Disability Survey Research Articles

The Mediating Effect of Information and Communication Technology Usages on the Nexus Between Assistive Technology and Quality of Life Among People with Communication Disability.

This study aims to investigate the mediating effect of information and communication technology (ICT) on the nexus between quality of life (QoL) and assistive technology among people with communication disabilities. Using a national-level disability survey data in Australia, this study employs a series of causal mediation models based on counterfactual framework for mediation analysis. The results indicate that about 61% to 73% of the impact of assistive technology on QoL among people with communication disabilities is mediated through ICT use. Furthermore, it is evident that the degree of communication impairment partially moderates the impact of ICT-enabled assistive technology on QoL. The findings of the study have several practical implications. First, this study indicates that better integration of assistive technology with ICT will enhance the quality of people with communication disabilities. The second broad recommendation is that improved accessibility with affordable high-speed broadband Internet can deliver services that people with disabilities need.

Quantifying the size of the informal care sector for Australian adults with mental illness: caring hours and replacement cost

To quantify and value the total informal support provided by family and friends to Australian adults with mental illness in 2018. The number of mental health carers was drawn from the 2015 Survey of Disability, Ageing and Carers (SDAC), adjusted to the 2018 population. Annual caring hours by type of assistance were estimated using the SDAC, 2007 National Survey of Mental Health and Wellbeing and an online carer survey. Caring hours for each task were assigned an hourly replacement cost from the National Disability Insurance Scheme. Informal caring was valued as the sum of these costs minus expenditure on carer income support payments, estimating how much it would hypothetically cost governments to replace this care with formal support services. An estimated 354,000 (95% uncertainty interval (UI): 327,000-383,000) Australian mental health carers provided 186 million (95% UI: 159-215) hours of support in 2018. The estimated replacement cost was AU$8.4 billion (95% UI: 7.0-10.0), excluding AU$1.3 billion in income support. Univariate sensitivity analyses demonstrated that results were robust to variation in model inputs, with total caring hours the most influential parameter. Using an alternative estimate of mean caring hours, the replacement cost could be as high as AU$13.2 billion (95% UI: 11.2-15.4). Informal carers provide substantial support to people with mental illness, highlighting their important contribution to the mental health system and reinforcing the need for carer support services. Future valuation studies would benefit from refinement of available data collections, particularly on hours and types of care provided.

A multiple state model for the working-age disabled population using cross-sectional data

A multiple state model describes the transitions of the disability risk among the states of active, inactive and dead. Ideally, estimations of transition probabilities and transition intensities rely on longitudinal data; however, most of the national surveys of disability are based on cross-sectional data measuring the disabled status of an individual at one point in time. This paper aims to propose a generic method of the estimation of the expected transition probabilities when the model allows recovery from disability using the UK cross-sectional data. The disability prevalence rates are modelled by taking into consideration the effect of age and time. Under some plausible assumptions concerning the death rates among inactive and active people, the estimated prevalence rates of disability are used to decompose survival probabilities in each state.

Rationale and feasibility of a combined rapid assessment of avoidable blindness and hearing loss protocol.

