1
|
Hjorth CF, Schmidt JA, Farkas DK, Cronin-Fenton D. Social characteristics and social benefit use among premenopausal breast cancer survivors in Denmark: a population-based cohort study. J Cancer Surviv 2024:10.1007/s11764-024-01598-z. [PMID: 38647591 DOI: 10.1007/s11764-024-01598-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 04/09/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE In 2020, one million women aged < 55 years were diagnosed with breast cancer globally. The impact of breast cancer and its treatments on these women's ability to work and need for social benefits may differ by social characteristics. We evaluated social benefit use following breast cancer by education and cohabitation. METHODS We conducted a nationwide population-based cohort study, including women aged 18-55 years diagnosed with stage I-III breast cancer in Denmark during 2002-2011. Statistics Denmark provided information on cohabitation, education, and social benefit use from 1 year pre-diagnosis to 10 years post-diagnosis. We calculated weekly proportions of self-support, unemployment, disability pension, flexi jobs, and sick leave according to education and cohabitation. RESULTS Of 5345 women, 81.8% were self-supporting, 4.5% received disability pensions, 1.6% had flexi jobs, 3.6% were on sick leave, and 5.5% were unemployed 1 year pre-diagnosis. Ten years post-diagnosis, the proportions were 69.0%, 13.0%, 10.5%, 3.4%, and 2.0% of 3663 survivors. Disability pensions and flexi jobs increased from 12.1 to 26.4% and 2.8 to 13.5% in women with short education, from 4.1 to 12.8% and 1.8 to 12.2% in women with medium education, and from 0.8 to 6.0% and 0.9 to 6.9% in longer educated. Disability pensions increased more in women living alone (7.8 to 19.9%), than in cohabiting women (3.6 to 11.3%). CONCLUSIONS Use of social benefits reflecting lost ability to work was highest in less educated women and in women living alone. IMPLICATIONS FOR CANCER SURVIVORS Awareness of these groups is crucial when tailoring efforts to support work participation in cancer survivors.
Collapse
Affiliation(s)
- Cathrine F Hjorth
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark.
| | - Julie A Schmidt
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Dóra K Farkas
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| | - Deirdre Cronin-Fenton
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Olof Palmes Allé 43-45, 8200, Aarhus N, Denmark
| |
Collapse
|
2
|
Siebinga TM, Janssen SHM, Boumans AW, Van Eenbergen MC, Siflinger B, Van Der Graaf WTA, Husson O. Financial outcomes of adolescent and young adult cancer survivors: a longitudinal population-based registry study. J Natl Cancer Inst 2023; 115:1294-1301. [PMID: 37280086 DOI: 10.1093/jnci/djad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/05/2023] [Accepted: 06/04/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND The patterns and determinants of long-term income among adolescent and young adult (AYA) cancer survivors, and the differences compared with peers, have not yet been fully explored. This study investigated the long-term effects of cancer on the income of AYA cancer survivors. METHODS The Netherlands Cancer Registry identified all AYA cancer patients (aged 18-39 years) diagnosed in 2013 and alive 5 years postdiagnosis. Clinical data of the selected AYA patients were linked to individual, administrative real-world labor market data of Statistics Netherlands. The control group consisted of a random sample of individuals of the same age, sex, and migration background without cancer. Data on 2434 AYA cancer patients and 9736 controls were collected annually from 2011 until 2019. Changes in income level were measured and compared with the control group using difference-in-difference regression models. RESULTS AYA cancer survivors experience, on average, an 8.5% decrease in annual earnings, relative to the control population. The effects are statistically significant and permanent (P < .01). Younger AYAs (those aged 18-25 years 15.5% income reduction), married cancer survivors (12.3%), females (11.6%), those diagnosed with stage IV disease (38.1%), and central nervous system (15.7%) cancer patients experienced the largest decline in income, on average, relative to controls, all else constant. CONCLUSION Although dependent on the sociodemographic and clinical characteristics, a cancer diagnosis at AYA age has significant implications on the income of cancer patients. Awareness of vulnerable groups and the development of policies to mitigate the financial impact of cancer are critical.
Collapse
Affiliation(s)
- Ties M Siebinga
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Silvie H M Janssen
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Anke W Boumans
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
| | - Mies C Van Eenbergen
- Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
- Department of Communication and Cognition, Tilburg University, Tilburg, the Netherlands
| | - Bettina Siflinger
- Department of Econometrics and Operations Research, Tilburg University, Tilburg, the Netherlands
| | - Winette T A Van Der Graaf
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Olga Husson
- Department of Medical Oncology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, the Netherlands
- Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
3
|
Nurminen M, Rättö H. Impact of diabetes diagnosis on dental care utilization: evidence from Finland. HEALTH ECONOMICS REVIEW 2023; 13:26. [PMID: 37129732 PMCID: PMC10152714 DOI: 10.1186/s13561-023-00440-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/20/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Poor oral health is associated with many chronic diseases, including diabetes. As diabetes can worsen oral health and vice versa, care guidelines recommend that patients with diabetes maintain good oral health and have regular dental checkups. We analyzed the impact of receiving an initial type 2 diabetes diagnosis on dental care utilization. METHODS We used register data on residents aged over 25 in the city of Oulu, Finland, covering the years 2013-2018. We used the difference-in-differences method and individuals with no diabetes diagnosis as control group. As robustness checks, we used propensity score matching and constructed an alternative control group from patients that received the same diagnosis a few years apart. RESULTS Despite the guideline recommendations, we found that receiving a diabetes diagnosis did not increase the probability for dental care visits in a two-year follow-up. The findings remained similar for both high-income and low-income persons. CONCLUSIONS The finding is concerning in terms of diabetes management and oral health. Further research is needed on the reasons behind the lack of response to guidelines.
Collapse
Affiliation(s)
- Mikko Nurminen
- Research Department, The Social Insurance Institution of Finland, P.O. Box 450, Helsinki, 00056, Finland.
| | - Hanna Rättö
- Research Department, The Social Insurance Institution of Finland, P.O. Box 450, Helsinki, 00056, Finland
| |
Collapse
|
4
|
Montagna C, Zangelidis A. Labour market implications of thyroid dysfunctions. ECONOMICS AND HUMAN BIOLOGY 2023; 50:101247. [PMID: 37148629 DOI: 10.1016/j.ehb.2023.101247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/17/2023] [Accepted: 04/19/2023] [Indexed: 05/08/2023]
Abstract
This paper aims to shed some light on the labour market implications of thyroid disease. Undetected hypothyroidism has adverse effects on wages for female workers,thus widening the existing gender wage gap. However, once female individuals are diagnosed (and therefore assumed to be treated) with hypothyroidism, they experience wage gains and have a higher employment probability. In relation to other labour market outcomes, thyroid disease does not appear to play a significant role on individuals' labour force participation decision and their working hours. Results suggest that productivity gains may drive the improvement in wages.
