Global Cardiovascular Disease: An Expanding Burden with Expanding Solutions
Economic effects
The rise of cardiovascular disease has had impacts that range beyond the health burden to also create a large economic challenge for developing countries. Deaths from cardiovascular disease in these countries tend to occur one to two decades earlier than in Western Hemisphere countries with half of cardiovascular deaths in the developing world occurring before age 70.[10] In these low- and middle-income countries, the fact that cardiovascular disease occurs in younger people of working age affects the number of people in the workforce and reduces economic growth.
Table 2.2
Effect of Expected Changes in Chronic Disease Mortality Rates on Economic Growth, 2002-2030
Source: Adapted from Stuckler D, Population causes and consequences of leading chronic diseases: a
comparative analysis of prevailing explanations. The Milbank Quarterly. 2008;86:273-326.
Mortality from cardiovascular disease among working-age people in Brazil, India, and South Africa are 1.5 to 2 times higher than in the United States.[11] The regions most affected by these early deaths are those regions that are most in need of a young, vibrant workforce to energize their economies. Countries that already are plagued by poverty will not be able to cope with the economic impact of losing a large fraction of their workforce to cardiovascular disease. Several reports suggest direct associations between the rate of rise in chronic diseases and the rate of decline in economic growth (see table 2.2).[12]
Added to the lost productivity, developing countries must provide long-term and expensive medical care in treating these chronic diseases, requiring resources, both human and financial, that many do not have. Even in the United States, health care spending and lost productivity from cardiovascular disease exceeded $400 billion in 2006, while in a country such as South Africa, 2 to 3 percent of the country’s gross national income was devoted to the treatment of cardiovascular disease.[13, 14]
Thus, the rise in cardiovascular disease will generate a growing financial burden on not only the developed nations, but also developing countries, thus straining already limited resources.
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Helina Kassahun, MD, and William B. Borden, MD, MBA
Helina Kassahun, MD, is a clinical cardiology fellow at New York-Presbyterian Hospital in New York City.
William B. Borden, MD, MBA, is an assistant professor of medicine and public health at the Weill Cornell Medical College in New York City and the Nanette Laitman Clinical Scholar in the department of public health. He is a practicing preventive cardiologist and health policy researcher. His current areas of research interest are in the real-world implementation of appropriate medical therapy prior to coronary interventions and in the socioeconomic equity of proposed hospital value-based purchasing programs.
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REFERENCES
- Kleinfield N. Modern ways opens India’s door to diabetes. New York Times. September 12, 2006.
- World Health Organization. International cardiovascular disease statistics: statistical fact sheet for populations, 2008 update.
- Rosamond W, Flegal K, Furie K, et al. Heart disease and stroke statistics, 2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics. Circulation. 2008;117:e25-146.
- Stewart L, McInnes G, Murray L, et al. Risks of socioeconomic deprivation on mortality in hypertensive patients. J Hypertens. 2009;27:730-735.
- Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular diseases. Circulation. 2001;104:2746-2753.
- Omran A. The epidemiologic transition: a theory of the epidemiology of population change. Milbank Memorial Fund Q. 1971;49:509-538.
- Yusuf S, Hawken S, Ounpuu S. Effect of potentially modifiable risk factors associated with myocardial infarction in fifty-two countries: the INTERHEART Study case-control study. Lancet. 2004;364:937-952.
- Greenberg H, Raymond S, Leeder S. Global health assistance for chronic illness: a look at the practical. Prog in Cardiovasc Dis. 2008;51:89-96.