Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Literature Search
2.2. Eligibility Criteria
2.2.1. Types of Populations and Exposures
2.2.2. Types of Comparators
2.2.3. Types of Outcomes
2.2.4. Types of Studies
2.3. Data Extraction
2.4. Assessment of Risk of Bias
2.5. Evidence Synthesis
2.6. Quality of Evidence Assessment
3. Results
3.1. Study Selection
3.2. Characteristics of Included Studies
3.3. Risk of Bias
Included Study | Selection Bias | Lack of Blinding | Exposure Misclassification | Outcome Misclassification | Incomplete Exposure Data | Incomplete Outcome Data | Selective Reporting of Exposures | Selective Reporting of Outcome | Differences in Numerator and Denominator | Conflict of Interest |
---|---|---|---|---|---|---|---|---|---|---|
Any health services use | ||||||||||
Giatti 2008 * [22] | + | + | + | + | + | + | + | + | ++ | + |
Giatti 2011 [23] | + | + | + | + | + | + | + | + | ++ | + |
Le 2015 [24] | - | + | - | + | + | + | ++ | + | ||
Miquillan 2013 [25] | ++ | + | + | + | + | + | ++ | + | ||
Fatal occupational injuries | ||||||||||
Lopez- Bonilla 2011 [26] | + | + | ++ | - | - | + | -- | + | + | |
Mora 2011 [27] | + | + | + | + | -- | + | - | + | + | |
Non-fatal occupational injuries | ||||||||||
Cunningham 2012 [28] | - | + | ++ | + | ++ | - | ++ | - | - | + |
Calys-Tagoe 2017 [29] | - | + | - | ++ | - | ++ | + | - | + | |
Santana 2003 [30] | + | + | + | ++ | + | + | + | - | ++ | + |
Depression | ||||||||||
Abbas 2013 [31] | + | + | ++ | ++ | ++ | ++ | + | ++ | + | |
Da Silva 2006 a [32] | - | + | - | + | + | ++ | + | ++ | + | + |
Giatti 2008 * [22] | + | + | + | + | + | + | + | + | ++ | + |
Musculoskeletal disorders | ||||||||||
Da Silva 2006 b [33] | - | + | - | + | ++ | + | + | + | + | + |
3.4. Findings
3.4.1. Any Health Services Use
3.4.2. Fatal Occupational Injuries
3.4.3. Non-Fatal Occupational Injuries
3.4.4. Depression
3.4.5. Musculoskeletal Disorders
4. Discussion
4.1. Summarised Findings
4.2. Comparison with Other Evidence
4.3. Limitations and Research Considerations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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No | Outcome in This Review | Relevant Sustainable Development Goals Indicator |
---|---|---|
1 | Has used any health service | 3.8.1 Coverage of essential health services (defined as the average coverage of essential services based on tracer interventions that include reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases and service capacity and access, among the general and the most disadvantaged population) |
2 | Has used any occupational safety and health service | |
3 | Has died from an occupational injury | 8.8.1 Frequency rates of fatal and non-fatal occupational injuries, by sex and migrant status |
4 | Has had any non-fatal occupational injury | |
5 | Has human immunodeficiency virus infection | 3.3.1 Number of new HIV infections per 1000 uninfected population, by sex, age and key populations |
6 | Has tuberculosis | 3.3.2 Tuberculosis incidence per 1000 population |
7 | Has depression | 3.4.2 Suicide mortality rate |
8 | Has any musculoskeletal disorder | - |
9 | Has noise induced hearing loss (NIHL) | - |
10 | Has respiratory infections | 3.4.1 Mortality rate attributed to cardiovascular disease, cancer, diabetes or chronic respiratory disease |
No | First Author | Year of Publication | Country | Study Design | Year of Data Collection | Outcome of Interest | Population | Sex | Occupation | Total Workers in Informal Economy (IE) | Number of Cases in IE | Number of Non-Cases in IE | Total Workers in Formal Economy (FE) | Number of Cases in FE | Number of Non-Cases in FE | Point Estimate (SE) [Ref FE Workers] | 95% CI |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | Giatti [22] | 2008 | Brazil | Cross sectional | 2003 | Health services use | 32,887 | Male | Multiple | 8255 | 3599 * | 4656 * | 16,673 | 9554 * | 7119 * | OR 0.60 (0.03) | 0.56–0.64 |
2 | Giatti [23] | 2011 | Brazil | Cross sectional | 2008 | Health services use | 31,331 | Male | Multiple | 10,185 | 5052 | 5133 | 21,146 | 13,089 | 8057 | OR 0.83 (0.05) | 0.81–0.85 |
3 | Le [24] | 2015 | Vietnam | Cross sectional | x | Health services use | 1800 | Both | Multiple | 210 | 120 | 90 | 340 | 213 | 127 | OR 0.38 (0.35) | 0.19–0.74 |