Collapse
Affiliation(s)
- Catia Montagna
- Economics, Centre for Labour Market Research, Business School, University of Aberdeen, Aberdeen, AB24 3QY, Scotland, UK
| | - Alexandros Zangelidis
- Economics, Centre for Labour Market Research, Business School, University of Aberdeen, Aberdeen, AB24 3QY, Scotland, UK.
| |
Collapse
|
5
|
Nurminen M. Association of mental health and behavioral disorders with health care and service utilization in children before and after diagnosis. PLoS One 2022; 17:e0278198. [PMID: 36441702 PMCID: PMC9704676 DOI: 10.1371/journal.pone.0278198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
Mental health is one of the most important contributors to the global burden of disease in children and adolescents. Mental health conditions are associated with lower quality of life in adulthood. These conditions have an early onset and typically first occur in childhood. However, little is known about how these conditions are related to service utilization before the initial diagnosis, or about the significance of the diagnosis on later service utilization. To study this, register data on 5-15-year-old children in the city of Oulu, Finland, covering the years 2013-2018 were used. To identify the association of mental health and behavioral conditions with service utilization, counterfactuals were constructed from children who were similarly diagnosed three years later. Event study regressions on several health care and service utilization outcomes were estimated. The findings showed that primary and specialized health care utilization increased sharply before the initial diagnosis and peaked during the time of diagnosis. Primary care utilization started decreasing slowly after, while specialized health care utilization remained high for two years after the diagnosis. Probability of visiting a mental health professional, use of rehabilitation services, psychiatric medication, and utilization of child protection services increased significantly after the diagnosis. The results highlighted the importance of outpatient health care in detecting and treating the conditions in children. In a fragmented system, knowledge on utilization trajectories in different services may be of help in allocating resources to improve the health of these children.
Collapse
Affiliation(s)
- Mikko Nurminen
- The Social Insurance Institution of Finland (Kela), Helsinki, Finland
- * E-mail:
| |
Collapse
|
6
|
Martin E, Di Meglio A, Menvielle G, Arvis J, Bourmaud A, Michiels S, Pistilli B, Vaz-Luis I, Dumas A. Informing the development of multidisciplinary interventions to help breast cancer patients return to work: a qualitative study. Support Care Cancer 2022; 30:8287-8299. [PMID: 35819520 DOI: 10.1007/s00520-022-07262-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Return to work (RTW) after breast cancer (BC) can be a major challenge for patients. Multidisciplinary interventions seem to be effective but the role of digital solutions is under-developed and therefore not evaluated. We explored the preferences, needs, and barriers regarding RTW interventions, including opinions about the use of digital approaches to deliver such interventions. METHODS We conducted a qualitative study based on interviews with 30 patients with BC and 18 healthcare providers in four French regions. Emergent themes were identified using thematic content analysis. RESULTS Most providers declared that they did not proactively address RTW with patients, mainly due to having other priorities and a lack of knowledge. The following themes emerged: several development and deployment barriers regarding RTW interventions exist, multidisciplinary interventions are preferred, and there is a need to maintain contact between the patient and workplace during sick leave, including pathways and interlocutors that can facilitate RTW. Participants had mostly positive representations of using digital tools to facilitate RTW; however, fear of loss of human contact and the exacerbation of inequalities were identified as possible risks associated with the development of digital-only interventions. CONCLUSIONS Interventions blending the needs and preferences of patients with BC and the healthcare system are warranted. A personalized multimodal approach with mixed digital and in-person features has surfaced as a possible solution to address the weaknesses of existing interventions. IMPLICATIONS FOR CANCER SURVIVORS Since most women work at the time of diagnosis, it is of particular relevance to build interventions promoting RTW.
Collapse
Affiliation(s)
- Elise Martin
- Université Paris-Saclay, Gustave Roussy, Inserm, Biomarqueurs Prédictifs Et Nouvelles Stratégies Thérapeutiques en Oncologie, 94800, Villejuif, France.
| | - Antonio Di Meglio
- Université Paris-Saclay, Gustave Roussy, Inserm, Biomarqueurs Prédictifs Et Nouvelles Stratégies Thérapeutiques en Oncologie, 94800, Villejuif, France.,Medical Oncology Department, Gustave Roussy, 94800, Villejuif, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Sante Publique, Paris, France
| | | | | | - Stefan Michiels
- Office of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France.,Oncostat U1018, Inserm, University Paris-Saclay, Labeled Ligue Contre Le Cancer, Villejuif, France
| | - Barbara Pistilli
- Medical Oncology Department, Gustave Roussy, 94800, Villejuif, France
| | - Ines Vaz-Luis
- Université Paris-Saclay, Gustave Roussy, Inserm, Biomarqueurs Prédictifs Et Nouvelles Stratégies Thérapeutiques en Oncologie, 94800, Villejuif, France.,Medical Oncology Department, Gustave Roussy, 94800, Villejuif, France
| | - Agnès Dumas
- Université Paris Cité, ECEVE, UMR 1123, INSERM, Paris, France
| |
Collapse
|
7
|
Kambourova Z, Kalwij A. Are there employment and income gains of a national breast cancer screening program? HEALTH ECONOMICS REVIEW 2022; 12:33. [PMID: 35727354 PMCID: PMC9210695 DOI: 10.1186/s13561-022-00380-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Dutch national breast cancer screening program invites women aged 50-75 for screening. By detecting the disease in an early phase, the program aims to achieve lower breast cancer mortality and improve breast cancer survivors' health. Arguably, the latter also improves the employability of diagnosed women. OBJECTIVE This study investigates the effects of the Dutch national breast cancer screening program on diagnosed women's employment and income. METHODS The empirical analysis uses data of 229,357 women aged 40-59, of whom 10,515 were diagnosed with breast cancer at an age in the range 47-53. A regression-based difference-in-differences estimator is used to identify program effects by comparing outcomes for women diagnosed at ages 47-49 with the outcomes for those diagnosed at ages 50-53. The empirical models account for individual fixed effects, and for age and year fixed effects by using a control group of women who were not diagnosed with breast cancer. RESULTS Women's employment rates declined in the six-year period after a breast cancer diagnosis with, on average, about 3 percentage points and their incomes declined with, on average, about 5% over this period. The empirical evidence, based on a comparison of outcomes for women diagnosed at ages 47-49 with the outcomes for those diagnosed at ages 50-53 when covered by the breast cancer screening program, does not support that these declines in employment and income were affected by the program. The evidence also does not support short or medium-term survival gains of the program. CONCLUSIONS The findings of this study suggest that the Dutch national breast cancer screening program yields no discernible short or medium-term employment and income gains for women diagnosed with breast cancer.
