The economic impact of cancer mortality among working-age individuals in Brazil from 2001 to 2030

BACKGROUND

About half of cancer deaths in Brazil occur among individuals of working-age (under 65 years for men, under 60 for women), resulting in a substantial economic impact for the country. We aimed to estimate the years of potential productive life lost (YPPLL) and value the productivity lost due to premature deaths from cancer between 2001 and 2015 and the projected to 2030.

METHODS

We used the Human Capital Approach to estimate the productivity losses corresponding to YPPLL for cancer deaths in working age people (15-64 years). Mortality data were obtained from the Mortality Information System from 2001 to 2015 and projected between 2016 and 2030. Economic data were obtained from the Continuous National Household Sample Survey and forecasted to 2030. Productivity lost was calculated as the monetary value arising from YPPLL in Int$(2016).

RESULTS

Between 2001 and 2030, a total of 2.3 million premature deaths from all cancers combined were observed and forecasted in Brazil (57% men, 43% women), corresponding to 32 million YPPLL and Int$141.3 billion in productivity losses (men: Int$102.5 billion, women: Int$38.8 billion). Between 2001 and 2030, among men, lung (Int$ 12.6 billion), stomach (Int$ 10.6 billion) and colorectal (Int$ 9.4 billion) cancers were expected to contribute to the greatest productivity losses; and among women, it will be for breast (Int$ 10.0 billion), cervical (Int$ 6.4 billion) and colorectal (Int$ 3.2 billion) cancers.

CONCLUSIONS

Many preventable cancers result in high lost productivity, suggesting measure to reduce smoking prevalence, alcohol consumption, physical inactivity and inadequate diet, improving screening programs and increasing vaccination coverage for human papillomavirus and hepatitis B would have a positive impact on the economy, as well as reducing morbidity and mortality from cancer.

The economic impact of cancer-related premature mortality in Brazil: A human capital approach analysis

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Background: One method of calculating indirect costs of cancer is the analysis of productivity loss. Using the human capital approach, we estimate how much cancer-related premature mortality indirectly impacts the economy. Given the diverse causes of cancer death and sociodemographic profiles in Brazil, we estimated lost productivity due to cancer by regions, providing evidence for local decision-makers. Methods: Data of all cancers deaths among working-age people (15-64 years for men and 15-60 for women) occurring in 2016 were extracted from the National Mortality System, by region, sex and age-group. Data on life expectancy, workforce participation, unemployment and wages were extracted from the Brazilian National Institute of Geographics and Statistics. Loss of productivity was calculated as the value of time between death and potential retirement age. Results: In total 536,827 (men) and 407,737 (women) years of potential productive life (YPPLL) were lost in 2016, corresponding to US$ 6,196,682,092 (PPP) for Brazil. The profile of YPPLL by cancer type varied by region. In the affluent South and Southeast regions, the cancers with higher impact in men were lung (12.4% and 9.9% of total YPPLL) and colorectal (9.6% and 10.4% of total YPPLL) while in the less affluent North and Northeast, stomach cancer was responsible for 17% and 12% of YPPLL, respectively. Among women, breast cancer had the highest impact in all regions (21.7%-26.2%), excepting the North, where cervical cancer was responsible for 31.3% of the YPPLL. Nationally, individual YPPLL was higher for testicular cancer in males (31.3 years) and Hodgkin’s disease in females (20.2). In the North and the Northeast, despite lower mortality rates, the economic impact of productivity loss was higher, representing 0.23 and 0.29% of the regional GDP. Conclusions: Our results show the indirect economic impact of premature cancer mortality in Brazil, at a total cost of US$ 6,196,682,092 in 2016, representing 0.2% of the entire country’s GDP. The regional patterns highlight the need for adaption of public policies, typical from a country in transition, with the impact of lifestyle and infection-related cancers simultaneously and differently affecting economically the regions.

Disparities in cancer premature mortality in Brazil: Predictions up to 2030 and sustainable development goals

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Background: Premature mortality affects the economy directly due to the loss of productivity of individuals who decease, thus ceasing to contribute economically to the country. The 1/3 reduction in premature mortality (30-69 years) from chronic noncommunicable diseases is goal 3.4 of the UN Sustainable Development Goals (SDG). Although cancer is a chronic disease, it comprises more than 100 different conditions, with different risk factors and prognosis. This study aimed to calculate current and predicted premature mortality by 2030 for Brazil and regions, compare with SDG 3.4 target and identify regional progress and future needs. Methods: Mortality data were extracted from the National Mortality Information System of Brazil (SIM) and subsequently corrected for ill-defined causes. Crude and age-standardized mortality rates per 100,000 inhabitants were calculated. NordPred package by software R was used to calculate predictions up to 2030 and compared with the goal of 1/3 reduction of premature deaths. Results: Comparison of observed (2011-2015) and predicted (2016-2030) mortality rates show a 12.0% reduction in the likelihood of death among men and 4.6% among women nationally. Although predicted rates for 2026-2030 are lower than those observed in 2011-2015 predicted number of deaths increases by 75,341 for men and 90,513 for women. Lung cancer mortality rates are predicted to decrease more among men than women, while colorectal cancer mortality will increase for both sexes. Conclusions: The profile of cancer premature mortality is diverse in Brazil. Nationally, only male lung cancer will be close to reaching SDG 3.4 target, endorsing government’s long term efforts to reduce tobacco consumption. Colorectal cancer mortality increases in most regions, reflecting the epidemiological transition. Despite progress in cervical cancer control, it will continue to be a major challenge, especially in the North and Northeast. Our results provide a baseline for public policies for both prevention and access to treatment to reduce premature mortality in Brazil. Differences in cancer patterns show the need to plan and to adapt regionally for each reality.