Article Text

Download PDFPDF

Original article
Mortality differences between self-employed and paid employees: a 5-year follow-up study of the working population in Sweden
  1. Susanna Toivanen1,
  2. Rosane Härter Griep1,2,
  3. Christin Mellner3,
  4. Stig Vinberg4,
  5. Sandra Eloranta5
  1. 1Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, Stockholm, Sweden
  2. 2Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
  3. 3Department of Psychology, Stockholm University, Stockholm, Sweden
  4. 4Department of Health Sciences, Mid Sweden University, Östersund, Sweden
  5. 5Scandinavian Development Services, Stockholm, Sweden
  1. Correspondence to Dr Susanna Toivanen, Centre for Health Equity Studies, CHESS, Stockholm University/Karolinska Institutet, SE-106 91 Stockholm 10691, Sweden; susanna.toivanen{at}


Objectives Analyse mortality differences between self-employed and paid employees with a focus on industrial sector, educational level and gender using Swedish register data.

Methods A cohort of the total working population (4 776 135 individuals; 7.2% self-employed; 18–100 years of age at baseline 2003) in Sweden with a 5-year follow-up (2004–2008) for all-cause and cause-specific mortality (57 743 deaths). Self-employed individuals were categorised as sole proprietors or limited liability company (LLC) owners according to their enterprise's legal form. Cox proportional hazards models were applied to compare mortality rates between sole proprietors, LLC owners and paid employees, adjusted for sociodemographic confounders.

Results Mortality from cardiovascular diseases was 16% lower and from suicide 26% lower among LLC owners than among paid employees, adjusted for confounders. Within the industrial category, all-cause mortality was 13–15% lower among sole proprietors and LLC owners compared with employees in manufacturing and mining (MM) as well as personal and cultural services (PCS), and 11–20% higher in sole proprietors in trade, transport and communication and the welfare industry (W). A significant three-way interaction indicated 17–23% lower all-cause mortality among male LLC owners in MM and female sole proprietors in PCS, and 50% higher mortality in female sole proprietors in W than in employees in the same industries.

Conclusions Mortality differences between self-employed individuals and paid employees vary by the legal form of self-employment, across industries, and by gender. Differences in work environment exposures and working conditions, varying market competition across industries and gender segregation in the labour market are potential mechanisms underlying these findings.

  • self-employed
  • mortality
  • cohort
  • industry
  • Sweden

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.