title: The global impact of non-communicable diseases on macro-economic productivity: a systematic review.
abstract: Non-communicable diseases (NCDs) have large economic impact at multiple levels. To systematically review the literature investigating the economic impact of NCDs [including coronary heart disease (CHD), stroke, type 2 diabetes mellitus (DM), cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD)] on macro-economic productivity. Systematic search, up to November 6th 2014, of medical databases (Medline, Embase and Google Scholar) without language restrictions. To identify additional publications, we searched the reference lists of retrieved studies and contacted authors in the field. Randomized controlled trials, cohort, case-control, cross-sectional, ecological studies and modelling studies carried out in adults (>18 years old) were included. Two independent reviewers performed all abstract and full text selection. Disagreements were resolved through consensus or consulting a third reviewer. Two independent reviewers extracted data using a predesigned data collection form. Main outcome measure was the impact of the selected NCDs on productivity, measured in DALYs, productivity costs, and labor market participation, including unemployment, return to work and sick leave. From 4542 references, 126 studies met the inclusion criteria, many of which focused on the impact of more than one NCD on productivity. Breast cancer was the most common (n = 45), followed by stroke (n = 31), COPD (n = 24), colon cancer (n = 24), DM (n = 22), lung cancer (n = 16), CVD (n = 15), cervical cancer (n = 7) and CKD (n = 2). Four studies were from the WHO African Region, 52 from the European Region, 53 from the Region of the Americas and 16 from the Western Pacific Region, one from the Eastern Mediterranean Region and none from South East Asia. We found large regional differences in DALYs attributable to NCDs but especially for cervical and lung cancer. Productivity losses in the USA ranged from 88 million US dollars (USD) for COPD to 20.9 billion USD for colon cancer. CHD costs the Australian economy 13.2 billion USD per year. People with DM, COPD and survivors of breast and especially lung cancer are at a higher risk of reduced labor market participation. Overall NCDs generate a large impact on macro-economic productivity in most WHO regions irrespective of continent and income. The absolute global impact in terms of dollars and DALYs remains an elusive challenge due to the wide heterogeneity in the included studies as well as limited information from low- and middle-income countries.
authors.affiliation: Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Office NA29-16, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: Layal
authors.initials: L
authors.lastname: Chaker
authors.forename: Abby
authors.initials: A
authors.lastname: Falla
authors.forename: Sven J
authors.initials: SJ
authors.lastname: van der Lee
authors.forename: Taulant
authors.initials: T
authors.lastname: Muka
authors.forename: David
authors.initials: D
authors.lastname: Imo
authors.forename: Loes
authors.initials: L
authors.lastname: Jaspers
authors.forename: Veronica
authors.initials: V
authors.lastname: Colpani
authors.forename: Shanthi
authors.initials: S
authors.lastname: Mendis
authors.forename: Rajiv
authors.initials: R
authors.lastname: Chowdhury
authors.forename: Wichor M
authors.initials: WM
authors.lastname: Bramer
authors.forename: Raha
authors.initials: R
authors.lastname: Pazoki
authors.forename: Oscar H
authors.initials: OH
authors.lastname: Franco
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000191:economics*; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000191:economics*; D004651:Employment / Q000191:economics; D014943:Global Health; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007182:Income; D038622:Internationality; D008297:Male; D017063:Outcome Assessment, Health Care; D018434:Sickness Impact Profile
