White Coat, Black Art·DR. BRIAN'S BLOG

A heart attack affects more than your health

Dr. Brian Goldman assesses the economic fallout when a heart attack or stroke happens during your peak earning years.
Unemployment and lost earnings after a heart attack can have consequences for patients, families and governments.

The Public Health Agency of Canada says a third of all heart attacks and a quarter of strokes happen to Canadians in mid-career. A study published in the Canadian Medical Association Journal tallies the economic fallout. The financial cost of a heart attack or stroke can be huge. 

Researchers from the Universities of Manitoba, Toronto, Michigan, the Massachusetts Institute of Technology and Statistics Canada looked at a database that linked hospitalization and income tax records in the years 2005 to 2013. The researchers looked at more than 24, 000 people ages 40 to 61 who had a heart attack, cardiac arrest or stroke. To be included in the study, participants had to have worked in the two years prior to being hospitalized. They were compared to healthy people of the same age.

For those who had a heart attack, the annual loss of income was $3,834 in 2012 Canadian dollars. For those who survived a witnessed cardiac arrest, the financial hit was $11,143. The biggest financial loss came to people who had a stroke. For them, the hit was $13,278.

Those figures correspond to a loss of income that ranged between eight and 31 per cent.

The researchers identified several factors that led to the loss of income. Not surprisingly, the big factor was loss of employment. At the three-year mark, the employment rate for those who had a heart attack dropped by five per cent. For those who survived cardiac arrest, the fall-off was nearly 13 per cent, and for those who had a stroke, it was just under 20 per cent.

Those who continued to work saw their earnings drop five to 20 per cent following the onset of heart disease. 

There were other contributing factors. The loss of income was greatest for patients who had lower income to begin with. The longer the hospital stay, the greater the loss of employment and the loss of income. Having other illnesses such as chronic kidney disease and chronic obstructive pulmonary disease also increased the amount of lost earnings.

Other studies have shown similar results, but the authors say this is the largest controlled study of its kind.

The findings were not entirely unexpected, but there were some surprises. To me, the biggest one came from the factors that turned out to have no impact on income following a heart attack or stroke. I expected that women would lose more income than men, but women and men lost income equally. I also expected that being married would provide a hedge against income loss, but married patients suffered losses just as great as patients who were single, divorced or widowed.

Students at UQAM helped low-income Montrealers prepare their income tax returns. Tax credits could help address income disparities brought on by catastrophic illness. (Radio-Canada)

I also expected that employed patients would lose less income that those who were self-employed because I assumed that employment was more likely to come with short-term disability insurance. I was wrong there as well. 

Declare bankruptcy 

There are major consequences to the huge loss of income the researchers uncovered. Some families borrow money to keep afloat financially and end up declaring bankruptcy. The stress of precarious income can lead to anxiety and depression, both of which can have an adverse effect on blood pressure and heart health.

And it's not just the patient who is affected. So is the family. The loss of income forces healthy family members to pick up the slack. The income loss can also affect the career plans of the patient's children. And let's not forget that people ages 40 to 61 are in their peak earning years. This is the time when they tend pay off mortgages and sock away money for retirement. A serious illness can therefore derail retirement plans. 

The authors say more research is needed to help understand economic consequences of heart and stroke disease. Still, it's not hard to see what might be needed to help these patients. Those who have had a stroke experience the biggest drop in income. Clearly, that has something to do with the amount of disability caused by strokes. As we found out this season on White Coat, Black Art, in many rural and remote parts of Canada, stroke rehabilitation is slow and inadequate. That needs to be fixed.

I also think the federal government can use other means to address income disparities brought on by catastrophic illness. It can provide tax credits. It can also provide an income supplement to people who are unemployed or under-employed following a heart attack or stroke.

Some might say that's rewarding patients whose lifestyles increased the risk of heart disease. My view is that addressing income losses up front will help reduce the need for early access to government pension. It will also save the provinces and territories the cost of managing health problems made worse by loss of income. 

About the Author

Dr. Brian Goldman is a veteran ER physician and an award-winning medical reporter. As host of CBC Radio’s White Coat, Black Art, he uses his proven knack for making sense of medical bafflegab to show listeners what really goes on at hospitals and clinics. He is the author of The Night Shift and The Power of Kindness: Why Empathy is Essential in Everyday Life.

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