title: The economic impact of early retirement attributed to rheumatic diseases: results from a nationwide population-based epidemiologic study.
abstract: OBJECTIVE
  To measure early retirement due to self-reported rheumatic diseases (RDs) and to estimate the respective indirect costs and years of working life lost (YWLL).
  
  
  METHODS
  We used individual level data from the national, cross-sectional, population-based EpiReumaPt study (September 2011-December 2013) where 10,661 inhabitants were randomly surveyed in order to capture and characterize all cases of RD within a representative sample of the Portuguese population. In this analysis, we used all participants aged between 50 and 64 years, near the official retirement age. A national database was used to calculate productivity values by gender, age and region, using the human capital approach. YWLL were estimated as the difference between each participant's current age and the respective retirement age, while the potential years of working life lost (PYWLL) were given by the difference between official and actual retirement ages. We also calculated the percentage of time in inactivity (inactivity ratio = YWLL/Active age-range [15-64 years old]).
  
  
  RESULTS
  29.9% of the Portuguese population with ages between 50 and 64 years were retired with 13.1% self-reporting retirement due to RD. The estimated annual indirect cost following premature retirement attributed to RD was €910 million (€555 per capita; €1625 per self-reported RD patient and €13,592 per early retiree due to RD). Females contributed with 84% for these costs (€766 million; €882 per capita vs €187 from males). We observed a total number of 389,939 accumulated YWLL (228 per 1000 inhabitants) and 684,960 PYWLL (401 per 1000 inhabitants). The mean YWLL and PYWLL inactivity ratios were 12% and 21%, respectively. RD patients with higher values of disability have the highest risk of early retirement.
  
  
  CONCLUSIONS
  Early retirement attributed to self-reported RD amounts to approximately 0.5% of the national gross domestic product (GDP) in 2013, due to large YWLL. Both 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.affiliation: Faculdade de Medicina da Universidade de Lisboa, Lisbon Academic Medical Center, Lisbon, Portugal; Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Lisbon, Portugal; EpiReumaPt Study Group - Sociedade Portuguesa de Reumatologia, Lisbon, Portugal. Electronic address: laires.pedro@gmail.com.
authors.forename: P A
authors.initials: PA
authors.lastname: Laires
authors.affiliation: Catolica Lisbon School of Business and Economics, Lisbon, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Gouveia
authors.affiliation: EpiReumaPt Study Group - Sociedade Portuguesa de Reumatologia, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Lisboa, Portugal.
authors.forename: H
authors.initials: H
authors.lastname: Canhão
authors.affiliation: EpiReumaPt Study Group - Sociedade Portuguesa de Reumatologia, Lisbon, Portugal; Chronic Diseases Research Center (CEDOC), NOVA Medical School, Universidade Nova de Lisboa (NMS/UNL), Lisboa, Portugal; Rheumatology Department, Hospital Egas Moniz - Centro Hospitalar Lisboa Ocidental (CHLO-E.P.E.), Lisbon, Portugal.
authors.forename: J C
authors.initials: JC
authors.lastname: Branco
mesh_terms: D017281:Cost of Illness; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011174:Portugal; D012179:Retirement / Q000191:economics* / Q000706:statistics & numerical data*; D012216:Rheumatic Diseases / Q000191:economics*; D012306:Risk; D057566:Self Report; D013997:Time Factors
keywords: Early retirement; Epidemiologic study; Exit from paid work; Population-based survey; Rheumatic diseases; Work disability; Years of working life lost