Collapse
Affiliation(s)
- Zornitza Kambourova
- Utrecht University School of Economics, P.O. Box 80125, 3508, TC Utrecht, The Netherlands
| | - Adriaan Kalwij
- Utrecht University School of Economics, P.O. Box 80125, 3508, TC Utrecht, The Netherlands
| |
Collapse
|
8
|
Sohn M, Moon D, O'Campo P, Muntaner C, Chung H. Who loses more? Identifying the relationship between hospitalization and income loss: prediction of hospitalization duration and differences of gender and employment status. BMC Public Health 2022; 22:232. [PMID: 35120472 PMCID: PMC8814781 DOI: 10.1186/s12889-022-12647-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/25/2022] [Indexed: 11/21/2022] Open
Abstract
Background The major determinants of health and well-being include wider socio-economic and political responses to poverty alleviation. To data, however, South Korea has no related social protection policies to replace income loss or prevent non-preferable health conditions for workers. In particular, there are several differences in social protection policies by gender or occupational groups. This study aimed to investigate how hospitalization affects income loss among workers in South Korea. Methods The study sample included 4876 Korean workers who responded to the Korean Welfare Panel Study (KoWePS) for all eight years from 2009 to 2016. We conducted a receiver operating characteristics (ROC) analysis to determine the cut-off point for the length of hospitalization that corresponded to the greatest loss of income. We used panel multi-linear regression to examine the relationship between hospitalization and income loss by gender and employment arrangement. Results The greatest income loss for women in non-standard employment and self-employed men was observed when the length of hospitalization was seven days or less. When they were hospitalized for more than 14 days, income loss also occurred among men in non-standard employment. In addition, when workers were hospitalized for more than 14 days, the impact of the loss of income was felt into the subsequent year. Conclusion Non-standard and self-employed workers, and even female standard workers, are typically excluded from public insurance coverage in South Korea, and social security is insufficient when they are injured. To protect workers from the vicious circle of the poverty-health trap, national social protections such as sickness benefits are needed. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12647-6.
Collapse
Affiliation(s)
- Minsung Sohn
- Division of Health and Medical Sciences , The Cyber University of Korea, Seoul, Republic of Korea
| | - Daseul Moon
- BK21PLUS Program in Public Health Sciences, Korea University, Seoul, Republic of Korea
| | - Patricia O'Campo
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Carles Muntaner
- Bloomberg School of Nursing, University of Toronto, Toronto, Canada
| | - Haejoo Chung
- BK21FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea. .,School of Health Policy and Management, Korea University, Seoul, Republic of Korea.
| |
Collapse
|
9
|
Bøgelund M, Jørgensen NB, Madsbad S, Spanggaard M, Panton UH, Pedersen MH, Johansen P. The Effect of Bariatric Surgery on Healthcare Costs and Labor Market Attachment. Obes Surg 2022; 32:998-1004. [PMID: 35083702 PMCID: PMC8933378 DOI: 10.1007/s11695-022-05913-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 11/24/2022]
Abstract
Purpose We aimed to estimate the total cost of bariatric surgery in Denmark. Materials and Methods The study population included all Danish citizens ≥ 18 years who had received bariatric surgery, identified in the Danish National Patient Register in the period from 2002 to 2018. Patients who had received bariatric surgery were matched with three controls on gender, year of birth, and region of residence. A difference-in-difference approach was used to estimate the healthcare costs attributable to bariatric surgery from 3 years before to 5 years after surgery. Results Total healthcare costs for cases receiving bariatric surgery during the first 5 years following surgery amounted to EUR 32,899, and EUR 16,651 for their matched controls. Thereby, the difference in total healthcare costs (EUR 16,248) between persons receiving bariatric surgery and their matched controls was 2.2 times the DRG rate for the surgery itself (EUR 7387). Moreover, the results suggest that receiving bariatric surgery led to a total increase in gross earnings of EUR 5970 (5%) and a total reduction in receipt of transfer payments of EUR 4488 (12%) in the period up until 5 years after surgery. Conclusion The results showed a significant and persistent increase in healthcare costs for people with obesity receiving bariatric surgery during the first 5 years after surgery. We also found that bariatric surgery was associated with increased attachment to the labor market. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s11695-022-05913-4.
Collapse
Affiliation(s)
- Mette Bøgelund
- Incentive, Holte Stationsvej 14, 1, 2840, Holte, Denmark
| | - Nils B Jørgensen
- Department of Endocrinology, Hvidovre Hospital, Kettegaard Allé 30, 2650, Hvidovre, Denmark
| | - Sten Madsbad
- Department of Endocrinology, Hvidovre Hospital, Kettegaard Allé 30, 2650, Hvidovre, Denmark
| | | | - Ulrik H Panton
- Novo Nordisk North West Europe Pharmaceuticals A/S, Ørestads Boulevard 108, 2300, København S, Denmark
| | | | - Pierre Johansen
- Novo Nordisk North West Europe Pharmaceuticals A/S, Ørestads Boulevard 108, 2300, København S, Denmark
| |
Collapse
|
10
|
Kristiansen IL. Consequences of serious parental health events on child mental health and educational outcomes. HEALTH ECONOMICS 2021; 30:1772-1817. [PMID: 33931927 DOI: 10.1002/hec.4278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
I show that serious, yet common, parental health events in childhood have immediate and lasting effects on mental health and educational outcomes for children. Following a parental health event, the children are more likely to receive therapy and consume anti-depressant (AD) medication. More so, the children achieve lower test scores and have lower school enrollment rates. The effect immediately occurs following the event and persists at least into early adulthood. I find that the effect on test scores doesn't differ significantly across family income, but that children from low-income families are more likely to be prescribed ADs following the event, while children from high-income families are more likely to receive therapy. Exploiting differences in general practitioners' behavior in prescribing AD and referring children to therapy, I find suggestive evidence that children who are more exposed to medical treatment of mental health issues have lower educational attainments in early adulthood.
