Abstract
Workforce participation is reduced among people with cardiovascular disease (CVD). However, detailed quantitative evidence on this is limited. We examined the relationship of CVD to workforce participation in older working-age people, by CVD subtype, within population subgroups and considering the role of physical disability. Questionnaire data (2006-2009) for participants aged 45-64 years (n = 163,562) from the population-based 45 and Up Study (n = 267,153) were linked to hospitalisation data through the Centre for Health Record Linkage. Prior CVD was from self-report or hospitalisation. Modified Poisson regression estimated adjusted prevalence ratios (PRs) for non-participation in the workforce in people with versus without CVD, adjusting for sociodemographic factors. There were 19,161 participants with CVD and 144,401 without. Compared to people without CVD, workforce non-participation was greater for those with CVD (40.0% vs 23.5%, PR = 1.36, 95%CI = 1.33-1.39). The outcome varied by CVD subtype: myocardial infarction (PR = 1.46, 95%CI = 1.36-1.55); cerebrovascular disease (PR = 1.92, 95%CI = 1.80-2.06); heart failure (PR = 1.83, 95%CI = 1.68-1.98) and peripheral vascular disease (PR = 1.76, 95%CI = 1.65-1.88). Workforce non-participation in those with CVD versus those without was at least 21% higher in all population subgroups examined, with PRs ranging from 1.75 (95%CI = 1.65-1.85) in people aged 50-55 years to 1.21 (95%CI = 1.19-1.24) among those aged 60-64. Compared to people with neither CVD nor physical functioning limitations, those with physical functional limitations were around three times as likely to be out of the workforce regardless of CVD diagnosis; participants with CVD but without physical functional limitations were 13% more likely to be out of the workforce (PR = 1.13, 95%CI = 1.07-1.20). While many people with CVD participate in the workforce, participation is substantially lower, especially for people with cerebrovascular disease, than for people without CVD, highlighting priority areas for research and support, particularly for people experiencing physical functioning limitations.
Highlights
Cardiovascular disease (CVD) remains a leading contributor to global burden of disease internationally [1] and is the second largest contributor to burden of disease in Australia [2], despite declining CVD mortality globally
The outcome varied by CVD subtype: myocardial infarction (PR = 1.46, 95%CI = 1.36–1.55); cerebrovascular disease (PR = 1.92, 95%CI = 1.80–2.06); heart failure (PR = 1.83, 95%CI = 1.68–1.98) and peripheral vascular disease (PR = 1.76, 95%CI = 1.65–1.88)
Workforce non-participation in those with CVD versus those without was at least 21% higher in all population subgroups examined, with prevalence ratios (PRs) ranging from 1.75 (95%CI = 1.65–1.85) in people aged 50–55 years to 1.21 (95%CI = 1.19–1.24) among those aged 60–64
Summary
Cardiovascular disease (CVD) remains a leading contributor to global burden of disease internationally [1] and is the second largest contributor to burden of disease in Australia [2], despite declining CVD mortality globally. In Australia, studies have reported lower productivity in work [14], lower income [15,16,17] and higher retirement due to ill-health [18] among people with CVD compared to those general population, but there is no large-scale comparative evidence on workforce participation in people with and without CVD. Physical functional limitations are common among people with CVD [19] and are a key determinant of employment [20], no studies have examined the extent to which this might account for the lower workforce participation among people with CVD. We examined the relationship of CVD to workforce participation in older working-age people, by CVD subtype, within population subgroups and considering the role of physical disability
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