Labor Income Losses Associated With Heart Disease and Stroke From the 2019 Panel Study of Income Dynamics

Abstract

ImportanceCurrent 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.ObjectiveTo 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 ParticipantsThis 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.ExposureThe key exposure was heart disease or stroke.Main Outcomes and MeasuresThe 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.ResultsIn 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.Conclusions and RelevanceThese 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.

The Economic Burden of Illness

“…The study by Luo et al of lost labor costs reinforces the idea that we need to think beyond the cost of medical care to the cost of illness. The societal burden of illness is very high and not fully appreciated.…”

“…Luo et al note several important limitations. The study did not have sufficient detail to estimate the income lost to specific types or severity of heart disease or stroke.…”

“…Luo et al estimate lost labor productivity elsewhere in JAMA Network Open . The source of data was the 2019 Panels Study of Income Dynamics (PSID), a long-standing survey (begun in 1968) of households in the US designed to assess the dynamics of a nationally representative sample of income and poverty .…”

“…Since 1997, PSID has provided cross-sectional weights calibrated to US population characteristics, and since 1999, data on chronic diseases. The current study uses the 2019 survey, which includes 9569 families and 26 084 individuals. This study focuses on a reference person in the survey and their spouses.…”

“…Although causality cannot be proven, it seems likely that heart disease and stroke could lead to substantial loss of income. The economic effects of illness should include both lost labor costs due to lower income, early mortality and effect on employers . The last is the most difficult to assess and is also potentially in the multiple billions of dollars.…”