Collapse
|
11
|
Tanaka A. The effects of sudden health reductions on labor market outcomes: Evidence from incidence of stroke. HEALTH ECONOMICS 2021; 30:1480-1497. [PMID: 33819359 DOI: 10.1002/hec.4259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
While increasing attention is given to how health reductions affect workers, estimating their effects is usually challenging. This paper aims to identify the causal effect of health deterioration on labor market outcomes by exploiting the incidence of stroke. Stroke, which often reduces health suddenly and unexpectedly, allows us to exploit the within-person random variation of the timing and isolate the effects of health reduction. By applying the fixed-effects method to a sample of stroke survivors in the University of Michigan Health and Retirement Study data, I find that stroke immediately halves the employment probability as well as hours and weeks worked 1 year after the occurrence and its effects persist for at least 3 years, while earnings reduction is relatively moderate and gradual. I also find the negative effects of stroke are larger among men with severe stroke and women with longer pre-stroke job tenure, while the effects are mitigated for younger women. These results make a stark contrast with the studies on other health events such as cancer diagnosis, which generally find much smaller effects and significant heterogeneity by education and occupation. This analysis shows that the labor market effects largely differ by types of diseases and calls for disease-specific studies in order to understand the social gradient in health and how workers adjust to work limitations.
Collapse
Affiliation(s)
- Atsuko Tanaka
- Department of Economics, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
12
|
Lennon C. Are the costs of employer-sponsored health insurance passed on to workers at the individual level? ECONOMICS AND HUMAN BIOLOGY 2021; 41:100995. [PMID: 33706224 DOI: 10.1016/j.ehb.2021.100995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 02/12/2021] [Accepted: 02/23/2021] [Indexed: 06/12/2023]
Abstract
Because employer-sponsored health insurance (ESI) is experience rated, employers have an incentive to try to offset its cost by paying lower wages to employees who have greater medical expenditures. The existing evidence on this topic, however, illustrates only that ESI is associated with lower wages for groups of workers who are costlier to cover. In contrast, I use the variation provided by the Affordable Care Act's employer mandate to examine if differences in medical expenditures are passed on to workers at the individual level. My estimates rely on Medical Expenditure Panel Survey data in a dose response difference-in-difference framework that examines how wages change for workers with varying medical expenditures when they must soon be offered ESI. I find that each $1 difference in medical expenditures is associated with a $0.35 to $0.51 wage offset after the employer mandate's announcement wherever ESI must soon be offered to workers. Placebo analyses, focusing on workers whose employers are not affected by the mandate, provide support for a causal interpretation. I also show that my findings are not sensitive to sample selection or data reliability issues and that they cannot be explained by the effects of the Great Recession, demographic characteristics that correlate with medical expenditures, or location- or industry-specific idiosyncratic shocks.
Collapse
|
13
|
Parro F, Pohl RV. The effect of accidents on labor market outcomes: Evidence from Chile. HEALTH ECONOMICS 2021; 30:1015-1032. [PMID: 33647182 DOI: 10.1002/hec.4230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 10/21/2020] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
We estimate the causal effect of accidents on employment and earnings among Chilean men using event study methods and monthly administrative data. An accident of any type reduces the probability of being employed by 8.4 percentage points in the first year, by 11.2 percentage points in the second year, and by 14.8 percentage points in the third year after the accident. On average, over the three years after the accident, employment declines by 14%, relative to the pre-accident mean. In addition, accidents reduce monthly earnings by around 11% in the first year, 17% in the second year, and 22% in the third year after the accident. On average, monthly earnings fall by 16%, relative to the pre-accident average. Thus, we estimate persistent and increasing labor market effects of accidents over time. These effects vary by individuals' age, education, and industry and by severity of the accident. Our findings imply that the economic consequences of health shocks go beyond direct medical expenses.
Collapse
Affiliation(s)
- Francisco Parro
- School of Business, Universidad Adolfo Ibáñez, Santiago, Chile
| | - R Vincent Pohl
- Division of Health Policy Assessment, Mathematica, Seattle, Washington, USA
| |
Collapse
|
14
|
Differences in work participation between incident colon and rectal cancer patients-a 10-year follow-up study with matched controls. J Cancer Surviv 2021; 16:73-85. [PMID: 33763805 DOI: 10.1007/s11764-021-01005-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/12/2021] [Indexed: 10/24/2022]
Abstract
PURPOSE Work-related issues have become increasingly relevant for colorectal cancer (CRC) patients, since the cancer is detected at an earlier age due to screening. The aim was to evaluate work participation up to 10 years after colon or rectal cancer diagnosis compared between diagnosis and to a matched cancer-free population. METHODS In this national register-based cohort study, all first-time CRC patients in the period 2000-2015 with no previous cancer, between 20 and 60 years, were identified in the Danish Cancer Registry. A control group with no previous cancer was matched on gender, age, education, and income. For each year a mean Work Participation Score (WPS) was calculated (a percentage of weeks working) for individuals part of the labour market. RESULTS A total of 5625 colon cancer patients and 3856 rectal cancer patients and 25,341 and 17,256 matched controls were included in the study, respectively. The WPS increased for colon cancer patients from 45.69% after 1 year to 83.94% after 4 years, while rectal cancer patients had a score of 38.07% after 1 year and 80.07% after 4 years. The WPS was lower for cancer patients compared with controls, but the difference decreased after 4 years. CONCLUSION CRC patients had a lower work participation up to 10 years after diagnosis compared with controls, while rectal cancer patients had a lower participation the first 7 years after diagnosis compared with colon cancer patients. IMPLICATIONS FOR CANCER SURVIVORS Work-related issues should be considered in the early stage of rehabilitation to increase work participation and thereby improve quality of life.
