title: Indirect costs associated with early exit from work attributable to rheumatic diseases.
abstract: BACKGROUND
  Rheumatic diseases (RD) cause physical disability that may lead to early exit from work, generating indirect costs to society. We aimed to measure these costs in a population approaching the statutory retirement age.
  
  
  METHODS
  The analysis was based on the prevalence of self-reported RD using a bottom-up approach. Health and sociodemographic data were retrieved from the fourth National Health Survey (INS), for all people between 50 and 64 years of age (3762 men and 4241 women), whereas an official national database was used to estimate productivity values by gender, age group and region, using the human capital approach. The effects of RD on the likelihood of early exit from paid employment and the attributable fractions estimates were obtained at the individual level by logistic regression.
  
  
  RESULTS
  At the time of the survey, 37.2% of the population aged 50-64 years self-reported at least one RD. Among these, 52.6% were not employed, compared with 40.7% of those without RD (P < 0.001). The annual indirect costs following premature exit from work attributable to RD were €650 million (€892 per RD patient). Early retirement amounted to €367 million, whereas early retirement and unemployment totalized €385 million (€504 and €528 per RD patient, respectively). Females are responsible for about 60% of these costs; however, males contribute with higher individual productivity losses.
  
  
  CONCLUSIONS
  Early exit from work attributable to RD amounts to approximately 0.4% of the national GDP. The public health concern and the economic impact highlight the need to prioritize investments in health and social protection policies targeting patients with rheumatic conditions.
authors: 1 Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Center, Lisbon, Portugal laires.pedro@gmail.com.
authors: Pedro A
authors: PA
authors: Laires
authors: 2 Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal 3 Rheumatology Department, Hospital de Santa Maria, Lisbon, Portugal.
authors: Helena
authors: H
authors: Canhão
authors: 4 Catolica Lisbon School of Business and Economics, Lisbon, Portugal.
authors: Miguel
authors: M
authors: Gouveia
mesh_terms: D017281:Cost of Illness; D004651:Employment / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D012179:Retirement / Q000706:statistics & numerical data*; D012216:Rheumatic Diseases / Q000191:economics* / Q000453:epidemiology*; D057566:Self Report; D012959:Socioeconomic Factors; D014478:Unemployment / Q000706:statistics & numerical data*