PurposeThis study has two main objectives: 1) to assess the value of combining the rapid assessment of avoidable blindness (RAAB) and the recently developed rapid assessment of hearing loss (RAHL) based on existing population-based data from Cameroon andIndia; 2) to test the feasibility of a combined RAAB-RAHL protocol.MethodsA secondary data analysis of population-based disability surveys in India and Cameroon (in 2013–2014) was conducted, focussing on people aged 50+. Hearing impairment (HI) was defined as pure tone average of ≥41dB (better ear).Visual impairment (VI) was defined as presenting visual acuity of <6/18 (better eye). The relationship between HI and VI was examined. The feasibility of a combined RAAB-RAHL survey was assessed within a RAHL conducted among adults aged 50+ in Malawi in 2018. Outcomes included: time taken, costs, number of people examined in a day, and qualitative feedback from participants and field teams.ResultsThe prevalence of combined VI and HI among people aged 50+ was 4.4% (95% confidence interval (CI) 3.0, 6.4) in India and 4.8% (95%CI 3.0, 8.0) in Cameroon. Among participants with VI, approximately a third in India (29.3%) and Cameroon (35.1%) also had HI. A quarter of participants in India (25.4%) and Cameroon (26.9%) who had HI also had VI. In Malawi, the total time taken to complete both RAAB and RAHL assessments was approximately 27 minutes per participant. It was feasible to complete 30 participants per day for a team of four people. The estimated cost of a combined RAAB-RAHL approach in comparison to two separate impairment surveys is up to 37% less depending on the method of combination.ConclusionThe substantial overlap between VI and HI supports a combined rapid survey of the two impairments. The pilot study of a combined RAAB-RAHL survey demonstrates feasibility and lower cost compared to conducting two standalone impairment surveys. A combined RAAB-RAHL approach could maximize limited resources to increase prevalence data for both vision and hearing impairment.

Financial Catastrophism Inherent with Out-of-Pocket Payments in Long Term Care for Households: A Latent Impoverishment.

Background: Out-of-pocket (OOP) payments are configured as an important source of financing long-term care (LTC). However, very few studies have analyzed the risk of impoverishment and catastrophic effects of OOP in LTC. To estimate the contribution of users to the financing of LTC and to analyze the economic consequences for households in terms of impoverishment and catastrophism after financial crisis in Spain. Methods: The database that was used is the 2008 Spanish Disability and Dependency Survey, projected to 2012. We analyze the OOP payments effect associated to the impoverishment of households comparing volume and financial situation before and after OOP payment. At the same time, the extent to which OOP payment had led to catastrophism was analyzed using different thresholds. Results: The results show that contribution of dependent people to the financing of the services they receive exceeds by 50% the costs of these services. This expenditure entails an increase in the number of households that live below the poverty. In terms of catastrophism, more than 80% of households dedicate more than 10% of their income to dependency OOP payments. In annual terms, the catastrophe gap generated by devoting more than 10% of the household income to dependent care OOP payment reached €3955, 1 million (0.38% of GDP). Conclusion: This article informs about consequences of OOP in LCT and supplements previous research that focus on health. Our results should serve to develop strategic for protection against the financial risk resulting from facing the costs of a situation of dependence.

Prevalence of common mental disorders among Syrian refugee children and adolescents in Sultanbeyli district, Istanbul: results of a population-based survey.

Research demonstrates elevated levels of common mental disorders among Syrian refugees, but the majority of studies have, to date, focused on adult populations. This study aims to estimate the prevalence of depression, anxiety and post-traumatic stress disorder (PTSD) among Syrian children and adolescents living in Sultanbeyli district of Istanbul, Turkey. A population-based survey among Syrian children and adolescents aged 8-17 years living in Sultanbeyli district was conducted in 2019, as part of an all-age survey of disability. 80 clusters of 50 participants (all-ages) were selected from the local municipality's refugee registration database using probability proportionate to size sampling. Children aged 8-17 years were assessed for symptoms of common mental disorders using the Child Revised Impact of Event Scale (CRIES-8) and abbreviated versions of the Center for Epidemiologic Studies Depression Scale for Children (CES-DC) and the Screen for Child Anxiety Related Disorders (SCARED). Of the 852 participants, 23.7% (95% CI 19.9-27.2) screened positive for symptomatic depression, PTSD and anxiety. The prevalence estimates for depression, PTSD and anxiety were 12.5% (95% CI 9.8-15.6), 11.5% (95% CI 9.1-14.4) and 9.2% (95% CI 6.8-12.1), respectively. Depression and PTSD were significantly more common in older adolescents, whilst anxiety and PTSD were significantly more common in girls. Depression was more common in children from poorer households and those who had received no education. Children coming from larger households were less likely to show symptoms of PTSD. Syrian refugee children and adolescents are vulnerable to common mental disorders, and culturally appropriate prevention and intervention support are needed for this population.

