The global impact of non-communicable diseases on macro-economic productivity: a systematic review

The global impact of non-communicable diseases on macro-economic productivity: a systematic review Layal Chaker 0 1 2 3 4 5 Abby Falla 0 1 2 3 4 5 Sven J. van der Lee 0 1 2 3 4 5 Taulant Muka 0 1 2 3 4 5 David Imo 0 1 2 3 4 5 Loes Jaspers 0 1 2 3 4 5 Veronica Colpani 0 1 2 3 4 5 Shanthi Mendis 0 1 2 3 4 5 Rajiv Chowdhury 0 1 2 3 4 5 Wichor M. Bramer 0 1 2 3 4 5 Raha Pazoki 0 1 2 3 4 5 Oscar H. Franco 0 1 2 3 4 5 0 Department of Public Health, Erasmus MC , Rotterdam , The Netherlands 1 Department of Endocrinology, Erasmus MC , Rotterdam , The Netherlands 2 Medical Library, Erasmus MC , Rotterdam , The Netherlands 3 Department of Public Health and Primary Care, University of Cambridge , Cambridge , UK 4 Chronic Diseases Prevention and Management, Department of Chronic Diseases and Health Promotion, World Health Organization , Geneva , Switzerland 5 Division of Infectious Disease Control, Municipal Public Health Service (GGD) Rotterdam-Rijnmond , Rotterdam , The Netherlands Non-communicable diseases (NCDs) have large economic impact at multiple levels. To systematically review the literature investigating the economic impact of NCDs [including coronary heart disease (CHD), stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on macro-economic productivity. Systematic search, up to November 6th 2014, of medical databases (Medline, Embase and Google Scholar) without language Layal Chaker, Abby Falla and Sven J. van der Lee have contributed equally to this work. - restrictions. To identify additional publications, we searched the reference lists of retrieved studies and contacted authors in the field. Randomized controlled trials, cohort, casecontrol, cross-sectional, ecological studies and modelling studies carried out in adults ([18 years old) were included. Two independent reviewers performed all abstract and full text selection. Disagreements were resolved through consensus or consulting a third reviewer. Two independent reviewers extracted data using a predesigned data collection form. Main outcome measure was the impact of the selected NCDs on productivity, measured in DALYs, productivity costs, and labor market participation, including unemployment, return to work and sick leave. From 4542 references, 126 studies met the inclusion criteria, many of which focused on the impact of more than one NCD on productivity. Breast cancer was the most common (n = 45), followed by stroke (n = 31), COPD (n = 24), colon cancer (n = 24), DM (n = 22), lung cancer (n = 16), CVD (n = 15), cervical cancer (n = 7) and CKD (n = 2). Four studies were from the WHO African Region, 52 from the European Region, 53 from the Region of the Americas and 16 from the Western Pacific Region, one from the Eastern Mediterranean Region and none from South East Asia. We found large regional differences in DALYs attributable to NCDs but especially for cervical and lung cancer. Productivity losses in the USA ranged from 88 million US dollars (USD) for COPD to 20.9 billion USD for colon cancer. CHD costs the Australian economy 13.2 billion USD per year. People with DM, COPD and survivors of breast and especially lung cancer are at a higher risk of reduced labor market participation. Overall NCDs generate a large impact on macro-economic productivity in most WHO regions irrespective of continent and income. The absolute global impact in terms of dollars and DALYs remains an elusive challenge due to the wide heterogeneity in the included studies as well as limited information from lowand middle-income countries. Methods Search strategy and inclusion criteria Introduction Non-communicable diseases (NCDs), such as coronary heart disease (CHD), stroke, chronic obstructive pulmonary disease (COPD), cancer, type 2 diabetes and chronic kidney disease (CKD) currently constitute the number one cause of morbidity and mortality worldwide, claiming 36 million lives each year (accounting for 63 % of all adult deaths) [1]. Infectious disease prevention and control, economic growth, improvements in medical and scientific knowledge, and health and social systems development have all contributed to increased life expectancy, improved quality of life and increased likelihood of living to age 60 years and beyond. While these are notable achievements, together with lifestylerelated shifts, these epidemiological and socio-demographic changes also mean that the burden of NCDs will grow [2]. Productivity is a measure of the efficiency of a person, business or country in converting inputs into useful outputs. The productive age span of a person is from adulthood to retirement and ranges from 18 years to around 65 years of age depending on, amongst other things, profession and country. The measurement of productivity greatly relies on the output and the economic or social system context. The focus in this report is macro-economic productivity loss in the productive age range due to NCDs. Key macro-economic measures related to the labor market include: (un-) employment, (loss in) hours worked (including full or part-time work status change), presenteeism (defined as impaired performance while at work), absenteeism, disability adjusted life years (DALYs) and productivity costs/losses. Key macro-economic outcomes are reduction in the able workforce, NCD-related health and welfare expenditure and loss of income earned by the productive workforce. While both the burden of NCDs and the socio-economic contexts vary greatly, the impact of the former on macro-economic outcomes across the global regions remains unclear. We aimed to systematically identify and summarize the literature investigating the impact of six NCDs (CHD, stroke, COPD cancer, type 2 diabetes and CKD) on macroeconomic productivity and to determine directions for future research. We systematically searched the electronic medical databases (Medline, Embase and Google Scholar) up to November 6th, 2014 (date of last search) to identify relevant articles evaluating the macro-economic consequences of the six selected NCDs, specifically the impact on economic productivity of working age citizens. The complete search strategy is available in Appendix 1. We defined the major NCDs of interest as CHD, stroke, chronic obstructive lung disease (COPD), type 2 diabetes mellitus (DM), cancer (lung, colon, breast and cervical) and chronic kidney disease (CKD). The step-wise inclusion and exclusion procedure is outlined in Fig. 1. Eligible study design included randomized controlled trials (RCTs), cohort, casecontrol, cross-sectional, systematic reviews, metaanalysis, ecological studies and modeling studies. We included studies that estimated the impact of at least one of the NCDs defined above on at least one of the following measures of macro-economic productivity: DALYs, economic costs related to reduced work productivity, absenteeism, presenteeism, (un) employment, (non (...truncated)