title: Cardiovascular Disease and Health Care System Impact on Functionality and Productivity in Argentina: A Secondary Analysis.
abstract: OBJECTIVE
  To examine the impact of cardiovascular disease (CVD) events on patient functionality and productivity on the basis of patient use of public or social/private institution health care.
  
  
  METHODS
  A secondary analysis was conducted of data drawn from records of Argentinian patients, 3 to 15 months posthospitalization after a CVD event, who had originally participated in a multicountry, cross-sectional study assessing the microeconomic impact of a CVD event. Respondents were stratified according to their use of health care institution (public or social/private). Among these groups, pre- and post-CVD event changes in functionality and productivity were compared.
  
  
  RESULTS
  Participants' (N = 431) mean age was 56.5 years, and 73.5% were men. Public sector patients reported significantly higher rates of decline in ability to perform moderate activities (P < 0.05), a greater decrease in time spent at work (P < 0.01), a greater limit in the type of work-related activities (P < 0.01), and a higher rate of emotional problems (P < 0.01). Having health insurance (private or social) (odds ratio [OR] = 0.55; 95% confidence interval [CI] 0.35-0.85; P < 0.01) and a higher income (OR = 0.99; 95% CI 0.99-0.99; P < 0.01) were inversely and significantly associated with loss of productivity. Cerebrovascular disease (OR = 2.55; 95% CI 1.42-4.60; P < 0.01) was also significantly associated with productivity loss.
  
  
  CONCLUSIONS
  In Argentina, patients receiving care in the public sector experienced a greater impact on functionality and productivity after their hospitalization for a CVD event. Lack of insurance, low income, and cerebrovascular disease event were the major determinants of productivity loss. Further investigation is needed to better understand contributors to these differences.
authors.affiliation: Institute of Clinical Effectiveness and Health Policy, Buenos Aires, Argentina; Fogarty International Clinical Research Scholars Program, Bethesda, MD, USA. Electronic address: calcagnoji@gmail.com.
authors.forename: Juan I
authors.initials: JI
authors.lastname: Calcagno
authors.affiliation: Institute of Clinical Effectiveness and Health Policy, Buenos Aires, Argentina; Fogarty International Clinical Research Scholars Program, Bethesda, MD, USA; Columbia University, New York, NY, USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Iribarren
authors.affiliation: Institute of Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
authors.forename: Joaquín E
authors.initials: JE
authors.lastname: Caporale
authors.affiliation: Loyola University, New Orleans, LA, USA.
authors.forename: Patricia F
authors.initials: PF
authors.lastname: Pearce
authors.affiliation: Centre for Chronic Disease Control, New Delhi, India.
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
authors.affiliation: Institute of Clinical Effectiveness and Health Policy, Buenos Aires, Argentina.
authors.forename: Andrés
authors.initials: A
authors.lastname: Pichón-Riviere
mesh_terms: D001118:Argentina; D002318:Cardiovascular Diseases / Q000150:complications / Q000191:economics / Q000628:therapy; D003430:Cross-Sectional Studies; D004526:Efficiency; D004651:Employment; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged
keywords: cardiovascular disease; epidemiology; functionality; productivity