Who uses residential aged care now, how has it changed and what does it mean for the future?

Objective This paper presents past trends in resident characteristics and usage patterns in residential aged care and explores implications for the future. Methods Time series analyses were undertaken of national aged care administrative datasets and the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers. Results Although the number of people in residential care has continued to increase, resident profiles have changed as a result of higher growth rates in the number of men and of people aged 65-74 years and 90 years and over, and a decline in the number of women aged 75-89 years. Relative to population size, usage rates are declining across all age groups, the average length of stay is shortening, and dependency levels appear to be rising. Conclusion Changing trends in residential aged care use, when combined with key trends in the broader population of older Australians, offer useful insights in planning for the future. What is known about the topic? Trends in the changing characteristics of permanent aged care residents and patterns of use of Australian residential aged care have received sparse attention in scholarly journals. Government reports and databases contain useful statistics, but they do not provide a coherent analysis and interpretation of the implications of these trends or situate them in broader population patterns. What does this paper add? The analyses in this paper demonstrate patterns of change and continuity in the use of residential care over the past decade, and locate those changes in the context of broader trends in the ageing population. Together, this provides useful insights into current and likely future trends, as well as a basis for imagining an improved residential aged care system in the future. What are the implications for practitioners? These analyses illustrate how data on aged care services, demographic trends and disease patterns can be used to consider the challenges that have affected our residential aged care system in the past and how that may be addressed in the future.

Corrigendum to: Who uses residential aged care now, how has it changed and what does it mean for the future?

ObjectiveThis paper presents past trends in resident characteristics and usage patterns in residential aged care and explores implications for the future.MethodsTime series analyses were undertaken of national aged care administrative datasets and the Australian Bureau of Statistics Surveys of Disability, Ageing and Carers.ResultsAlthough the number of people in residential care has continued to increase, resident profiles have changed as a result of higher growth rates in the number of men and of people aged 65-74 years and 90 years and over, and a decline in the number of women aged 75-89 years. Relative to population size, usage rates are declining across all age groups, the average length of stay is shortening, and dependency levels appear to be rising.ConclusionChanging trends in residential aged care use, when combined with key trends in the broader population of older Australians, offer useful insights in planning for the future.What is known about the topic?Trends in the changing characteristics of permanent aged care residents and patterns of use of Australian residential aged care have received sparse attention in scholarly journals. Government reports and databases contain useful statistics, but they do not provide a coherent analysis and interpretation of the implications of these trends or situate them in broader population patterns.What does this paper add?The analyses in this paper demonstrate patterns of change and continuity in the use of residential care over the past decade, and locate those changes in the context of broader trends in the ageing population. Together, this provides useful insights into current and likely future trends, as well as a basis for imagining an improved residential aged care system in the future.What are the implications for practitioners?These analyses illustrate how data on aged care services, demographic trends and disease patterns can be used to consider the challenges that have affected our residential aged care system in the past and how that may be addressed in the future.

Informal caring for back pain: overlooked costs of back pain and projections to 2030.

This study models the economic costs of informal caring for people with back pain, using a microsimulation model, Care&WorkMOD, from 2015 to 2030. Care&WorkMOD was based on 3 national Australian Surveys of Disability, Ageing and Carers (2003, 2009, 2012) data sets for individuals aged 15 to 64 years. Estimated national income loss due to caring for people with back pain was AU$258 million in 2015, increasing to $398 million in 2030 (54% increase). Lost income tax revenue to the Australian government due to informal care of people with back pain was estimated to be AU$78 million in 2015, increasing to AU$118 million in 2030 (50% increase), and additional welfare payments were estimated to rise from $132 million in 2015 to AU$180 in 2030 (36% increase). Larger growth in lost income, compared with the increase in welfare payments, means that there would be an increasing income gap between those out of the labour force providing informal care and noncarers who are in the labour force, leading to increased inequality. Informal carers are defined as providers of informal, unpaid assistance to someone with a health condition, for at least 6 months. Informal carers of people with back pain who are out of the labour force incur substantial economic costs. Furthermore, back pain is a large economic burden on national governments. Policies addressing back pain prevention and treatment, and supporting carers, may offset government welfare expenditure, while improving the socioeconomic well-being of carers and patients.

