Occupational diseases in self-employed workers

Introduction
Even in countries with a well-developed occupational health legislation and infrastructure, self-employed workers generally fall outside the scope of the legislation and services that are intended to prevent accidents and disease at work. Yet, self-employed people also run occupational health risks in agriculture, crafts, or service professions. The burden of occupational disease among self-employed workers is not known.

Methods
We identified all currently self-employed workers who were referred to the outpatient clinic dedicated to the diagnosis occupational or environmental health within the division of pneumology of the University Hospitals of Leuven during the period 2003-2008. Their main demographic, occupational and medical characteristics were compared to those of salaried employees seen during the same period.

Results
Out of 733 referrals, 52 (7%) concerned self-employed-workers. Most of them worked in the agricultural sector (farmers (n=9; 17,3%), followed by artisans (hairdressers (n=5; 9,6%), beauticians, jewellers, bakers, artists, cooks), building contractors (building workers, metal workers, carpenters, painters) and health professionals (dentists, nurses) ... Thirty-five patients (67%) presented with respiratory diseases: asthma (n=12), interstitial lung disease (n=4), asbestos-related disorders (n=2) and other respiratory diseases (emphysema/COPD, infections, …). Sixteen patients (30%) presented with non-respiratory work-related diseases: skin disease (n=4; eczema, scleroderma, urticaria), solvent encephalopathy (n=3), chronic intoxication (n=3; metals, pesticides, solvents), psycho-somatic disorders (n=1; MCS, HVS, CFS) and others (n=5).

Discussion
Self-employed workers may suffer from occupational respiratory and non-respiratory diseases. Although the evidence is largely anecdotal, it appears that the severity at clinical presentation is higher in self-employed persons than in salaried employees. Although the socio-economic consequences of occupational disease are often dramatic for most workers, it appears that this is even more the case for self-employed persons.