Collapse
|
15
|
Jones AM, Rice N, Zantomio F. Acute health shocks and labour market outcomes: Evidence from the post crash era. ECONOMICS AND HUMAN BIOLOGY 2020; 36:100811. [PMID: 31521566 DOI: 10.1016/j.ehb.2019.100811] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/24/2019] [Accepted: 08/02/2019] [Indexed: 06/10/2023]
Abstract
We investigate the labour supply response to an acute health shock for individuals of all working ages, in the post crash era, combining coarsened exact matching and entropy balancing to preprocess data prior to undertaking parametric regression. Identification exploits uncertainty in the timing of an acute health shock, defined by the incidence of cancer, stroke, or heart attack, based on data from Understanding Society. The main finding implies a substantial increase in the baseline probability of labour market exit along with reduced hours and earnings. Younger workers display a stronger labour market attachment than older counterparts, conditional on a health shock. Impacts are stronger for women, older workers, and those who experience more severe limitations and impairments. This is shown to be robust to a broad range of approaches to estimation. Sensitivity tests based on pre-treatment outcomes and using future health shocks as a placebo treatment support our identification strategy.
Collapse
Affiliation(s)
- Andrew M Jones
- Department of Economics and Related Studies, University of York, United Kingdom; Centre for Health Economics, Monash University, Australia
| | - Nigel Rice
- Centre for Health Economics and Department of Economics and Related Studies, University of York, United Kingdom
| | - Francesca Zantomio
- Department of Economics, Ca' Foscari University of Venice, Italy; Health Econometrics and Data Group, University of York, United Kingdom.
| |
Collapse
|
16
|
Jeon SH, Pohl RV. Medical innovation, education, and labor market outcomes of cancer patients. JOURNAL OF HEALTH ECONOMICS 2019; 68:102228. [PMID: 31521025 DOI: 10.1016/j.jhealeco.2019.102228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 06/10/2023]
Abstract
Innovations in cancer treatment have lowered mortality, but little is known about their economic benefits. We assess the effect of two decades of improvement in cancer treatment options on the labor market outcomes of breast and prostate cancer patients. In addition, we compare this effect across cancer patients with different levels of educational attainment. We estimate the effect of medical innovation on cancer patients' labor market outcomes employing tax return and cancer registry data from Canada and measuring medical innovation by using the number of approved drugs and a quality-adjusted patent index. We find that innovations in cancer treatment during the 1990s and 2000s reduced the negative employment effects of cancer by 63% to 70%, corresponding to a reduction in the economic costs of prostate and breast cancer diagnoses by 13,500 and 5800 dollars per year, respectively. The benefits of medical innovation are limited to cancer patients with postsecondary education.
Collapse
Affiliation(s)
- Sung-Hee Jeon
- Statistics Canada, Social Analysis and Modelling Division, R.H. Coats Building, Ottawa, ON K1A 0T6, Canada.
| | - R Vincent Pohl
- University of Georgia, Terry College of Business, Department of Economics, 620 S Lumpkin St, Athens, GA 30602, USA.
| |
Collapse
|
17
|
Shen Z, Zheng X, Tan Y. The Spillover Effects of Spousal Chronic Diseases on Married Couples' Labour Supply: Evidence from China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16214214. [PMID: 31671680 PMCID: PMC6862332 DOI: 10.3390/ijerph16214214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 01/29/2023]
Abstract
The objective of this study is to examine the spillover effects of chronic diseases experienced by spouses on their wives or husbands’ labour supply. Using data from 2010 and 2012 of the China Family Panel Studies (CFPS), this study employed a difference-in-difference (DD) strategy to investigate the average treatment effect of affected adults on their spouses’ working hours. The results show that, after their spouses were diagnosed with chronic diseases, the average weekly working hours of wives and husbands would be significantly reduced by 3.7–4.2 h and 3.8–4.4 h, respectively. Specially, the average weekly hours of full-time work would be reduced by 2.1–3.3 h for wives and 3.6–3.8 h for husbands. The effect was stronger for those married couples with lower socioeconomic status (SES), such as low-level education, family asset, non-labour income, while the effect was insignificant for high-level SES households. Therefore, as a result of the adverse spillover effects on household labour supply, chronic diseases could cause a greater loss of labour force productivity. Additionally, households in low levels of SES may suffer more losses from reduced labour supply when spousal chronic diseases take place.
Collapse
Affiliation(s)
- Zheng Shen
- School of Economics and Management, Zhejiang A&F University, Hangzhou 311300, China.
| | - Xiaodong Zheng
- School of Economics, Zhejiang Gongshang University, Hangzhou 310018, China.
| | - Yiwen Tan
- College of Economics and Management, China Agricultural University, Beijing 100083, China.
| |
Collapse
|
18
|
Candon D. The joint effect of health shocks and eligibility for social security on labor supply. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:969-988. [PMID: 31093845 DOI: 10.1007/s10198-019-01053-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Accepted: 04/11/2019] [Indexed: 06/09/2023]
Abstract
This paper investigates whether or not suffering a health shock, and becoming eligible for social security, have a joint effect on labor supply. Despite millions of people experiencing both of these events each year, no paper has focused exclusively on the joint effect that these events may have on work outcomes. This is surprising given that experiencing a health shock may impact on how a worker responds to becoming eligible for social security. With data from the Health and Retirement Study, I model weekly hours of work as a function of health shocks, social security eligibility, and their interaction. I find that this interaction leads to a 3-4 h reduction in weekly hours of work for men, but has no effect for women. The results are robust to using different work outcomes, age groups, health shock definitions, subgroups, as well as falsification and placebo tests. The results appear to be driven by men who would have had to return to work with impaired health. Policies that promote a more flexible work situation for older men may alleviate these problems in the future.