references.citation: J Occup Environ Med. 2008 Jul;50(7):777-84
references.pmid: 18617833
references.citation: Eur J Cancer. 2004 Nov;40(16):2488-93
references.pmid: 15519524
references.citation: Int Arch Occup Environ Health. 2005 Jul;78(6):467-74
references.pmid: 15895242
references.citation: Cancer. 2004 Oct 15;101(8):1703-11
references.pmid: 15386303
references.citation: J Cancer Surviv. 2013 Jun;7(2):191-202
references.pmid: 23378060
references.citation: Eur J Health Econ. 2011 Aug;12(4):311-7
references.pmid: 20306109
references.citation: BMC Health Serv Res. 2012;12:315
references.pmid: 22970797
references.citation: Chest. 2002 Jan;121(1):264-72
references.pmid: 11796461
references.citation: Cancer Epidemiol. 2013 Dec;37(6):788-92
references.pmid: 24035552
references.citation: Popul Health Manag. 2012 Oct;15(5):267-75
references.pmid: 22401150
references.citation: J Clin Oncol. 2012 Aug 10;30(23):2853-60
references.pmid: 22778312
references.citation: COPD. 2013 Dec;10(6):629-39
references.pmid: 23845002
references.citation: J Occup Environ Med. 2004 Jun;46(6 Suppl):S38-45
references.pmid: 15194894
references.citation: Support Care Cancer. 2012 Apr;20(4):741-7
references.pmid: 21479789
references.citation: BMC Health Serv Res. 2011;11:35
references.pmid: 21314995
references.citation: Work. 2010;36(4):441-7
references.pmid: 20714100
references.citation: J Clin Oncol. 2008 Mar 10;26(8):1302-9
references.pmid: 18323554
references.citation: Int Arch Occup Environ Health. 2008 Oct;82(1):39-45
references.pmid: 18264715
references.citation: J Rehabil Med. 2003 May;35(3):127-31
references.pmid: 12809195
references.citation: Pneumologie. 2004 Dec;58(12):837-44
references.pmid: 15597250
references.citation: Diabetes Care. 2011 Jun;34(6):1344-9
references.pmid: 21562323
references.citation: J Occup Rehabil. 2011 Sep;21(3):431-40
references.pmid: 21153688
references.citation: J Occup Environ Med. 2005 Jun;47(6):547-57
references.pmid: 15951714
references.citation: Am J Prev Med. 2011 Aug;41(2):e5-e14
references.pmid: 21767717
references.citation: Cancer. 2005 Mar 15;103(6):1292-301
references.pmid: 15700265
references.citation: Health Serv Res. 2002 Oct;37(5):1309-28
references.pmid: 12479498
references.citation: Lancet Glob Health. 2014 Apr;2(4):e216-24
references.pmid: 24782954
references.citation: PLoS One. 2012;7(7):e41795
references.pmid: 22848610
references.citation: Stroke. 1994 Aug;25(8):1611-6
references.pmid: 8042212
references.citation: J Occup Rehabil. 2008 Sep;18(3):267-72
references.pmid: 18670868
references.citation: J Occup Environ Med. 2011 Mar;53(3):253-7
references.pmid: 21346633
references.citation: J Occup Environ Med. 2011 Jan;53(1):55-61
references.pmid: 21187787
references.citation: CA Cancer J Clin. 2011 Nov-Dec;61(6):409-18
references.pmid: 21969133
references.citation: J Occup Med. 1992 Nov;34(11):1084-9
references.pmid: 1432298
references.citation: COPD. 2012 Feb;9(1):46-57
references.pmid: 22292597
references.citation: Psychooncology. 2013 Jun;22(6):1411-20
references.pmid: 22912069
references.citation: Work. 2013;46(4):417-22
references.pmid: 24004730
references.citation: J Cancer Surviv. 2013 Jun;7(2):227-36
references.pmid: 23400733
references.citation: Scand J Public Health. 2014 May;42(3):319-28
references.pmid: 24482429
references.citation: Public Health. 2012 Dec;126(12):1024-31
references.pmid: 23062632
references.citation: Respir Med. 2003 Mar;97 Suppl C:S81-9
references.pmid: 12647946
references.citation: J Health Econ. 2002 Sep;21(5):757-79
references.pmid: 12349881
references.citation: Arch Neurol. 1987 May;44(5):479-82
references.pmid: 3579657
