Economic influences on population health in the United States: Toward policymaking driven by data and evidence

Venkataramani, Atheendar S.; O’Brien, Rourke; Whitehorn, Gregory L.; Tsai, Alexander C.

doi:10.1371/journal.pmed.1003319

Cited by 33 publications

(32 citation statements)

References 156 publications

(182 reference statements)

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“…This result is not aligned with a study from the United States, for example, that found the probability of missing work was significant across all professional categories for obese women, although among men, the results varied by occupation [ 26 ]. This discrepancy with our findings can by justified due to a much more complex mechanism, including differences in the democracy, as well in the economic situation, labour market and social welfare between Portugal and United States that could be considered as potentially important factor that explaining differences in population health behaviors and consequently in absenteeism [ 27 , 28 ].…”

Section: Discussioncontrasting

confidence: 66%

Obesity- attributable costs of absenteeism among working adults in Portugal

et al. 2022

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Background Obesity leads to poor health outcomes and may adversely affect work productivity. This study, aimed to investigate the obesity- attributable costs of absenteeism among working adults in Portugal. Methods The study population included individuals actively working at baseline from the Epidemiology of Chronic Diseases Cohort (EpiDoC), a large Portuguese population-based prospective study. Body mass index was measured at baseline and in two follow-up interviews. Absenteeism in each wave of the EpiDoC was assessed by the question “Did you have a sick leave in the previous 12 months? yes/no”, followed by “How many days did you miss work due to sickness in the previous twelve months?”. Body mass index (BMI) was classified into underweight, normal weight, overweight, and obese, based on the standard World Health Organization definition. Association between obesity and absenteeism was estimated with the negative binomial regression model adjusted for BMI, chronic diseases, and lifestyle. Obesity- attributable costs were calculated using lost gross income during the time absent from work, through the human-capital approach. Results The EpiDoC included 4338 working adults at baseline. Of these, 15.2% were obese at the beginning of the study and 22.7% of the population had been absent from work in the last 12 months. Participants with obesity missed 66% more days at work (IRR: 1.66; CI 95%:1.13–2.44; (p = 0.009.) than those with normal weight. The odds of having been absent from work were 1.4 times higher in obese compared to non-obese individuals (CI 95%: 1.18–1.67; p < 0.01) adjusted to sex and type of work. Obese individuals missed 3.8 more days per year than those with normal weight (95%CI: 3.1–4.5). Extrapolating to the entire Portuguese working population, absenteeism due to obesity incurred an additional cost of €238 million per year. Conclusion Obesity imposes a financial burden due to absenteeism in Portugal. Employers and national health regulators should seek effective ways to reduce these costs.

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Section: Discussioncontrasting

confidence: 66%

Obesity- attributable costs of absenteeism among working adults in Portugal

et al. 2022

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“…US research suggests that these largely reflect 'worsening health among working-age individuals of lower socioeconomic status' consistent with evidence that increasing numbers of people are experiencing ever more precarious lives. 28 Our findings are also consistent with evidence from Statistics Canada, 29 which found that while death rates were falling at older ages, at ages 20-44 years, especially among men, they were increasing. This was attributed largely to the opioid crisis which was afflicting several provinces.…”

Section: Discussionsupporting

confidence: 92%

“…US research suggests that these largely reflect ‘worsening health among working-age individuals of lower socioeconomic status’ consistent with evidence that increasing numbers of people are experiencing ever more precarious lives. 28…”

Section: Discussionmentioning

confidence: 99%

What can lifespan variation reveal that life expectancy hides? Comparison of five high-income countries

2021

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Objectives In most countries, life expectancy at birth (e0) has improved for many decades. Recently, however, progress has stalled in the UK and Canada, and reversed in the USA. Lifespan variation, a complementary measure of mortality, increased a few years before the reversal in the USA. To assess whether this measure offers additional meaningful insights, we examine what happened in four other high-income countries with differing life expectancy trends. Design We calculated life disparity (a specific measure of lifespan variation) in five countries -- USA, UK, France, Japan and Canada -- using sex- and age specific mortality rates from the Human Mortality Database from 1975 to 2017 for ages 0--100 years. We then examined trends in age-specific mortality to identify the age groups contributing to these changes. Setting USA, UK, France, Japan and Canada Participants aggregate population data of the above nations. Main Outcome Measures Life expectancy at birth, life disparity and age-specific mortality. Results The stalls and falls in life expectancy, for both males and females, seen in the UK, USA and Canada coincided with rising life disparity. These changes may be driven by worsening mortality in middle-age (such as at age 40). France and Japan, in contrast, continue on previous trajectories. Conclusions Life disparity is an additional summary measure of population health providing information beyond that signalled by life expectancy at birth alone.

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“…The digital divide appears to contribute to gaps in educational and occupational opportunities, health awareness, access to health care services, and many other factors affecting health disparities 43,44 . In addition, discrimination in the criminal justice system and incarceration may further limit educational and employment opportunities for people of color 45‐47 . Care providers' implicit or explicit racial bias could also lead to substandard medical treatment 15 …”

Section: Factors That Contribute To Cancer Disparities Across the Can...mentioning

confidence: 99%

American Cancer Society's report on the status of cancer disparities in the United States, 2021

Islami

Guerra

Minihan

et al. 2021

CA A Cancer J Clinicians

159

121

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In this report, the authors provide comprehensive and up‐to‐date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5‐year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence‐based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.

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Economic influences on population health in the United States: Toward policymaking driven by data and evidence

Cited by 33 publications

References 156 publications

Obesity- attributable costs of absenteeism among working adults in Portugal

Obesity- attributable costs of absenteeism among working adults in Portugal

What can lifespan variation reveal that life expectancy hides? Comparison of five high-income countries

American Cancer Society's report on the status of cancer disparities in the United States, 2021

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