Collapse
Affiliation(s)
- David Candon
- School of Economics, University of Edinburgh, 30 Buccleuch Place, Edinburgh, EH8 9JT, UK.
| |
Collapse
|
19
|
Lo JC. Employment pathways of cancer survivors-analysis from administrative data. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:637-645. [PMID: 30604311 DOI: 10.1007/s10198-018-1025-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 12/11/2018] [Indexed: 06/09/2023]
Abstract
The incidence of cancer and its survival rate have been increasing worldwide, resulting in a greater number of cancer survivors. Since one's job often forms a central basis for self-esteem and provides financial security, knowing whether and how cancer can affect the employment of employed cancer survivors are important issues. While the past studies generally used survey data, this study utilizes pre-existing administrative data and employs the difference-in-differences model. We take newly diagnosed cancer patients in 2012, aged from 15 to 60 years and employed upon diagnosis, as the study group (N = 12694) and the propensity-score matching-adjusted non-cancer employed population as the control group. Monthly employment information for 2011-2014 was retrieved for both groups. We define the pre-event period as the months before the diagnosis and the post-event period as the months from the diagnosis and afterwards. A pseudo-date symbolizing the index point for cancer diagnosis is assigned to the control group. The logistic regression results show that the impact of cancer on the employment status of cancer survivors is significantly negative for both genders. However, if the differences in employment status between the study and control groups prior to the incidence of cancer are significant, then some past research that used only post-period observations might have rendered biased estimates. The employment pathways indicate that 88% of female cancer survivors employed upon diagnosis continue to work during the full 12 months after diagnosis. Further analyses on earnings demonstrate the possibility of cancer survivors retaining their job, but at lower pay.
Collapse
Affiliation(s)
- Joan C Lo
- Institute of Economics, Academia Sinica, Nankang, Taipei, Taiwan.
| |
Collapse
|
20
|
Candon D. The effect of cancer on the labor supply of employed men over the age of 65. ECONOMICS AND HUMAN BIOLOGY 2018; 31:184-199. [PMID: 30292988 DOI: 10.1016/j.ehb.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 07/21/2018] [Accepted: 08/24/2018] [Indexed: 06/08/2023]
Abstract
This paper investigates the relationship between cancer diagnosis and the labor supply of employed men over the age of 65. While almost 60% of male cancers are diagnosed in men over the age of 65, no previous research has examined the effect that cancer has on this age group, which is surprising given the relevance of this group to public policy. With data from the Health and Retirement Study, I show that cancer has a significant negative effect on the labor supply of these workers. Using a combination of linear regression models and propensity score matching, I find that respondents who are diagnosed with cancer work 3 fewer hours per week than their non-cancer counterparts. They are also 10 percentage points more likely to stop working. This reduction seems to be driven by a deterioration in physical and mental health.
Collapse
Affiliation(s)
- David Candon
- School of Economics, University of Edinburgh, 30 Buccleuch Place, Edinburgh EH8 9JT, UK.
| |
Collapse
|
21
|
Heinesen E, Imai S, Maruyama S. Employment, job skills and occupational mobility of cancer survivors. JOURNAL OF HEALTH ECONOMICS 2018; 58:151-175. [PMID: 29486331 DOI: 10.1016/j.jhealeco.2018.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 06/08/2023]
Abstract
Previous studies find significant negative effects of cancer on employment, with stronger effects for less-educated workers. We investigate whether the effect of cancer varies by skill requirement in the pre-cancer occupation, whether such heterogeneity can explain educational gradients, and whether cancer is associated with changes in job characteristics for cancer survivors who remain employed four years after the diagnosis. We combine Danish administrative registers with detailed skill requirement data and use individuals without cancer as a control group. Our main findings are the following: the negative effect of cancer on employment is stronger if the pre-cancer occupation requires high levels of manual skills or low levels of cognitive skills; the educational gradient diminishes substantially if we allow the effects of cancer to also depend on pre-cancer skill requirements; and cancer is not associated with occupational mobility, indicating potential for policies that reduce labour market frictions for cancer survivors.
Collapse
Affiliation(s)
- Eskil Heinesen
- Rockwool Foundation Research Unit, Sølvgade 10, 1307 Copenhagen K, Denmark.
| | - Susumu Imai
- Hokkaido University, Kita 9 Nishi 7, Kita-ku, Sapporo, Hokkaido 060-0809, Japan; University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia
| | - Shiko Maruyama
- University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia
| |
Collapse
|
22
|
Jensen LS, Overgaard C, Bøggild H, Garne JP, Lund T, Overvad K, Fonager K. The long-term financial consequences of breast cancer: a Danish registry-based cohort study. BMC Public Health 2017; 17:853. [PMID: 29084512 PMCID: PMC5661907 DOI: 10.1186/s12889-017-4839-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/06/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A breast cancer diagnosis affects an individual's affiliation to labour market, but the long-term consequences of breast cancer on income in a Danish setting have not been examined. The present study investigated whether breast cancer affected future income among Danish women that participated in the work force. We also examined the roles of sociodemographic factors and prior psychiatric medical treatment. METHODS This registry-based cohort study was based on information retrieved from linked Danish nationwide registries. We compared the incomes of 13,101 women (aged 30-59 years) diagnosed with breast cancer (exposed) to those of 60,819 women without breast cancer (unexposed). Changes in income were examined during a 10-year follow-up; for each follow-up year, we calculated the mean annual income and the relative change compared to the income earned one year prior to diagnosis. Expected changes in Danish female income, according to calendar year and age, were estimated based on information from Statistics Denmark. For exposed and unexposed groups, the observed income changes were dichotomized to those above and those below the expected change in income in the Danish female population. We examined the impact of breast cancer on income each year of follow-up with logistic regression models. Analyses were stratified according to educational level, marital status, and prior psychiatric medical treatment. RESULTS Breast cancer had a temporary negative effect on income. The effect was largest during the first three years after diagnosis; thereafter, the gap narrowed between exposed and unexposed cohorts. The odds ratio for an increase in income in the cancer cohort compared to the cancer-free cohort was 0.81 (95% CI 0.77-0.84) after three years. After seven years, no significant difference was observed between cohorts. Stratified analyses demonstrated that the negative effect of breast cancer on income lasted longest among women with high educational levels. Being single or having received psychiatric medical treatment increased the chance to experience an increase in income among women with breast cancer. CONCLUSION A breast cancer diagnosis led to negative effects on income, which ameliorated over the following seven years. Sociodemographic factors and prior psychiatric medical treatment might influence long-term consequences of breast cancer on income.
