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首页> 美国卫生研究院文献>International Journal of Environmental Research and Public Health >Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis
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Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis

机译：与正规经济工作者相比非正式经济工作者的卫生服务和健康结果：系统审查和荟萃分析

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Background: There are approximately two billion workers in the informal economy globally. Compared to workers in the formal economy, these workers are often marginalised with minimal or no benefits from occupational health and safety regulations, labour laws, social protection and/or health care. Thus, informal economy workers may have higher occupational health risks compared to their formal counterparts. Our objective was to systematically review and meta-analyse evidence on relative differences (or inequalities) in health services use and health outcomes among informal economy workers, compared with formal economy workers. Methods: We searched PubMed and EMBASE in March 2020 for studies published in 1999–2020. The eligible population was informal economy workers. The comparator was formal economy workers. The eligible outcomes were general and occupational health services use, fatal and non-fatal occupational injuries, HIV, tuberculosis, musculoskeletal disorders, depression, noise-induced hearing loss and respiratory infections. Two authors independently screened records, extracted data, assessed risk of bias with RoB-SPEO, and assessed quality of evidence with GRADE. Inverse variance meta-analyses were conducted with random effects. Results: Twelve studies with 1,637,297 participants from seven countries in four WHO regions (Africa, Americas, Eastern Mediterranean and Western Pacific) were included. Compared with formal economy workers, informal economy workers were found to be less likely to use any health services (odds ratio 0.89, 95% confidence interval 0.85–0.94, four studies, 195,667 participants, I2 89%, low quality of evidence) and more likely to have depression (odds ratio 5.02, 95% confidence interval 2.72–9.27, three studies, 26,260 participants, I2 87%, low quality of evidence). We are very uncertain about the other outcomes (very-low quality of evidence). Conclusion: Informal economy workers may be less likely than formal economy workers to use any health services and more likely to have depression. The evidence is uncertain for relative differences in the other eligible outcomes. Further research is warranted to strengthen the current body of evidence and needed to improve population health and reduce health inequalities among workers.
机译：背景：全球非正式经济中大约有20亿工人。与正规经济中的工人相比，这些工人经常被职业健康和安全法规，劳动法，社会保护和/或医疗保健的最少或没有利益。因此，与正式同行相比，非正式经济工人可能具有更高的职业健康风险。与正式经济工人相比，我们的目标是系统地审查和荟萃分析卫生服务使用和健康成果中的相对差异（或不平等）的证据。方法：我们在2020年3月搜索了PubMed and Embase进行了1999 - 2012年3月出版的研究。符合条件的人口是非正式经济工作者。比较者是正式的经济工作者。符合条件的成果是一般和职业卫生服务的使用，致命和非致命的职业伤害，艾滋病毒，结核病，肌肉骨骼障碍，抑郁症，噪声诱导的听力丧失和呼吸道感染。两位作者独立筛选的记录，提取数据，评估偏向的风险与罗伯斯 - Speo，并评估了等级的证据质量。用随机效应进行逆差率元分析。结果：包括来自四个国家的1,637,297名参与者在七个国家（非洲，美洲，东部地中海和西太平洋）有12项研究。与正规经济工作人员相比，非正式经济工作人员被发现不太可能使用任何卫生服务（赔率比0.89，95％置信区间0.85-0.94，四项研究，195,667名参与者，I2 89％，证据质量低）和更多可能有抑郁症（赔率比5.02,95％置信区间2.72-9.27，三项研究，26,260名参与者，I2 87％，证据质量低）。我们对其他结果非常不确定（非常低的证据）。结论：非正式经济工人可能不太可能比正规经济工人使用任何卫生服务，更有可能有抑郁症。证据不确定其他合格成果的相对差异。有权进一步研究，以加强目前的证据，需要改善人口健康，并减少工人之间的健康不平等。

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