Health Services Use and Health Outcomes among Informal Economy Workers Compared with Formal Economy Workers: A Systematic Review and Meta-Analysis

Abstract

BACKGROUND AND AIM: There are approximately two billion informal workers globally. Compared to the formal economy, workers in the informal economy are often marginalised with minimal benefits from occupational health and safety regulations and labour laws as well as decreased access to social protection and health care. Thus these informal economy workers may have higher occupational health risks compared to their formal counterparts. The aim was to systematically review and meta-analyse evidence on health services use and health outcomes among informal economy workers, compared with formal economy workers. METHODS: We searched for studies between 1999–2020 in March 2020. The eligible population was informal economy workers. The comparator was formal economy workers. The outcomes were: use of general and occupational health services, fatal and non-fatal occupational injuries, HIV, tuberculosis, musculoskeletal disorders, noise induced hearing loss, respiratory infections and depression. Two authors independently screened records, extracted data, and assessed risk of bias and quality of evidence. 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 any common mental disorder (odds ratio 5.02, 95% confidence interval 2.72–9.27, three studies, 26 260 participants, I2 = 87%, low quality of evidence). We are uncertain about the other outcomes due to the very low quality of evidence. CONCLUSIONS:Informal economy workers are less likely than formal economy workers to use any health services and more likely to have depression. The evidence is uncertain for the other eligible outcomes and warrants further research to strengthen the body of evidence. KEYWORDS: Occupational exposures, Occupational epidemiology, Outcomes