Potential impact of COVID-19 related unemployment on increased cardiovascular disease in a high-income country: Modeling health loss, cost and equity

  1. Nhung Nghiem
  2. Nick Wilson

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Abstract

Cardiovascular disease (CVD) is a leading cause of health loss and health sector economic burdens in high-income countries. Unemployment is associated with increased risk of CVD, and so there is concern that the economic downturn associated with the COVID-19 pandemic will increase the CVD burden.

Aims

This modeling study aimed to quantify potential health loss, health cost burden and health inequities among people with CVD due to additional unemployment caused by COVID-19 pandemic-related economic disruption in one high-income country: New Zealand (NZ).

Methods

We adapted an established and validated multi-state life-table model for CVD in the national NZ population. We modeled indirect effects (ie, higher CVD incidence due to high unemployment rates) for various scenarios of pandemic-related unemployment projections from the NZ Treasury.

Results

We estimated the potential CVD-related heath loss in NZ to range from 23,300 to 36,900 health-adjusted life years (HALYs) for the different unemployment scenarios. Health inequities would be increased with the per capita health loss for Māori (Indigenous population) estimated to be 3.7 times greater than for non-Māori (49.9 vs 13.5 HALYs lost per 1000 people). The estimated additional health system costs ranged between (NZ$303 million [m] to 503m in 2019 values; or US$209m to 346m).

Conclusions and policy implications

Unemployment due to the COVID-19 pandemic could cause significant health loss, increase health inequities from CVD, and impose additional health system costs in this high-income country. Prevention measures should be considered by governments to reduce this risk, including additional job creation programs and measures directed towards the primary prevention of CVD.

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  1. Version published to 10.1371/journal.pone.0246053
  2. ScreenIT

    SciScore for 10.1101/2020.12.15.20248284: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Study limitations: We did not consider that all-cause mortality and CVD mortality can also change due to behavioral changes vs supply changes (tobacco, fast food, alcohol, and physical activity level) as a result of the COVID-19 pandemic restrictions. We assumed that the background trend in case fatality risk before the COVID-19 pandemic still held. While it is possible that there is an effect of recessions on poorer health care delivery care (that might increase case fatality risk in those with CVD), in the absence of data we assumed no such additional impact. Also if a recession lowers the affordability of tobacco and alcohol – then there might be non-linear social contagion impacts as whole cohorts of people reduce consumption of these products in social settings (eg, going out less to bars and restaurants). But we had inadequate data on such impacts to consider these in this research. If increased unemployment-induced poverty resulted in less affordable tobacco and less expenditure on junk food (generally more expensive than home-cooked food in NZ(39)),– then those factors would tend to reduce CVD. Finally, we ignored people aged 64+ who are in retirement age (although around 20% of this group are still in formal employment in NZ). d. Potential policy implications: This modeling work suggests that unemployment due to the COVID-19 pandemic is likely to cause significant health loss and health costs from CVD in NZ. Furthermore, this burden exacerbates the health inequities ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2020.12.15.20248284v1 on medRxiv