references.citation: Aust N Z J Public Health. 2008 Dec;32(6):569-74
references.pmid: 19076751
references.citation: Acta Oncol. 2014 Jun;53(6):735-43
references.pmid: 24345277
references.citation: Am J Prev Med. 2014 Jan;46(1):71-9
references.pmid: 24355674
references.citation: Diabetes Care. 2009 Dec;32(12):2187-92
references.pmid: 19729528
references.citation: Public Health Rep. 1996 May-Jun;111(3):236-41
references.pmid: 8643814
references.citation: Am J Respir Crit Care Med. 2002 Mar 1;165(5):704-7
references.pmid: 11874818
references.citation: BMJ Open. 2014;4(4):e003932
references.pmid: 24699459
references.citation: Eur J Public Health. 2013 Feb;23(1):116-22
references.pmid: 22227027
references.citation: Respirology. 2004 Nov;9(4):466-73
references.pmid: 15612957
references.citation: Arch Phys Med Rehabil. 1990 Apr;71(5):285-90
references.pmid: 2327878
references.citation: Occup Environ Med. 2001 Apr;58(4):246-52
references.pmid: 11245741
references.citation: Clin Transl Oncol. 2008 Dec;10(12):826-30
references.pmid: 19068455
references.citation: Breast Cancer Res Treat. 2009 Aug;116(3):609-16
references.pmid: 18855135
references.citation: J Cancer Surviv. 2012 Sep;6(3):345-56
references.pmid: 22457217
references.citation: J Occup Health. 2009;51(3):267-72
references.pmid: 19305117
references.citation: J Cancer Surviv. 2008 Sep;2(3):149-58
references.pmid: 18792789
references.citation: PLoS One. 2011;6(3):e18040
references.pmid: 21479209
references.citation: Eur J Cancer. 2007 Mar;43(5):914-20
references.pmid: 17314041
references.citation: Am J Kidney Dis. 2012 May;59(5):700-6
references.pmid: 21958597
references.citation: Psychooncology. 2006 Aug;15(8):739-47
references.pmid: 16374893
references.citation: Psychooncology. 2008 Jan;17(1):91-7
references.pmid: 17429835
references.citation: J Clin Oncol. 2006 Jan 20;24(3):345-53
references.pmid: 16421415
references.citation: Eur J Cancer. 2009 Mar;45(4):625-33
references.pmid: 19036577
references.citation: Stroke. 1999 Dec;30(12):2568-73
references.pmid: 10582979
references.citation: Eur J Cancer Care (Engl). 2012 Sep;21(5):634-41
references.pmid: 22320237
references.citation: J Occup Rehabil. 2010 Mar;20(1):49-58
references.pmid: 19902340
references.citation: Popul Health Manag. 2014 Apr;17(2):112-20
references.pmid: 24152055
references.citation: Popul Health Manag. 2011 Oct;14(5):223-30
references.pmid: 21506731
references.citation: Support Care Cancer. 2013 Jul;21(7):1901-9
references.pmid: 23417517
references.citation: BMJ Open. 2013 Feb 26;3(2):null
references.pmid: 23444446
references.citation: Eur J Cardiovasc Prev Rehabil. 2008 Apr;15(2):230-3
references.pmid: 18391653
references.citation: BMC Public Health. 2009;9:42
references.pmid: 19183440
references.citation: J Occup Environ Med. 2003 Dec;45(12):1303-11
references.pmid: 14665817
references.citation: Am J Kidney Dis. 2002 Dec;40(6):1132-7
references.pmid: 12460030
references.citation: Psychooncology. 2009 Jul;18(7):691-9
references.pmid: 19021127
references.citation: COPD. 2014 Jun;11(3):237-46
references.pmid: 24354969
references.citation: Chest. 2001 Feb;119(2):344-52
references.pmid: 11171708
references.citation: Gesundheitswesen. 2013 Jul;75(7):413-23
references.pmid: 23553190
references.citation: Stroke. 1984 Nov-Dec;15(6):1039-44
references.pmid: 6506115
references.citation: Stroke. 2011 Jun;42(6):1515-21
references.pmid: 21493909
references.citation: Womens Health Issues. 2005 May-Jun;15(3):97-108
references.pmid: 15894195
references.citation: BMJ Open. 2014;4(1):e004069
references.pmid: 24394800
references.citation: Aust N Z J Public Health. 2013 Jun;37(3):218-25
references.pmid: 23731103
references.citation: Pharmacoeconomics. 2003;21(15):1123-34
references.pmid: 14596631
references.citation: Disabil Rehabil. 2009;31(18):1487-93
references.pmid: 19479493
