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Self-employment linked to better cardiovascular health outcomes in Hispanic women
Self-employment is linked to lower rates of high blood pressure, obesity, diabetes, poor health and binge drinking in Hispanic women, research suggests.
The findings, published in the peer-reviewed journal Ethnicity & Disease, suggest work structure may be related to cardiovascular disease risk among this group.
Dr Kimberly Narain is assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA, senior author of the study, and director of health services and health optimisation research for the Iris Cantor-UCLA Women’s Health Center.
She said: “Hispanic women experience a disproportionate burden of heart disease compared to non-Hispanic women. This is the first study to link the structure of work with risks for heart disease among this group of women.”
The researchers examined 2003 to 2022 data from the Behavioral Risk Factor Surveillance System to assess the association between self-employment, cardiovascular disease risk factors and health outcomes for Hispanic women.
The data included 165,600 Hispanic working women. Of those, about 21,000, or 13 per cent, were self-employed rather than working for wages or a salary.
Overall, the researchers found that self-employed women were less likely to report cardiovascular-disease-associated health problems.
They were also about 11 per cent more likely to report exercising compared with their non-self-employed counterparts.
Specifically, they found that self-employed Hispanic women had a 1.7 percentage point lower chance of reporting diabetes, roughly a 23 per cent decline.
They also had a 3.3 percentage point lower chance of reporting hypertension, roughly a 17 per cent decline.
The study also found a 5.9 percentage point lower chance of reporting obesity, roughly a 15 per cent decline.
It found a 2.0 percentage point lower chance of reporting binge drinking, roughly a 2 per cent decline.
It also found a 2.5 percentage point lower chance of reporting poor or fair overall health, roughly a 13 per cent decline.
The relationship between heart disease risks and the structure of work among Hispanic women was not driven by access to healthcare or differences in income, Narain said.
In fact, the decrease in high blood pressure linked to self-employment was nearly as large as the decrease in high blood pressure linked to being in the highest income group.
The study has some limitations.
The researchers relied on self-reported outcomes, which might be less reliable among ethnic and racial minorities and those from a lower socioeconomic background.
In addition, the researchers’ definition of poor mental health does not entirely match the accepted definition in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders.
They also did not have data allowing them to examine the specific types of occupations held by the women.
The study design also cannot prove any causal relationship between self-employment and cardiovascular disease risk, which is a subject the researchers will explore.
“The next step in the research is to conduct studies that are able to better assess if the structure of work is a cause of higher heart disease risks among Hispanic women.”
Narain said this.
Study co-authors are Lisette Collins, who led the research, and Dr Frederick Ferguson of UCLA.
Grants from the Iris Cantor-UCLA Women’s Health Center-Leichtman-Levine-TEM program and the UCLA National Clinician Scholars Program supported the research.
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Women with osteoporosis may be more likely to carry a gene linked to Alzheimer’s, according to new research.
Scientists found that APOE4, the most common genetic risk factor for Alzheimer’s, can weaken bone quality in women, even when standard scans appear normal.
The study, carried out by researchers at the Buck Institute for Research on Ageing in California, US, and UC San Francisco, suggests the gene may damage bone at a microscopic level long before any visible signs.
These changes can emerge as early as midlife and remain invisible to routine imaging tests used to assess bone strength.
The findings suggest a link between Alzheimer’s risk and skeletal health and could help pave the way for earlier detection of both conditions.
Professor Birgit Schilling, a senior author of the study, said: “What makes this finding so striking is that bone quality is being compromised at a molecular level that a standard bone scan simply will not catch.
“APOE4 is quietly disrupting the very cells responsible for keeping bone strong – and it is doing this specifically in females, which mirrors what we see with Alzheimer’s disease risk.”
Doctors have long observed that people with Alzheimer’s suffer higher rates of bone fractures, while osteoporosis in women is known to be one of the earliest predictors of the disease.
Now scientists believe they may have uncovered why.
