Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
Department of Economics, Tulane University, New Orleans, Louisiana.
JAMA Netw Open. 2023 Mar 1;6(3):e232658. doi: 10.1001/jamanetworkopen.2023.2658.
Current estimates of productivity losses associated with heart disease and stroke in the US include income losses from premature mortality but do not include income losses from morbidity.
To estimate labor income losses associated with morbidity of heart disease and stroke in the US due to missed or lower labor force participation.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used 2019 Panel Study of Income Dynamics data to estimate labor income losses associated with heart disease and stroke by comparing labor income between persons with and without heart disease or stroke, after controlling for sociodemographic characteristics and other chronic conditions and considering the situation of zero labor income (eg, withdrawal from the labor market). The study sample included individuals aged 18 to 64 years who were reference persons or spouses or partners. Data analysis was conducted from June 2021 to October 2022.
The key exposure was heart disease or stroke.
The main outcome was labor income, measured for the year 2018. Covariates included sociodemographic characteristics and other chronic conditions. Labor income losses associated with heart disease and stroke were estimated using the 2-part model, in which part 1 is to model the probability that labor income is greater than zero and part 2 is to regress positive labor income, with both parts having the same set of explanatory variables.
In the study sample consisting of 12 166 individuals (6721 [52.4%] females) representing a weighted mean income of $48 299 (95% CI, $45 712-$50 885), the prevalence of heart disease was 3.7% and the prevalence of stroke was 1.7%, and there were 1610 Hispanic persons (17.3%), 220 non-Hispanic Asian or Pacific Islander persons (6.0%), 3963 non-Hispanic Black persons (11.0%), and 5688 non-Hispanic White persons (60.2%). The age distribution was largely even, from 21.9% for the age 25 to 34 years group to 25.8% for the age 55 to 64 years group, except for young adults (age 18-24 years), who made up 4.4% of the sample. After adjustment for sociodemographic characteristics and other chronic conditions, persons with heart disease would receive an estimated $13 463 (95% CI, $6993-$19 933) less in annual labor income than those without heart disease (P < .001), and persons with stroke would receive an estimated $18 716 (95% CI, $10 356-$27 077) less in annual labor income than those without stroke (P < .001). Total labor income losses associated with morbidity were estimated at $203.3 billion for heart disease and $63.6 billion for stroke.
These findings suggest that total labor income losses associated with morbidity of heart disease and stroke were far greater than those from premature mortality. Comprehensive estimation of total costs of CVD may assist decision-makers in assessing benefits from averted premature mortality and morbidity and allocating resources to the prevention, management, and control of CVD.
目前美国与心脏病和中风相关的生产力损失估计包括因过早死亡而导致的收入损失，但不包括因发病而导致的收入损失。
估计因心脏病和中风导致的美国劳动力发病率造成的劳动力收入损失，这些损失是由于劳动力参与率降低或劳动力缺勤导致的。
设计、设置和参与者：这项横断面研究使用 2019 年收入动态面板研究数据，通过比较患有或未患有心脏病或中风的人与无心脏病或中风的人之间的劳动力收入，来估计与心脏病和中风发病率相关的劳动力收入损失，同时控制了社会人口统计学特征和其他慢性疾病，并考虑了零劳动力收入的情况（例如，退出劳动力市场）。研究样本包括年龄在 18 至 64 岁之间的参考人员或配偶或伴侣。数据分析于 2021 年 6 月至 2022 年 10 月进行。
主要暴露因素为心脏病或中风。
主要结果是劳动力收入，测量的是 2018 年的数据。协变量包括社会人口统计学特征和其他慢性疾病。使用两部分模型估计与心脏病和中风相关的劳动力收入损失，其中第 1 部分用于对劳动力收入大于零的概率进行建模，第 2 部分用于对正劳动力收入进行回归，两部分使用相同的解释变量集。
在研究样本中，有 12166 人（6721 名女性，占 52.4%），加权平均收入为 48299 美元（95%置信区间：45712-50885），心脏病的患病率为 3.7%，中风的患病率为 1.7%，样本中有 1610 名西班牙裔人（17.3%）、220 名非西班牙裔亚裔或太平洋岛民（6.0%）、3963 名非西班牙裔黑人（11.0%）和 5688 名非西班牙裔白人（60.2%）。年龄分布基本均匀，从 25 至 34 岁年龄组的 21.9%到 55 至 64 岁年龄组的 25.8%，但年轻成年人（18-24 岁）除外，他们占样本的 4.4%。在调整了社会人口统计学特征和其他慢性疾病后，患有心脏病的人预计每年的劳动力收入将比没有心脏病的人少 13463 美元（95%置信区间：6993-19933 美元）（P<.001），而患有中风的人预计每年的劳动力收入将比没有中风的人少 18716 美元（95%置信区间：10356-27077 美元）（P<.001）。与发病相关的劳动力收入总损失估计为心脏病 2033 亿美元，中风 636 亿美元。
这些发现表明，与心脏病和中风发病相关的劳动力总收入损失远远大于因过早死亡而导致的损失。对 CVD 总费用的全面估计可能有助于决策者评估因避免过早死亡和发病而获得的收益，并分配资源用于 CVD 的预防、管理和控制。
