Living with cardiovascular disease (CVD) in Australia: Using large-scale linked data to investigate workforce participation and social interaction in relation to CVD diagnosis

Abstract

Cardiovascular disease (CVD) is a leading cause of global mortality and a major contributor to disability. The number of people living with CVD in Australia is expected to increase due to an aging population and improved treatment leading to higher survival. Evidence on longer-term health care outcomes that matter to individuals living with CVD, including disability and social and economic participation (person-centred outcomes), is critical to provide appropriate support to these individuals and inform effective policy and practice. In particular, the ability to participate in the workforce and to have meaningful social interaction are important person-centred outcomes that may be adversely affected by CVD. Yet we lack critical information on these outcomes. The purpose of this thesis was to gain a better understanding of the relationship between CVD and both workforce participation and social interaction in middle-age and older people in Australia. The thesis consists of two systematic reviews, which summarises important gaps in the evidence, and four empirical studies to address these gaps. Using PubMed, Scopus, and Web of Science until December 2019, I found twenty-seven articles on the relationship of CVD to workforce participation and six on CVD and social interaction. Available evidence was largely descriptive, small-scale, and lacking a suitable comparison group. There was limited information on variation in outcomes according to CVD subtype, and by population characteristics. In particular, the role of physical disability in workforce participation and social interaction amongst people with CVD has not been examined. For the empirical studies, I used data from the 45 and Up Study, a cohort study of 267,153 participants from New South Wales, Australia, with two waves of questionnaire data linked to hospitalisation and death data. I undertook two cross-sectional analyses, to quantify workforce participation and social interaction in people with existing versus no CVD. To better understand the likely causal role of CVD, I conducted two longitudinal analyses, examining exit from the workforce, and becoming socially isolated after incident CVD in comparison to people without CVD. Regression models were adjusted for sociodemographic characteristics, and comorbidity where applicable. Results showed that most people aged 45-64 years old with CVD were in the workforce, but workforce non-participation was 36% higher compared to those without CVD. People with incident CVD versus those without had a 28% higher risk of leaving the workforce. People with CVD had slightly lower levels of social interaction compared to those without CVD. However, the risk of becoming socially isolated in people with incident CVD were similar to those seen in people without CVD. The relationship of CVD to workforce participation and social interaction varied by CVD subtype and population characteristics in both cross-sectional and longitudinal results. Generally, workforce participation and social interaction outcomes were poorer for those with cerebrovascular disease or heart failure compared to other types of CVD. Workforce participation and social interaction were much more strongly related to physical disability than to CVD diagnosis itself, with poorer outcomes observed in people with severe disability regardless of CVD diagnosis. I also examined loss to follow-up, a common problem in longitudinal studies, and found no evidence that it materially affected the findings. This thesis enriches current understanding of the consequences of CVD on important person-centred outcomes; the evidence on variation by CVD subtype and the role of physical disability are key novel contributions. The evidence generated can inform people with CVD and those caring for them, as well as policies that aim to improve quality of life by those living with CVD.