Abstract
Cardiovascular disease (CVD) can affect work productivity in the working populations. Despite this, there is scarcity of longitudinal studies addressing the cardiovascular health burden among school teachers in Malaysia. This study aimed to determine the incidence rate of CVD, identify predictors, assess the effect of incident CVD and monetary loss on workplace productivity among school teachers in Peninsular Malaysia. Baseline data (sociodemographic characteristics, six lifestyle factors and clinical factors) were obtained from a cohort of school teachers without pre-existing CVD. In Phase One, three computerised registries - National CVD-Acute Coronary Syndrome (ACS) Database, National Stroke Registry and National Hospital Admission Database were accessed to confirm incident CVD cases among teachers. Cumulative incidence and crude incidence rates were calculated. Adjusted hazard ratios (aHR) with 95% confidence interval (CI) were estimated using multivariable Cox regression model to identify predictors of incident CVD. In Phase Two, a nested case-control design (1: 4 ratio) was employed. Short version of the Malay-validated World Health Organization-Health and Work Performance Questionnaire (WHO-HPQ) was used to estimate the workplace productivity effect among teachers with incident CVD (cases) before 31st December 2021. Similar questionnaire was distributed to teachers of a single state in Peninsular Malaysia without incident CVD (controls). Absenteeism, presenteeism and annual monetary loss were computed based on the scoring rules in WHO-HPQ. Analysis of covariance was performed with covariate adjustment using propensity score. Bootstrapping method was applied to better estimate marginal mean differences (with
standard errors and appropriate effect sizes). A total of 14,046 eligible school teachers were followed up. There were 209 incident cases (195.7 CVD cases per 100,000 person-years) over a median follow-up of 7.71 years. The incidence rate for males was higher than that for females, with 538.8 versus 117.3 cases per 100,000 person-years, respectively. Being married (aHR = 0.50, 95% CI: 0.26, 0.96) was associated with a lower risk of CVD. Being male (aHR = 3.05, 95% CI: 2.07, 4.49), aged . 50 years old (aHR = 3.94, 95% CI: 1.45, 10.74), Malay (aHR = 2.32, 95% CI: 1.04, 5.19), Indian or others (aHR = 3.22, 95% CI: 1.25, 8.27), having laboratory-confirmed diabetes mellitus (aHR = 2.67, 95% CI: 1.70, 4.21), self-reported hypertension (aHR = 2.42, 95% CI: 1.60, 3.67), high low-density lipoprotein cholesterol (aHR = 3.53, 95% CI: 1.98, 6.31) or high triglyceride (aHR = 2.01, 95% CI: 1.38, 2.93) were predictors for incident CVD among these school teachers. Marginal mean scores of absolute presenteeism among 48 cases (76.30) were lower (p = 0.001, eta squared = 0.075) than 192 controls (85.97). Marginal mean annual cost of presenteeism (MYR 21,237.52) was higher (p = 0.001, eta squared = 0.082) in cases, as opposed to controls (MYR 12,089.74). In conclusion, incidence rate of CVD was relatively high, especially among male school teachers in Peninsular Malaysia. Targeted screening at-risk teachers for modifiable predictors such as diabetes mellitus, hypertension or dyslipidemia and implementing supportive work strategies in school settings may be useful in increasing absolute presenteeism or decreasing its annual cost associated with incident CVD.
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@phdthesis{drph-Yap-Jun-Fai-2024,
title = {A Cohort Study of Cardiovascular Disease Incidence, Its Predictors, Effects on Workplace Productivity and Monetary Loss Among School Teachers in Peninsular Malaysia},
author = {Yap Jun Fai},
year = {2024},
date = {2024-09-30},
urldate = {2024-09-30},
abstract = {Cardiovascular disease (CVD) can affect work productivity in the working populations. Despite this, there is scarcity of longitudinal studies addressing the cardiovascular health burden among school teachers in Malaysia. This study aimed to determine the incidence rate of CVD, identify predictors, assess the effect of incident CVD and monetary loss on workplace productivity among school teachers in Peninsular Malaysia. Baseline data (sociodemographic characteristics, six lifestyle factors and clinical factors) were obtained from a cohort of school teachers without pre-existing CVD. In Phase One, three computerised registries - National CVD-Acute Coronary Syndrome (ACS) Database, National Stroke Registry and National Hospital Admission Database were accessed to confirm incident CVD cases among teachers. Cumulative incidence and crude incidence rates were calculated. Adjusted hazard ratios (aHR) with 95% confidence interval (CI) were estimated using multivariable Cox regression model to identify predictors of incident CVD. In Phase Two, a nested case-control design (1: 4 ratio) was employed. Short version of the Malay-validated World Health Organization-Health and Work Performance Questionnaire (WHO-HPQ) was used to estimate the workplace productivity effect among teachers with incident CVD (cases) before 31st December 2021. Similar questionnaire was distributed to teachers of a single state in Peninsular Malaysia without incident CVD (controls). Absenteeism, presenteeism and annual monetary loss were computed based on the scoring rules in WHO-HPQ. Analysis of covariance was performed with covariate adjustment using propensity score. Bootstrapping method was applied to better estimate marginal mean differences (with
standard errors and appropriate effect sizes). A total of 14,046 eligible school teachers were followed up. There were 209 incident cases (195.7 CVD cases per 100,000 person-years) over a median follow-up of 7.71 years. The incidence rate for males was higher than that for females, with 538.8 versus 117.3 cases per 100,000 person-years, respectively. Being married (aHR = 0.50, 95% CI: 0.26, 0.96) was associated with a lower risk of CVD. Being male (aHR = 3.05, 95% CI: 2.07, 4.49), aged . 50 years old (aHR = 3.94, 95% CI: 1.45, 10.74), Malay (aHR = 2.32, 95% CI: 1.04, 5.19), Indian or others (aHR = 3.22, 95% CI: 1.25, 8.27), having laboratory-confirmed diabetes mellitus (aHR = 2.67, 95% CI: 1.70, 4.21), self-reported hypertension (aHR = 2.42, 95% CI: 1.60, 3.67), high low-density lipoprotein cholesterol (aHR = 3.53, 95% CI: 1.98, 6.31) or high triglyceride (aHR = 2.01, 95% CI: 1.38, 2.93) were predictors for incident CVD among these school teachers. Marginal mean scores of absolute presenteeism among 48 cases (76.30) were lower (p = 0.001, eta squared = 0.075) than 192 controls (85.97). Marginal mean annual cost of presenteeism (MYR 21,237.52) was higher (p = 0.001, eta squared = 0.082) in cases, as opposed to controls (MYR 12,089.74). In conclusion, incidence rate of CVD was relatively high, especially among male school teachers in Peninsular Malaysia. Targeted screening at-risk teachers for modifiable predictors such as diabetes mellitus, hypertension or dyslipidemia and implementing supportive work strategies in school settings may be useful in increasing absolute presenteeism or decreasing its annual cost associated with incident CVD.},
keywords = {},
pubstate = {published},
tppubtype = {phdthesis}
}
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