1
|
Yang SC, Lai WW, Wu TI, Hwang JS, Wang JD, Wang F. Losses of lifetime employment duration and productivity for patients with different subtypes and stages of lung cancer. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024; 25:775-785. [PMID: 37548803 PMCID: PMC11192829 DOI: 10.1007/s10198-023-01624-4] [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: 08/13/2022] [Accepted: 07/24/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND How different subtypes and stages of lung cancer affect morbidity- and mortality-associated productivity have not been investigated. This study quantified the losses of lifetime employment duration and productivity among patients with various subtypes and stages of lung cancer. METHODS We identified nationwide lung cancer patients diagnosed at the ages of 50-64 between 2011 and 2019. Monthly survival probabilities were weighted by monthly employed-to-population ratios and working salaries to estimate lifetime employment duration and productivity. We compared lifetime employment duration and productivity of patients with those of the age-, sex-, calendar year-matched general population for losses of lifetime employment duration and productivity, which were multiplied by pathology and stage shifts based on the first-round screening of Taiwan Lung Cancer Screening in Never Smoker Trial (TALENT) to calculate the savings of lifetime employment duration and productivity. RESULTS Lung cancer patients had shorter survival and employment duration than the referents. Patients with lung cancers other than adenocarcinoma experienced greater losses of lifetime employment duration and productivity as compared to adenocarcinoma patients. Applying the estimations of never-smoking patients to 100 lung cancer patients with pathology and stage shifts based on the TALENT, the savings of lifetime employment duration and productivity were 132.2 (95% prediction interval: 116.2-147.4) years and 3353 (95% prediction interval: 2914-3802) thousand US dollars, respectively. CONCLUSIONS Early diagnosis of lung cancer would save the losses of employment duration and lifetime productivity. Future evaluation of the cost-effectiveness of lung cancer screening could consider incorporating these societal impacts.
Collapse
Affiliation(s)
- Szu-Chun Yang
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Wu-Wei Lai
- Department of Surgery, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-I Wu
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Occupational and Environmental Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Fuhmei Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Economics, College of Social Sciences, National Cheng Kung University, No.1 University Road, Tainan, 701, Taiwan.
| |
Collapse
|
2
|
AlHejaili F, Hashmi MN, Alsuwaida A, Ankawi GA, ALMehaideb SA, Alsuwaida AA, AlZahrani MT, Shehadah AE, AlNasser HA. Burden of Chronic Hemodialysis on the Ability to Work: Time for Action. Avicenna J Med 2024; 14:110-114. [PMID: 38957157 PMCID: PMC11216803 DOI: 10.1055/s-0044-1786869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Background Understanding the factors that contribute to unemployment will help in the design of creative resolutions to enable hemodialysis patients to return to a productive life. Methods We examined employment among 625 patients aged 18 to 60 years who were on hemodialysis in 8 dialysis units. Results Overall employment was low among patients on chronic hemodialysis at 49.7%. Unemployment was significantly higher in women than in men (86.6% vs 17.1%, p < 0.0001). The employment rate was 70.5% for those with no diabetes and hypertension, 29.5% for those with diabetes, and 25.9% for those with diabetes and hypertension. Furthermore, the results of the Cox regression showed that the variables of gender, level of education, capability of driving, and diabetes were related to employment of patients. Conclusions The majority of patients on hemodialysis are unemployed or exit paid employment due to early retirement. Patients with diabetes and women are a vulnerable population with a higher unemployment rate.
Collapse
Affiliation(s)
- Fayez AlHejaili
- Department of Nephrology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Muhammad N. Hashmi
- Department of Nephrology, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Abdulkareem Alsuwaida
- Department of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ghada A. Ankawi
- Department of Medicine, College of Medicine, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Shahad A. ALMehaideb
- Department of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Anas A. Alsuwaida
- Department of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mohammed T. AlZahrani
- Department of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ali E. Shehadah
- Department of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Hatem A. AlNasser
- Department of Medicine, King Saud University Medical City, King Saud University, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
3
|
Wang F, Hwang JS, Huang WY, Chang YT, Wang JD. Estimation of lifetime productivity loss from patients with chronic diseases: methods and empirical evidence of end-stage kidney disease from Taiwan. HEALTH ECONOMICS REVIEW 2024; 14:10. [PMID: 38319466 PMCID: PMC10848535 DOI: 10.1186/s13561-024-00480-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/13/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVE Studies that examine the broad allocation of resources, regardless of who bears the costs, should ideally estimate costs from a societal perspective. We have successfully integrated survival rates, employment ratios, and earnings to address the significant challenge of evaluating societal value through productivity assessments of patients with end-stage kidney disease (ESKD) in Taiwan. METHODS Using a theoretical framework, we interconnected two nationwide databases: the Taiwan National Health Insurance (NHI) and the Taiwan Mortality Registry from 2000 to 2017. Due to the statutory retirement age of 65, we collected data on all patients (83,358) aged 25-64 years diagnosed with ESKD and undergoing maintenance dialysis. We estimated the lifetime survival function through a rolling extrapolation algorithm, which was then combined with the monthly employment ratio and wages to calculate the lifetime employment duration and productivity up to the legal retirement age of ESKD patients. These were compared with sex-, age-, and calendar year-matched referents to determine the loss of employment duration and productivity of ESKD patients. RESULTS ESKD patients experienced a loss of approximately 25-56% in lifetime employment duration and a larger loss of about 32-66% in lifetime productivity after adjustments for different age, sex, and calendar year. The annual productivity loss per male (female) ESKD patient relative to that of the age-and calendar year-matched referent ranges from 75.5% to 82.1% (82.3% to 90.3%). During the periods when they are able to work (over the on-the-job duration) male ESKD patients lose between 34 and 56% of their income, and female ESKD patients lose between 39 and 68% of their income, compared to the age-and calendar year-matched referents. The loss of lifetime productivity is a combination of reduced lifetime employment duration, functional disability, absenteeism, and presenteeism at the workplace. The loss related to presenteeism is implied by the reduced wages. CONCLUSIONS In addition to the loss of employment duration, we have empirically demonstrated the lifetime loss of productivity in patients with ESKD, also indicating the "presenteeism" resulted from inability to perform their job with full capacity over long-term periods.
