT, et al. Stress, coping, and health outcomes among African-Americans: a review of the John Henryism hypothesis. Psychol Health. 2004;19(3):369–83.

    Article  Google Scholar 

  38. Dressler WW, Bindon JR, Neggers YH. John Henryism, gender, and arterial blood pressure in an African American community. Psychosom Med. 1998;60(5):620–4.

    Article  CAS  PubMed  Google Scholar 

  39. James SA, Keenan NL, Strogatz DS, Browning SR, Garrett JM. Socioeconomic-status, John Henryism, and blood-pressure in black adults - the pitt county study. Am J Epidemiol. 1992;135(1):59–67.

    Article  CAS  PubMed  Google Scholar 

  40. LeBron AMW, Schulz AJ, Mentz G, Perkins DW. John Henryism, socioeconomic position, and blood pressure in a multi-ethnic urban community. Ethn Dis. 2015;25(1):24–30.

    PubMed  Google Scholar 

  41. Subramanyam MA, James SA, Diez-Roux AV, Hickson DA, Sarpong D, Sims M, et al. Socioeconomic status, John Henryism and blood pressure among African-Americans in the Jackson Heart Study. Soc Sci Med. 2013;93:139–46.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Mujahid MS, James SA, Kaplan GA, Salonen JT. Socioeconomic position, John Henryism, and incidence of acute myocardial infarction in Finnish men. Soc Sci Med. 2017;173:54–62.

    Article  PubMed  Google Scholar 

  43. Bento A, Brown TN. Belief in systemic racism and self-employment among working blacks. Ethn Racial Stud. 2021;44(1):21–38.

    Article  Google Scholar 

  44. Wingfield AH, Taylor T. Race, gender, and class in entrepreneurship: intersectional counterframes and black business owners. Ethn Racial Stud. 2016;39(9):1698–718.

    Article  Google Scholar 

  45. Shapiro T, Meschede T, Osoro S. The widening racial wealth gap: why wealth is not color blind. In: Assets perspect: the rise of asset building and its impact on social policy. 2014. pp. 99–122. Available from: https://link.springer.com/chapter/10.1057/9781137384881_5.

  46. Shapiro T, Meschede T, Osoro S. The roots of the widening racial wealth gap: explaining the black-white economic divide. Inst Assets Soc Policy. 2013. Available from: https://drum.lib.umd.edu/bitstream/handle/1903/24590/racialwealthgapbrief.pdf.

  47. Brown TH. Diverging fortunes: racial/ethnic inequality in wealth trajectories in middle and late life. Race Soc Probl. 2016;8(1):29–41.

    Article  Google Scholar 

  48. Kroeger T, Wright G. Entrepreneurship and the racial wealth gap: the impact of entrepreneurial success or failure on the wealth mobility of Black and White families. J Econ Race Policy. 2021;4:183–95.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Hunt MO, Ray R. Social Class Identification Among Black Americans: trends and Determinants, 1974–2010. Am Behav Sci. 2012;56(11):1462–80.

    Article  Google Scholar 

  50. Fairlie RW. The absence of the African-American owned business: an analysis of the dynamics of self-employment. J Law Econ. 1999;17(1):80–108.

    Google Scholar 

  51. Fairlie RW, Robb AM. Why are black-owned businesses less successful than white-owned businesses? The role of families, inheritances, and business human capital. J Law Econ. 2007;25(2):289–323.

    Google Scholar 

  52. Fairlie R. Racial inequality in business ownership and income. Oxf Rev Econ Policy. 2018;34(4):597–614.

    Article  Google Scholar 

  53. Fisher M, Lewin PA. Push and pull factors and Hispanic self-employment in the USA. Small Bus Econ. 2018;51(4):1055–70.

    Article  Google Scholar 

  54. Lofstrom M, Bates T. African Americans’ pursuit of self-employment. Small Bus Econ. 2013;40(1):73–86.

    Article  Google Scholar 

  55. Chiteji NS. Wealth in the extended family an American dilemma. Du Bois Review-Soc Sci Res Race. 2010;7(2):357–79.

    Article  Google Scholar 

  56. Hilber CAL, Liu YC. Explaining the black-white homeownership gap: the role of own wealth, parental externalities and locational preferences. J Hous Econ. 2008;17(2):152–74.