Is disability exclusion associated with experiencing an unmet need for health care?

To examine the association between disability exclusion and experiencing an unmet need for health care. The 2015 Survey of Disability Ageing and Carers was used to measure the prevalence of unmet needs for health care stratified by measures of exclusion. Log-Poisson models were fitted to examine the association between discrimination, avoidance and unmet needs for health care. Approximately 10% of respondents reported an unmet need to attend a GP, specialist or hospital and 25% reported an unmet need to obtain dental treatment. For those reporting an instance of discrimination in the last 12months, the rates of experiencing unmet needs for health care were significantly higher (GP 29%, specialist 26%, dental 46%, hospital 18%). With controls included, discrimination or avoidance significantly increased the probability of reporting an unmet need for health care regardless of the context of previous experiences of exclusion. Disability discrimination or avoidance is strongly associated with experiencing an unmet need for health care among older people with disabilities.

What Are the Benefits of Hip Resurfacing in Appropriate Patients? A Retrospective, Propensity Score-Matched Analysis.

Hip arthritis is one of the major causes of disability worldwide. Hip resurfacing arthroplasty (HRA) has emerged in recent years as an alternative to total hip arthroplasty (THA), but complications of HRA have limited the patient population to younger male patients with primary osteoarthritis and large hip anatomy. How the functional benefits of HRA in this population compare with those of THA is not entirely clear. The primary aim of this study was to determine whether there were differences in hip disability and patient satisfaction with surgery between these two groups at 2 years after surgery, using patient-reported outcome measures (PROMs) and subjective measures of patient satisfaction. Additionally, we sought to determine whether there were differences in post-operative discharge disposition, revision rates, or adverse events. We searched an institutional database to identify patients undergoing unilateral HRA or THA between January 2007 and July 2011 who met today's recommended criteria for HRA: younger male patients with large-enough hip anatomy to make surgery viable (a femoral head of at least 48 mm in HRA patients and, in THA patients, an acetabular shell size of 54 mm, the minimum outer shell size that could accommodate a femoral head component of 48 mm; for matching purposes, acetabular shell size in THA was used as a surrogate for the femoral head size used in HRA). We used propensity score matching to control for potentially confounding pre-operative variables and administeredtheHip Disability and Osteoarthritis Outcome Score (HOOS) survey, including its subdomains, at the 2-year mark. We also assessed differences between groups in Lower Extremity Activity Scale scores, 12-item Short Form Health Survey results, and answers regarding satisfaction with surgery. We calculated minimal detectable change, minimum clinically important change, and substantial clinical benefit using anchor-based techniques for multiple outcome measures. There were 251 patients in each group. HRA patients scored significantly higher than THA patients on the 2-year HOOS sports and recreation (92 versus 87, respectively) and on rates of overall satisfaction (94% versus 89%, respectively). The HRA group also had a greater chance of achieving minimum clinically important change (18.75 points) in the HOOS sports and recreation subdomains than the THA group (97% versus 91%). No significant difference was found in 6-month adverse event rates. HRA patients also had a significantly shorter mean hospital stay, a higher rate of discharge to home, and a lower incidence of a "significant" limp after surgery. HRA may provide a functional benefit in sports and recreation and greater satisfaction in patients who meet the current criteria for HRA. Because these benefits may be small, pre-operative counseling should focus on balancing the possible functional benefits against the longer-term risks associated with metal-on-metal bearings.

Components of disability exclusion: Discrimination, avoidance and accessibility in later life.

