Association between morbidity of non-communicable disease and employment status: a comparison between Korea and the United States

Abstract

Background: Globally, the prevalence of chronic disease continues to rise and is likely to grow further over the coming decades due to population ageing. Since older age is associated closely with development of chronic disease, it stands to reason that demographic changes will increase the proportion of older workers with chronic disease. The aim of the present study was to determine how chronic diseases affect employment status in Korea and the USA.

Methods: The study was based on National Health and Nutrition Survey data (2007-2014) obtained by the Korean and American Centers for Disease Control and Prevention. A total of 44,693 subjects were categorized into two geographical groups: Korea (29,260 subjects) and the USA (15,433 subjects). A chi-square test was used to compare the groups in terms of socio-demographic factors, health-related factors, and chronic disease. Multivariate logistic regression analysis was conducted to determine the effect of five chronic diseases (hypertension, diabetes, dyslipidemia, cardiovascular disease, and cancer) on employment status.

Results: There were 29,260 Korean and 15,433 American respondents. Chronic disease increased the risk of unemployment in Korea markedly (Odds ratio [OR] range, 1.17-2.47). Cardiovascular disease and cancer had the most profound negative effect on Korean unemployment (OR = 2.47 and 2.03, respectively). The risk of unemployment was generally 2-3-fold lower in the USA (OR range, 0.5-1.04).

Conclusions: Chronic disease had a significant impact on economic activity in Korea, but a smaller impact in the USA. This difference may be related to different health insurance schemes and cultural approaches to people with diseases in the two countries. It is important to explore factors that limit economic participation by people with chronic diseases, and to identify social policies that will overcome these factors. Further between-country studies are needed to identify social solutions to the socio-economic burden of chronic illness.

Keywords: Chronic disease; Employment status; Korea; USA.

Fig. 1

Flowchart of the study population. A: Hypertension B: Diabetes C: Dyslipidemia D: Cardiovascular disease E: Cancer

Fig. 2

Association between chronic disease and unemployment status according to nationality. a: Hypertension b: Diabetes c: Dyslipidemia d: Cardiovascular disease e: Cancer

Fig. 3

Association between chronic disease and unemployment status in Americans. a: Hypertension b: Diabetes c: Dyslipidemia d: Cardiovascular disease e: Cancer

Fig. 4

Association between chronic disease and unemployment status of Koreans and Americans according to income level