    Article  Google Scholar 

  57. O’Brien RL. Depleting capital? Race, wealth and informal financial assistance. Soc Forces. 2012;91(2):375–95.

    Article  Google Scholar 

  58. Bone S, Christensen G, Williams J, Adams S, Lederer A. Shaping small business lending policy through matched-paired mystery shopping. J Public Policy Mark. 2017;38(3):391–9.

    Article  Google Scholar 

  59. Lee A, Mitchell B, Lederer A. Disinvestment, discouragement, and inequity in small business lending. 2019. Available from: https://ncrc.org/wp-content/uploads/2019/09/NCRC-Small-Business-Research-FINAL.pdf.

  60. Feagin JR, Imani N. Racial barriers to African-American entrepreneurship - an exploratory-study. Soc Probl. 1994;41(4):562–84.

    Article  Google Scholar 

  61. National Center for Health Statistics. National health and nutrition examination survey—information for health professionals. 2016. Available from https://www.cdc.gov/nchs/nhanes/hlthprofess.htm. Accessed 10 May 2022.

  62. Zou GY. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6.

    Article  PubMed  Google Scholar 

  63. Aiken LS, West SG. Multiple regression: testing and interpreting interactions. Sage Publications, Inc.; 1991.

  64. Johnson CL, Paulose-Ram R, Ogden CL, Carroll MD, Kruszan-Moran D, Dohrmann SM, et al. National health and nutrition examination survey: analytic guidelines, 2011–2012. Centers Dis Control Prev Vital Signs. 2013;61:1–24.

    Google Scholar 

  65. Centers for Disease Control and Prevention. NHANES 2013–2014 overview. 2015. Available from: http://www.cdc.gov/nchs/nhanes/nhanes2013-2014/overview_h.htm. Accessed 10 May 2022.

  66. Zuiker VS, Katras MJ, Montalto CP, Olson PD. Hispanic self-employment: does gender matter? Hisp J Behav Sci. 2003;25(1):73–94.

    Article  Google Scholar 

  67. Mindes SCH, Lewin P, Fisher M. Intergenerational and ethnonational disparities in Hispanic immigrant self-employment. Ethnicities. https://doi.org/10.1177/14687968211069136.

  68. Bajwa U, Gastaldo D, Di Ruggiero E, Knorr L. The health of workers in the global gig economy. Glob Health. 2018;14(1):1–4.

    Article  Google Scholar 

  69. Christie N, Ward H. The health and safety risks for people who drive for work in the gig economy. J Transp Health. 2019;13:115–27.

    Article  Google Scholar 

  70. Tran M, Sokas RK. The gig economy and contingent work: an occupational health assessment. J Occup Environ Med. 2017;59(4):E63–6.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Bahney A. More than 44 million Americans have a side hustle. 2017. Available from: https://money.cnn.com/2017/07/12/pf/side-hustle/index.html. Accessed 10 May 2022.

  72. Bailey ZD, Feldman JM, Bassett MT. How structural racism works - racist policies as a root cause of US racial health inequities. N Engl J Med. 2021;384(8):768–73.

    Article  PubMed  Google Scholar 

  73. Phelan JC, Link BG. Is racism a fundamental cause of inequalities in health? Ann Rev Sociol. 2015;41(41):311–30.

    Article  Google Scholar 

Download references

Funding

Roland Thorpe is supported by a grant from the National Institute of Minority Health and Health Disparities (#U54MD000214).

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Caryn N. Bell.

Ethics declarations

Ethics Approval

This study uses publicly available, deidentified data. No IRB approval was obtained or required.

Consent to Participate

Written informed consent was obtained by the National Center for Health Statistics.

Consent for Publication

NHANES participants are informed that data will be used for statistical research purposes.

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bell, C.N., Owens-Young, J.L. & Thorpe, R.J. Self-Employment, Working Hours, and Hypertension by Race/Ethnicity in the USA. J. Racial and Ethnic Health Disparities 10, 2207–2217 (2023). https://doi.org/10.1007/s40615-022-01400-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40615-022-01400-9

Keywords

Navigation