To examine the prevalence and context of disability exclusion reported by people with disability, with and without communication and mobility problems. The 2015 Survey of Disability Ageing and Carers was used to measure the prevalence of reported exclusion. Tests of proportions were used to examine differences in prevalence rates. Proportional Venn diagrams were used to examine the intersection of measures of exclusion. Approximately 53% of those with a communication or mobility difficulty reported at least one measure of exclusion. Among this group, 7% reported an instance of discrimination, 44% reported avoidance, and 29% reported an accessibility problem. The levels of discrimination and avoidance for those without communication or mobility difficulties were approximately half this level (16% avoidance and 3% discrimination). Avoidance and discrimination reduced with age, but accessibility was age-invariant. Exclusion measures intersected and occurred in a variety of contexts. Despite protections provided in Australian law, disability exclusion persists and is high among those with communication and mobility difficulties.

National Burden Estimates of healthy life lost in India, 2017: an analysis using direct mortality data and indirect disability data

Many countries, including India, seek locally constructed disease burden estimates comprising mortality and loss of health to aid priority setting for the prevention and treatment of diseases. We created the National Burden Estimates (NBE) to provide transparent and understandable disease burdens at the national and subnational levels, and to identify gaps in knowledge. To calculate the NBE for India, we combined 2017 UN death totals with national and subnational mortality rates for 2010-17 and causes of death from 211 166 verbal autopsy interviews in the Indian Million Death Study for 2010-14. We calculated years of life lost (YLLs) and years lived with disability (YLDs) for 2017 using published YLD-YLL ratios from WHO Global Health Estimates. We grouped causes of death into 45 groups, including ill-defined deaths, and summed YLLs and YLDs to calculate disability-adjusted life-years (DALYs) for these causes in eight age groups covering rural and urban areas and 21 major states of India. In 2017, there were about 9·7 million deaths and 486 million DALYs in India. About three quarters of deaths and DALYs occurred in rural areas. More than a third of national DALYs arose from communicable, maternal, perinatal, and nutritional disorders. DALY rates in rural areas were at least twice those of urban areas for perinatal and nutritional conditions, chronic respiratory diseases, diarrhoea, and fever of unknown origin. DALY rates for ischaemic heart disease were greater in urban areas. Injuries caused 11·4% of DALYs nationally. The top 15 conditions that accounted for the most DALYs were mostly those causing mortality (ischaemic heart disease, perinatal conditions, chronic respiratory diseases, diarrhoea, respiratory infections, cancer, stroke, road traffic accidents, tuberculosis, and liver and alcohol-related conditions), with disability mostly due to a few conditions (nutritional deficiencies, neuropsychiatric conditions, vision and other sensory loss, musculoskeletal disorders, and genitourinary diseases). Every condition that was common in one part of India was uncommon elsewhere, suggesting state-specific priorities for disease control. The NBE method quantifies disease burden using transparent, intuitive, and reproducible methods. It provides a simple, locally operable tool to aid policy makers in priority setting in India and other low-income and middle-income countries. The NBE underlines the need for many more countries to collect nationally representative cause of death data, paired with focused surveys of disability. Ministry of Health and Family Welfare, Government of India.

A Full Bayesian Implementation of A Generalized Partial Credit Model with an Application to an International Disability Survey

Summary Generalized partial credit models (GPCMs) are ubiquitous in many applications in the health and medical sciences that use item response theory. Such polytomous item response models have a great many uses ranging from assessing and predicting an individual's latent trait to ordering the items to test the effectiveness of the test instrumentation. By implementing these models in a full Bayesian framework, computed through the use of Markov chain Monte Carlo methods implemented in the efficient STAN software package, the paper exploits the full inferential capability of GPCMs. The GPCMs include explanatory covariate effects which allow simultaneous estimation of regression and item parameters. The Bayesian methods for ranking the items by using the Fisher information criterion are implemented by using Markov chain Monte Carlo sampling. This allows us to propagate fully and to ascertain uncertainty in the inferences by calculating the posterior predictive distribution of the item-specific Fisher information criterion in a novel manner that has not been exploited in the literature before. Lastly, we propose a new Monte Carlo method for predicting the latent trait score of a new individual by approximating the relevant Bayesian predictive distribution. Data from a model disability survey carried out in Sri Lanka by the World Health Organization and the World Bank are used to illustrate the methods. The approaches proposed are shown to provide simultaneous model-based inference for all aspects of disability which can be explained by environmental and socio-economic factors.