references.citation: J Health Econ. 2005 Jan;24(1):137-60
references.pmid: 15617792
references.citation: Diabetes Care. 1999 Jul;22(7):1105-9
references.pmid: 10388975
references.citation: Occup Med (Lond). 2008 Oct;58(7):509-11
references.pmid: 18667388
references.citation: Med Clin (Barc). 2015 Apr 20;144(8):353-9
references.pmid: 24863563
references.citation: Crit Rev Oncol Hematol. 2011 Feb;77(2):109-30
references.pmid: 20117019
references.citation: J Natl Cancer Inst. 2004 Sep 1;96(17):1322-30
references.pmid: 15339970
references.citation: Stroke. 1988 Sep;19(9):1101-7
references.pmid: 3413807
references.citation: Gynecol Oncol. 2007 May;105(2):335-40
references.pmid: 17258801
references.citation: Int Arch Occup Environ Health. 2009 Mar;82(4):543-6
references.pmid: 18795317
references.citation: Cerebrovasc Dis. 1998 Sep-Oct;8(5):296-302
references.pmid: 9712928
references.citation: J Natl Cancer Inst. 2004 Dec 15;96(24):1813-22
references.pmid: 15601637
references.citation: J Occup Environ Med. 2007 Jan;49(1):22-30
references.pmid: 17215710
references.citation: Chest. 2002 Dec;122(6):1994-2002
references.pmid: 12475838
references.citation: S Afr Med J. 2007 Aug;97(8 Pt 2):700-6
references.pmid: 17952227
references.citation: J Occup Environ Med. 2004 Jul;46(7):737-45
references.pmid: 15247814
references.citation: Psychooncology. 2010 Feb;19(2):115-24
references.pmid: 19507264
references.citation: Stroke. 1994 Jul;25(7):1360-5
references.pmid: 8023350
references.citation: J Clin Oncol. 2010 Apr 1;28(10):1700-5
references.pmid: 20194860
references.citation: Arch Phys Med Rehabil. 2000 Feb;81(2):205-9
references.pmid: 10668776
references.citation: Int J Occup Environ Health. 2006 Jan-Mar;12(1):28-34
references.pmid: 16523980
references.citation: Psychooncology. 2001 May-Jun;10(3):259-63
references.pmid: 11351378
references.citation: J Clin Epidemiol. 2002 Mar;55(3):260-8
references.pmid: 11864797
references.citation: Diabet Med. 1989 Dec;6(9):797-803
references.pmid: 2533040
references.citation: Eur J Cancer Care (Engl). 2013 Mar;22(2):144-60
references.pmid: 23279195
references.citation: Eur J Cardiovasc Prev Rehabil. 2009 Jun;16(3):387-91
references.pmid: 19318953
references.citation: Psychooncology. 2002 May-Jun;11(3):188-98
references.pmid: 12112479
references.citation: Health Econ. 2002 Jul;11(5):403-13
references.pmid: 12112490
references.citation: CA Cancer J Clin. 2011 Jul-Aug;61(4):212-36
references.pmid: 21685461
references.citation: J Natl Cancer Inst. 2008 Mar 5;100(5):321-32
references.pmid: 18314472
references.citation: Appl Health Econ Health Policy. 2010;8(3):179-89
references.pmid: 20408602
references.citation: J Occup Environ Med. 2001 Mar;43(3):218-25
references.pmid: 11285869
references.citation: BMC Public Health. 2008;8:394
references.pmid: 19036167
references.citation: J Rehabil Med. 2010 Mar;42(3):254-8
references.pmid: 20411221
references.citation: Occup Ther Int. 2008;15(2):87-99
references.pmid: 18322914
references.citation: Pharmacotherapy. 2004 Nov;24(11):1515-23
references.pmid: 15537556
references.citation: Stroke. 1993 Oct;24(10):1478-83
references.pmid: 8378950
references.citation: PLoS One. 2014;9(1):e86758
references.pmid: 24497976
references.citation: Disabil Rehabil. 2013 Mar;35(6):455-9
references.pmid: 22762207
references.citation: Int Arch Occup Environ Health. 2006 Oct;80(1):78-86
references.pmid: 16604365
references.citation: Eur J Cancer. 2003 Jul;39(11):1562-7
references.pmid: 12855263
references.citation: J Occup Environ Med. 2014 Aug;56(8):848-51
references.pmid: 25099411
references.citation: Popul Health Manag. 2009 Apr;12(2):103-10
references.pmid: 19361253
references.citation: Psychooncology. 2007 Mar;16(3):205-13
references.pmid: 16894641
references.citation: BMC Public Health. 2011;11:646
references.pmid: 21838919