Collapse
Affiliation(s)
- Laura Schärfe Jensen
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 2. Sal, 9000 Aalborg, Denmark
| | - Charlotte Overgaard
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
- Department of Epidemiology and Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Jens Peter Garne
- Department of Breast surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Thomas Lund
- Department of Public Health and Quality Improvement, Central Denmark Region, Aarhus, Denmark
| | - Kim Overvad
- Department of Public Health – Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Kirsten Fonager
- Department of Social Medicine, Aalborg University Hospital, Havrevangen 1, 2. Sal, 9000 Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
23
|
Jeon SH. The Long-Term Effects of Cancer on Employment and Earnings. HEALTH ECONOMICS 2017; 26:671-684. [PMID: 27045223 DOI: 10.1002/hec.3342] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 02/22/2016] [Accepted: 02/26/2016] [Indexed: 06/05/2023]
Abstract
The study examines long-term effects of cancer on the work status and annual earnings of cancer survivors who had a strong attachment to the labor market prior to their cancer diagnosis. We use linkage data combining Canadian 1991 Census microdata with administrative records from the Canadian Cancer Registry, the Vital Statistics Registry and longitudinal personal income tax records. We estimate changes in the magnitude of cancer effects during the first 3 years following the year of the diagnosis using a large sample of cancer survivors diagnosed at ages 25 to 61. The comparison group consists of similar workers never diagnosed with cancer. The empirical strategy combines coarsened exact matching and regression models to deal with observed and unobserved differences between the cancer and comparison groups. The results show moderate negative cancer effects on work status and annual earnings. Over the 3-year period following the year of the diagnosis, the probability of working is 5 percentage points lower for cancer survivors than for the comparison group, and their earnings are 10% lower. Our findings also suggest that the effects of cancer on labor market outcomes differ for high and low survival rate cancer categories. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
|
24
|
Cabus SJ, Groot W, Maassen van den Brink H. The short-run causal effect of tumor detection and treatment on psychosocial well-being, work, and income. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2016; 17:419-433. [PMID: 25842252 PMCID: PMC4837211 DOI: 10.1007/s10198-015-0688-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/18/2015] [Indexed: 06/04/2023]
Abstract
This paper estimates the short-run causal effect of tumor detection and treatment on psychosocial well-being, work and income. Tumor detection can be considered as a random event, so that we can compare individuals' average outcomes in the year of diagnosis with the year before. We argue for using panel data estimation techniques that enable us to control for observed and unobserved information intrinsic to the individual and time constants. We use data of a national representative panel in the Netherlands that includes health survey information and data on work, education, and income between 2007 and 2012. Our findings show differences in the psychosocial dysfunction of men and women in response to tumor detection and treatment. Women, not men, are decreasingly likely to participate in the labor force as a result of malignant tumor detection, while no significant effects are found on her personal or household income. We also demonstrate that fixed effects panel data models are superior to matching techniques.
Collapse
Affiliation(s)
- Sofie J. Cabus
- />Top Institute for Evidence Based Education Research, TIER-Maastricht University, Kapoenstraat 2, 6211 KW Maastricht, The Netherlands
| | - Wim Groot
- />Top Institute for Evidence Based Education Research, TIER-Maastricht University, Kapoenstraat 2, 6211 KW Maastricht, The Netherlands
- />Amsterdam School of Economics, University of Amsterdam, Roeterstraat 11, 1017 LW Amsterdam, The Netherlands
| | - Henriëtte Maassen van den Brink
- />Top Institute for Evidence Based Education Research, TIER-Maastricht University, Kapoenstraat 2, 6211 KW Maastricht, The Netherlands
- />Amsterdam School of Economics, University of Amsterdam, Roeterstraat 11, 1017 LW Amsterdam, The Netherlands
| |
Collapse
|
25
|
Kolodziejczyk C, Heinesen E. Labour market participation after breast cancer for employees from the private and public sectors: Educational and sector gradients in the effect of cancer. ECONOMICS AND HUMAN BIOLOGY 2016; 21:33-55. [PMID: 26744998 DOI: 10.1016/j.ehb.2015.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 09/30/2015] [Accepted: 12/07/2015] [Indexed: 06/05/2023]
Abstract
For employees who get cancer and survive, the probability of returning to work may depend on their ability to work, potential earnings losses if they do not return to work, qualifications and job type, but also on characteristics of the pre-cancer workplace. This paper focuses on differences between public and private sector employees in the effect of breast cancer on the probability of being out of the labour force three years after the diagnosis. We use propensity score weighting methods and a large longitudinal Danish administrative dataset which allows us to control for a wide range of important baseline characteristics such as education, sector of employment, labour market status, income, health, and demographics. We find that the educational gradient in the effect of cancer is significant in the public sector, where the estimated effects are 11.5 and 3.8 percentage points, respectively, for the low- and high-educated. The corresponding estimates for the private sector are 6.2 and 3.2 percentage points and here the educational gradient is only marginally significant. We discuss possible mechanisms behind the large sector gradient for the low-educated.
Collapse
Affiliation(s)
- Christophe Kolodziejczyk
- KORA, Danish Institute for Local and Regional Government Research, Købmagergade 22, DK-1150 Copenhagen K, Denmark.
| | - Eskil Heinesen
- Rockwool Foundation Research Unit, Sølvgade 10, DK-1307 Copenhagen K, Denmark.
| |
Collapse
|
26
|
Candon D. The effects of cancer on older workers in the English labour market. ECONOMICS AND HUMAN BIOLOGY 2015; 18:74-84. [PMID: 25965970 DOI: 10.1016/j.ehb.2015.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 03/04/2015] [Accepted: 04/14/2015] [Indexed: 06/04/2023]
Abstract
The continued rise in overall cancer survival rates has ignited a field of research which examines the effect that cancer has on survivors' employment. Previous estimates of the effect of cancer on labour market outcomes, using U.S. data, show significant reductions in employment in the first 6 months after diagnosis. However, this impact has been found to dissipate after 12 and 18 months. I use data from the English Longitudinal Study of Ageing and find that, in England, where there is a more generous welfare support system, not only does cancer have a negative impact in the first 6-month period following diagnosis, but also in the second 6-month period. I estimate that, in the second 6-month period after diagnosis, respondents with cancer are 12.2% points less likely to work and work 4.2 fewer hours a week when compared to matched, healthy controls. This suggests that the negative effects from cancer can persist for longer than the six months identified previously. These results have implications for government policy and employers, because it increases the length of time that survivors may be on government supported sick pay, and the expected time that workers will be absent from work due to illness.