An Examination of AT Usage and Impacts on Employment Between Minorities and Whites with Disabilities

To examine, identify, and describe differences in assistive technology (AT) usage and “striving to work” status rates between minorities and Whites with disabilities. The 2015 Kessler Foundation National Employment and Disability Survey (KFNEDS), a nationally representative sample, was utilized to conduct this analysis.

Intellectual disability and autism: socioeconomic impacts of informal caring, projected to 2030.

Intellectual disability and autism spectrum disorder (ASD) influence the interactions of a person with their environment and generate economic and socioeconomic costs for the person, their family and society. To estimate costs of lost workforce participation due to informal caring for people with intellectual disability or autism spectrum disorders by estimating lost income to individuals, lost taxation payments to federal government and increased welfare payments. We used a microsimulation model based on the Australian Bureau of Statistics' Surveys of Disability, Ageing and Carers (population surveys of people aged 15-64), and projected costs of caring from 2015 in 5-year intervals to 2030. The model estimated that informal carers of people with intellectual disability and/or ASD in Australia had aggregated lost income of AU$310 million, lost taxation of AU$100 million and increased welfare payments of AU$204 million in 2015. These are projected to increase to AU$432 million, AU$129 million and AU$254 million for income, taxation, and welfare respectively by 2030. The income gap of carers for people with intellectual disability and/or ASD is estimated to increase by 2030, meaning more financial stress for carers. Informal carers of people with intellectual disability and/or ASD experience significant loss of income, leading to increased welfare payments and reduced taxation revenue for governments; these are all projected to increase. Strategic policies supporting informal carers wishing to return to work could improve the financial and psychological impact of having a family member with intellectual disability and/or ASD. None.

Links between mental disorders and the use of disability allowances and services in France

The French social system offers many kinds of allowances and support (in work, everyday life and social life fields) to persons with disabilities. People with severe mental disorders are often considered as having less access than other disabled persons to the various forms of compensation offered by the national solidarity system. Purpose of research : Our objective was to study, for people with diverse kinds of mental disorders, those who are frequent users of support devoted to disability. By proceeding to an ascending hierarchical classification from the data of the Disability and Health National survey of 2008-2009 and by studying the characteristics of these groups with regards to the available resources of the disability field we wished to clarify the determinants of recourse. Two groups who very frequently have both various kinds of mental disorders (including mental retardation) and physical disorders have a very high rate of using solidarity support linked to disability. A third group, whose recourse to the field of the disability system is less high without being negligible includes people with different medical and social profiles, having signs of social difficulties and physical troubles which may precede or follow their mental problems instead of belonging to a same complex pattern. This self-reported data survey inevitably comprises approximate data as regards to diagnoses and impairments, but no other survey brings such diversified information and it usefully highlights that people with mental disorders should not be considered has having only mental disorders as long as they use the French disability system.

Caring hours and possible need for employment support among primary carers for adults with mental illness: Results from an Australian household survey.