Collapse
Affiliation(s)
- Fuhmei Wang
- Department of Economics in College of Social Science and Department of Public Health in College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Wen-Yen Huang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan
| | - Yu-Tzu Chang
- Department of Internal Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Jung-Der Wang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan.
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan.
- Departments of Public Health and Occupational and Environmental Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan.
| |
Collapse
|
4
|
Chan TC, Chuang YH, Hu TH, Y.-H. Lin H, Hwang JS. Mortality risk and years of life lost for people with reduced renal function detected from regular health checkup: A matched cohort study. Prev Med Rep 2023; 31:102107. [PMID: 36820368 PMCID: PMC9938332 DOI: 10.1016/j.pmedr.2022.102107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 12/06/2022] [Accepted: 12/31/2022] [Indexed: 01/04/2023] Open
Abstract
With the increasing threat of metabolic syndromes, a focus on maintaining kidney health from early- to mid-adulthood is necessary. This study elucidates mortality risk and years of life lost (YLLs) due to abnormal renal function. This was a retrospective, matched cohort study from health checkup data from 2000 to 2015. We identified 12,774 participants with abnormal renal function (eGFR < 60 mL/min/1.73 m2) and used propensity score matching to identify 25,548 participants with normal renal function (eGFR ≥ 60). YLLs were estimated using the life expectancy differences between the abnormal and matched normal cohorts. Cox models were used to estimate the adjusted mortality risk. The estimated life expectancy of participants with proteinuria and eGFR < 60 was 26.24 years, with a 95 % confidence interval of (23.96, 29.36), 17.62 (16.37, 18.78), and 11.70 (11.02, 12.46) for age groups of 30 - 54, 55 - 64, and 65 - 79 years, respectively. The estimated YLLs of participants with proteinuria and eGFR < 60, as compared with the matched normal cohort, were 17.86 (13.41, 20.36), 12.55 (11.41, 13.78), and 8.31 (7.47, 9.13) years for the three age groups, respectively. The Cox model estimates of mortality hazard ratios of participants having proteinuria and eGFR < 60 against matched referents were 5.29 (3.97, 7.05), 3.99 (3.34, 4.75), and 3.05 (2.62, 3.55) for the three age groups, respectively. Abnormal renal function shortens life expectancy, particularly in patients with proteinuria and in younger adults. Active health management of renal function can reduce the disease burden.
Collapse
Key Words
- AFP, Alpha-fetoprotein
- CI, Confidence Interval
- CKD, Chronic Kidney Disease
- COD, Cause of Death
- CVD, Cardiovascular Disease
- DM, Diabetes Mellitus
- ESRD, End-stage Renal Disease
- HR, Hazard Ratio
- HTN, Hypertension
- Hazard of death
- Health check-up
- LE, Life Expectancy
- Life expectancy
- PS, Propensity Score
- Proteinuria
- RAS, Renin-angiotensin System
- SLED, Standardized Life Expectancy Deviation
- SMD, Standardized Mean Difference
- TCR, Taiwan Cancer Registry
- YLL, Years of Life Lost
- eGFR
- eGFR, estimated Glomerular Filtration Rate
Collapse
Affiliation(s)
- Ta-Chien Chan
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan,Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan,Corresponding authors.
| | - Yung-Hsin Chuang
- Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - Tsuey-Hwa Hu
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan
| | - Hugo Y.-H. Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan,Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan,Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jing-Shiang Hwang
- Institute of Statistical Science, Academia Sinica, Taipei, Taiwan,Corresponding authors.
| |
Collapse
|
5
|
Effect of dialysis modalities on risk of hospitalization for gastrointestinal bleeding. Sci Rep 2023; 13:52. [PMID: 36593316 PMCID: PMC9807582 DOI: 10.1038/s41598-022-26476-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 12/15/2022] [Indexed: 01/03/2023] Open
Abstract
Dialysis patients are at risk of both thromboembolic and bleeding events, while thromboembolism prevention and treatment may confer a risk of major bleeding. Gastrointestinal (GI) bleeding is a great concern which can result in high subsequent mortality rates. Our object was to clarify whether hemodialysis (HD) and peritoneal dialysis (PD) confer different incidence of GI bleeding, and further assist individualized decision-making on dialysis modalities. We conducted a population-based retrospective cohort study which included all incident dialysis patients above 18 years old derived from the National Health Insurance database from 1998 to 2013 in Taiwan. 6296 matched pairs of HD and PD patients were identified. A propensity score matching method was used to minimize the selection bias. The adjusted hazard ratio for GI bleeding was 1.13 times higher in the HD group than in the PD group, and data from the unmatched cohort and the stratified analysis led to similar results. Among subgroup analysis, we found that the use of anticoagulants will induce a much higher incidence of GI bleeding in HD patients as compared to in PD patients. We concluded that PD is associated with a lower GI bleeding risk than HD, and is especially preferred when anticoagulation is needed.
Collapse
|
6
|
|