4 | Miquillan [25] | 2013 | Brazil | Cross sectional | 2008 | Health services use | 152,233 | Both | Multiple | 62,612 | 54,347 | 8265 | 76,246 | 65,267 | 10,979 | OR 0.86 (0.01) | 0.84–0.89 |
*5 | Lopez- Bonilla [26] | 2011 | Nicaragua | Cross sectional | 2005 | Fatal occupational injuries | 2,080,899 | Both | Multiple | 1,318,241 | 79,094 | 1,239,147 | 762,658 | 92,807 | 669,851 | OR 0.49 | |
*6 | Mora [27] | 2011 | Costa Rica | Cross sectional | 2005/2006 | Fatal occupational injuries | x | Both | Multiple | x | 159 | x | x | 163 | x | OR 1.05 | |
*7 | Cunningham [28] | 2012 | Paraguay | Cross sectional | 2009 | Non-fatal occupational injuries | 114 | Both | Waste recyclers | 102 | 13 | 89 | 12 | 2 | 10 | OR 0.76 | |
8 | Calys-Tagoe [29] | 2017 | Ghana | Cross sectional | 2014 | Non-fatal occupational injuries | 404 | Both | Small Scale Miners | 109 | 59 | 50 | 295 | 62 | 233 | OR 0.64 | 0.32–1.18 |
9 | Santana [30] | 2003 | Brazil | Cross sectional | 2000 | Non-fatal occupational injuries | 2947 | Both | Multiple | 1555 | 174 | 1381 | 1392 | 167 | 1225 | OR 0.92 | 0.74–1.16 |
10 | Abbas [31] | 2013 | Egypt | Cross sectional | 2012 | Depression | 451 | Both | Cleaners | 242 | 143 | 99 | 209 | 62 | 147 | OR 3.4 | 2.27–5.17 |
11 | Da Silva [32] | 2006 a | Brazil | Cross sectional | 2004 | Depression | 881 | Both | Waste recyclers | 441 | 197 | 244 | 440 | 148 | 292 | OR 1.4 | 1.2–1.7 |
1 | Giatti [22] | 2008 | Brazil | Cross sectional | 2003 | Depression | 32,887 | Male | Multiple | 8255 | x | x | 16,673 | x | x | OR 1.1 | 0.87–1.39 |
12 | Da Silva [33] | 2006 b | Brazil | Cross sectional | 2004 | Musculoskeletal disorders | 254 | Both | Waste recyclers | 441 | 61 | 380 | 44 | 25 | 415 | PR LBP 1.1 PR ULP 1.1 PR LLP 0.9 | 0.9–1.1 1.0–1.3 0.8–1.1 |
Population: Informal Economy Workers Setting: Any Country, Occupation, Industrial Sector and Workplace Comparator: Formal Economy Workers in the Same Country | ||||||
---|---|---|---|---|---|---|
Outcomes | Anticipated Absolute Risk * (95% CI) | Relative Difference (95% CI) | No of Participants (No of Studies) | Quality of the Evidence (GRADE) | Comments | |
Risk among Formal Economy Workers | Risk among Informal Economy Workers | |||||
Has used any health services | 770 per 1000 | 749 per 1000 (740 to 759) | OR 0.89 (0.85 to 0.94) | 195667 (4 studies) | ⊕⊕⊝⊝ Low—a,b,c | Informal economy workers may be less likely to have used any health service, compared with formal economy workers. |
Has used any occupational safety and health services | - | - | - | - | - | No evidence available on this outcome. |
Has died from an occupational injury | - | - | - | 15650750 (2 studies) | Very low—a,b,d,e | We are very uncertain about the estimate for this outcome. |
Has had any non-fatal occupational injury | - | - | - | 3465 (2 studies) | Very Low—a,b,d,f,g | We are very uncertain about the estimate for this outcome. |
Has depression | 20 per 1000 | 92 per 1000 (52 to 158) | OR 5.02 (2.72 to 9.27) | 26260 (3 studies) | ⊕⊕⊝⊝ Low—b,g | Informal economy workers may be more likely to have depression, compared with formal economy workers. |
Has any musculoskeletal disorder | - | - | - | 881 (1 study) | Very Low—b,g | We are very uncertain about the estimate for this outcome. |
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Naicker, N.; Pega, F.; Rees, D.; Kgalamono, S.; Singh, T. Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis. Int. J. Environ. Res. Public Health 2021, 18, 3189. https://doi.org/10.3390/ijerph18063189
Naicker N, Pega F, Rees D, Kgalamono S, Singh T. Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2021; 18(6):3189. https://doi.org/10.3390/ijerph18063189
Chicago/Turabian StyleNaicker, Nisha, Frank Pega, David Rees, Spo Kgalamono, and Tanusha Singh. 2021. "Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis" International Journal of Environmental Research and Public Health 18, no. 6: 3189. https://doi.org/10.3390/ijerph18063189
APA StyleNaicker, N., Pega, F., Rees, D., Kgalamono, S., & Singh, T. (2021). Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health, 18(6), 3189. https://doi.org/10.3390/ijerph18063189