Intensive unpaid caring is associated with greater likelihood of not being employed, but impacts for mental health carers specifically remain unknown. This study aimed to: (a) examine the association between caring intensity and not being employed for primary mental health carers, (b) ascertain whether this relationship differs from that for other disability carers, (c) enumerate Australian primary mental health carers with a possible need for employment support and (d) describe these carers' unmet support needs and barriers to employment. Co-resident, working age primary mental health (n=137) and other disability carers (n=821) were identified in the Survey of Disability, Ageing and Carers (collected July-December 2015). Multiple logistic regression analyses examined associations between levels of caring intensity (1-9, 10-19, 20-39, 40+hr/week) and not being employed. A 'possible need for employment support' indicator was derived from information about current employment status, caring hours, past impact of caring on employment and desire for more work or workplace accommodations. After controlling for demographic and caring role factors, mental health carers providing 40+hr of care weekly had greater odds of not being employed compared to carers providing <10hr (AOR 13.38, 95% CI: 2.17-82.39). For other disability carers, the odds of not being employed were also higher among those providing 20-39hr of care (AOR 3.21, 95% CI: 2.18-4.73). An estimated 54.1% (95% CI: 43.1-64.8) of carers had a possible need for employment support, with the proportion increasing as level of caring intensity increased. Of carers who were not employed, 42.2% (95% CI: 30.3-55.0) reported a desire to work, and the main reported barrier was no alternative care arrangements or disruption to the person supported. Findings suggest that improving employment participation for mental health carers requires a greater balance between unpaid care and access to formal services for people with mental illness.

Prevalence of disability among the major cities in Australia 2012 with geographical representation of distribution in Western Australia.

The aim of this study was to use a novel approach to geographically model the relationship between socio-economic disadvantage and prevalence of profound and severe disability. This study used national census data and the survey of disability, ageing and carers data to geographically model the relationship between socio-economic disadvantage and prevalence of profound and severe disability. The results in this study show that there were more people living in the least disadvantaged areas (wealthiest) when compared to the most disadvantaged (poorest) areas. Whereas for people with a disability as the relative socio-economic disadvantage of the area increased, the number of people reporting any disability also increased, with the highest number coming from the most disadvantaged areas. The maps show a significant distribution with fewer cases of disability in metropolitan areas and relatively higher number in the rural area along with the higher proportion of people with disability living in the relatively more disadvantaged areas. Socio-economic profile is one of the key factors influencing the various aspects of health and hence should hold an important place during policy making. Policy should be formulated and implemented to help reduce the inequality by either directly aiming at the most disadvantaged group or by trying to bridge the gap between them. SO WHAT?: This paper provides a geographic visualisation of the distribution of people with profound and severe disability to help identify priority areas with high prevalence of disability.

The indirect costs of ischemic heart disease through lost productive life years for Australia from 2015 to 2030: results from a microsimulation model

BackgroundMost studies measure the impact of ischemic heart disease (IHD) on individuals using quality of life metrics such as disability-adjusted life-years (DALYs); however, IHD also has an enormous impact on productive life years (PLYs). The objective of this study was to project the indirect costs of IHD resulting from lost PLYs to older Australian workers (45–64 years), government, and society 2015–2030.MethodsNationally representative data from the Surveys of Disability, Ageing and Carers (2003, 2009) were used to develop the base population in the microsimulation model (Health&WealthMOD2030), which integrated data from established microsimulation models (STINMOD, APPSIM), Treasury’s population and workforce projections, and chronic conditions trends.ResultsWe projected that 6700 people aged 45–64 were out of the labour force due to IHD in 2015, increasing to 8100 in 2030 (21 increase). National costs consisted of a loss of AU$273 (US$263) million in income for people with IHD in 2015, increasing to AU$443 ($US426) million (62% increase). For the government, extra welfare payments increased from AU$106 (US$102) million in 2015 to AU$143 (US$138) million in 2030 (35% increase); and lost income tax revenue increased from AU$74 (US$71) million in 2015 to AU$117 (US$113) million in 2030 (58% increase). A loss of AU$785 (US$755) million in GDP was projected for 2015, increasing to AU$1125 (US$1082) million in 2030.ConclusionsSignificant costs of IHD through lost productivity are incurred by individuals, the government, and society. The benefits of IHD interventions include not only improved health but also potentially economic benefits as workforce capacity.