Researchers led by Dr Charles Schurman carried out a detailed analysis of proteins in aged mouse bone and found that tissue was unusually rich in molecules linked to neurological disease, including those associated with Alzheimer’s.
In particular, long-lived bone cells known as osteocytes showed elevated levels of APOE, with levels twice as high in older female mice compared with younger or male animals.
Further experiments using genetically modified mice revealed that APOE4 had a strong and sex-specific impact on both bone and brain tissue.
The disruption at the protein level was even greater in bone than in the brain.
However, the bone structure itself appeared completely normal under scans.
Instead, the gene interfered with a key maintenance process inside bone cells, preventing them from repairing microscopic channels that keep bones strong and resilient.
When this process breaks down, bones become more fragile even if they look healthy on standard imaging.
These results suggest bone cells could potentially act as early biological warning signs of cognitive decline in women carrying APOE4.
Professor Lisa Ellerby, another senior author, said: “We think targeting these cells may open a new front in preserving bone quality in this population.”
Experts say the findings highlight the need to view the body as an interconnected system rather than treating diseases in isolation.
Dementia, of which Alzheimer’s is the most common form, remains one of the UK’s biggest health challenges.
Around 900,000 people are currently living with the condition, a figure expected to rise to 1.6 million by 2040.
It is already the leading cause of death, responsible for more than 74,000 deaths each year.
Health secretary Wes Streeting has relaunched England’s women’s health strategy, vowing to stop women being “gaslit” by doctors.
Speaking before publication of the renewed strategy, the health secretary said the NHS was “failing women” and set out measures to help them access the healthcare they need.
The government said the strategy would include a new standard of care to ensure women were offered pain relief for invasive procedures, such as fitting a contraceptive coil and hysteroscopies.
Feedback would be directly linked to provider funding through a new trial, giving women more power to affect change if they have a poor experience.
Action would also be taken to ensure women no longer face long waits for diagnoses for conditions such as endometriosis, which can take a decade to diagnose.
Streeting said: “[Women] have for so long been let down by a healthcare system that too often gaslights women, treating their pain as an inconvenience and their symptoms as an overreaction.
“Whether it’s being passed from one appointment to another for conditions like endometriosis and fibroids, or a lack of proper pain relief during invasive procedures, through to having to navigate symptoms for years before receiving a diagnosis, it’s clear the system is failing women.
“Women’s voices must be central to delivering effective, respectful and empathetic care. We need to hit medical misogyny where it hurts – the wallet.
“Today’s renewed strategy will tackle the issues women face every day and ensure no woman is left fighting to be heard.”
A report last month by the women and equalities committee found that gynaecological and menstrual health had not been “sufficiently prioritised” by the government.
MPs said parts of the 10-year women’s health strategy, launched in 2022 by the Conservatives, were at risk of being scaled back or discontinued under wider changes to the NHS.
These included initiatives that had reduced waiting lists and improved women’s access to healthcare, such as women’s health hubs.
Sarah Owen, chair of the committee and a Labour MP, said: “This would be a disaster for girls’ and women’s menstrual healthcare, when it is in dire need of more support.
“It is a national scandal that nearly half a million women are on hospital gynaecology waiting lists when there are effective treatments that could be administered in primary and community care, if only they could access them.”
The report said women faced “medical misogyny” and were left to “suck it up” and suffer in pain for years because of a lack of awareness of women’s health conditions.
A redesign of clinical pathways for some women’s health issues will aim to speed up diagnosis and treatment, and there will be a review of support for families who experience repeated baby loss.
The government also promised a “single referral point” to ensure women were directed to the right place the first time they sought help.
Dr Sue Mann, NHS England’s women’s health director, said too many women were dismissed for “serious symptoms” that affected every part of their lives.
“The renewed women’s health strategy will build significantly on the work the NHS has been doing to ensure women are heard and get the specialist care they need,” she said.
Women’s health groups cautiously welcomed the renewed strategy. Emma Cox, chief executive of Endometriosis UK, said decisive action would be vital to improve women’s healthcare in England.
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