Collapse
Affiliation(s)
- David Candon
- School of Economics and Geary Institute, University College Dublin, Ireland.
| |
Collapse
|
27
|
Thielen K, Kolodziejczyk C, Andersen I, Heinesen E, Diderichsen F. Cancer stage, comorbidity, and socioeconomic differences in the effect of cancer on labour market participation: a danish register-based follow-up study. PLoS One 2015; 10:e0128621. [PMID: 26030914 PMCID: PMC4451757 DOI: 10.1371/journal.pone.0128621] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/30/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose Socioeconomic inequality in return to work after cancer treatment and rehabilitation have been documented, but less is known about its causes. This paper investigates the role played by breast cancer stage at diagnosis and comorbidity. Methods We used the comprehensive Danish Cancer Registry to follow 7372 women aged 30-60, who were in the labour force when diagnosed with breast cancer in 2000-06 and survived at least three years. Controls were 213,276 women without breast cancer. Inequalities in employment outlook were estimated as interaction effects in linear regression between educational attainment and disease on employment. Results There is significant interaction between education and breast cancer, but it is only marginally affected by including stage and comorbidity in the regression models. Education, breast cancer stage, and comorbidity all have strong effects on later employment, and a considerable amount of the educational effect is mediated by comorbidity and pre-cancer labour market participation and income. Conclusion The result of the study is negative in the sense that the stronger effect of breast cancer on employment among low-educated compared to highly educated individuals is not explained by cancer stage or comorbidity. The fact that comorbidity has little impact on inequality may be due to a different social patterning of most comorbidity compared to breast cancer.
Collapse
Affiliation(s)
- Karsten Thielen
- Section of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | | | - Ingelise Andersen
- Section of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark
- * E-mail:
| | - Eskil Heinesen
- Rockwool Foundation Research Unit, Copenhagen K, Denmark
| | - Finn Diderichsen
- Section of Social Medicine, Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark
| |
Collapse
|
28
|
Andersen I, Kolodziejczyk C, Thielen K, Heinesen E, Diderichsen F. The effect of breast cancer on personal income three years after diagnosis by cancer stage and education: a register-based cohort study among Danish females. BMC Public Health 2015; 15:50. [PMID: 25636370 PMCID: PMC4320549 DOI: 10.1186/s12889-015-1387-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate whether there is an association between stage of incident breast cancer (BC) and personal income three years after diagnosis. The analysis further considered whether the association differed among educational groups. METHODS The study was based on information from Danish nationwide registers. A total of 7,372 women aged 30-60 years diagnosed with BC, 48% with metastasis, were compared to 213,276 controls. Generalised linear models were used to estimate the effect of a cancer diagnosis on personal gross income three years after diagnosis, stratified by education and stage of cancer. The models were adjusted for income two years prior to cancer diagnosis and demographic, geographic and co-morbidity covariates. RESULTS Adjusting for income two years prior to cancer diagnosis and other baseline covariates (see above), cancer had a minor effect on personal income three years after diagnosis. The effect of metastatic BC was a statistically significant reduction in income three years after diagnosis of -3.4% (95% CI -4.8;-2.0), -2.8% (95% CI -4.3;-1.3) and -4.1 (95% CI -5.9;-2.3) among further, vocational and low educated women, respectively. The corresponding estimates for the effect of localised BC were -2.5% (95% CI -3.8; -1.2), -1.6% (95% CI -3.0; -0.2) and -1.7% (95% CI -3.7; 0.3); the latter estimate (for the low-educated) was not statistically different from zero. We found no statistically significant educational gradient in the effect of cancer stage on income. CONCLUSIONS In a Danish context, the very small negative effect of BC on personal income may be explained by different types of compensation in low- and high-income groups. The public income transfers are equal for all income groups and cover a relatively high compensation among low-income groups. However, high-income groups additionally receive pay-outs from private pension and insurance schemes, which typically provide higher coverage for high-income workers.
Collapse
Affiliation(s)
- Ingelise Andersen
- Section of Social Medicine, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014, Copenhagen K, Denmark.
| | - Christophe Kolodziejczyk
- KORA, Danish Institute for Local and Regional Government Research, Købmagergade 22, DK-1150, Copenhagen K, Denmark.
| | - Karsten Thielen
- Section of Social Medicine, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014, Copenhagen K, Denmark.
| | - Eskil Heinesen
- Rockwool Foundation Research Unit, Sølvgade 10, 2. tv, DK-1307, Copenhagen K, Denmark.
| | - Finn Diderichsen
- Section of Social Medicine, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, P.O. Box 2099, 1014, Copenhagen K, Denmark.
| |
Collapse
|
29
|
Gordon LG, Beesley VL, Lynch BM, Mihala G, McGrath C, Graves N, Webb PM. The return to work experiences of middle-aged Australian workers diagnosed with colorectal cancer: a matched cohort study. BMC Public Health 2014; 14:963. [PMID: 25230842 PMCID: PMC4190428 DOI: 10.1186/1471-2458-14-963] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/18/2014] [Indexed: 11/21/2022] Open
Abstract
Background Few studies have been undertaken to understand the employment impact in patients with colorectal cancer and none in middle-aged individuals with cancer. This study described transitions in, and key factors influencing, work participation during the 12 months following a diagnosis of colorectal cancer. Methods We enrolled 239 adults during 2010 and 2011who were employed at the time of their colorectal cancer diagnosis and were prospectively followed over 12 months. They were compared to an age- and gender-matched general population group of 717 adults from the Household, Income and Labour Dynamics in Australia (HILDA) Survey. Data were collected using telephone and postal surveys. Primary outcomes included work participation at 12 months, changes in hours worked and time to work re-entry. Multivariable logistic and Cox proportional hazards models were undertaken. Results A significantly higher proportion of participants with colorectal cancer (27%) had stopped working at 12 months than participants from the comparison group (8%) (p < 0.001). Participants with cancer who returned to work took a median of 91 days off work (25–75 percentiles: 14–183 days). For participants with cancer, predictors of not working at 12 months included: being older, lower BMI and lower physical well-being. Factors related to delayed work re-entry included not being university-educated, working for an employer with more than 20 employees in a non-professional or managerial role, longer hospital stay, poorer perceived financial status and having or had chemotherapy. Conclusions In middle-adulthood, those working and diagnosed with colorectal cancer can expect to take around three months off work. Individuals treated with chemotherapy, without a university degree and from large employers could be targeted for specific assistance for a more timely work entry. Trial registration ACTRN12611000530921 Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-963) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Louisa G Gordon
- Griffith Health Institute, Centre for Applied Health Economics, Griffith University, University Drive, Meadowbrook QLD, 4131 Brisbane, Australia.
| | | | | | | | | | | | | |
Collapse
|