Economic burden of cancer and cardiovascular disease mortality among working-age Europeans: A lifecycle modelling study

This lifecycle modelling study estimates that premature cancer and cardiovascular disease mortality among working-age Europeans cost €195.7 billion (1.24% of GDP) in 2021, with cancer accounting for the majority of losses overall while cardiovascular disease costs were higher in Central and Eastern Europe and exhibited a larger gender gap.

The Gist

Imagine Europe's economy as a massive, bustling construction site. The workers are the people aged 15 to 74, and the "bricks" they lay every day are their work, ideas, and productivity. This paper is essentially a damage report from a storm that hit that construction site. The storm wasn't wind or rain, but two silent killers: Cancer and Heart Disease (Cardiovascular Disease, or CVD).

Here is the story of the damage, told in simple terms with some analogies to help you visualize it.

1. The Big Picture: A Hole in the Wallet

The researchers calculated exactly how much money Europe lost in 2021 because people died too young from these two diseases.

• The Number: They lost €195.7 billion.
• The Analogy: Imagine the entire European economy is a giant piggy bank. This disease "storm" knocked a hole in it, causing €1.24% of the money to fall out before it could be used to build the future. That's a lot of missing bricks.

2. The Two Villains: Cancer vs. Heart Disease

For a long time, people thought Heart Disease was the bigger bad guy. But when you look at the money lost from people dying while they were still working, the story changes.

• Cancer is the "Younger" Villain: Cancer tends to strike people when they are in their prime working years. It's like a thief stealing a worker right when they are about to become a master builder. Because these workers have many years of high wages left, the cost is huge.
  • Result: Cancer caused 62.5% of the total money lost.
• Heart Disease is the "Older" Villain: Heart disease often hits people later in life, closer to retirement. It's like a thief stealing a worker who was already packing their bags to leave the site. There are fewer "future years" of wages to lose.
  • Result: Heart Disease caused 37.5% of the money lost.

However, there is a twist: In Central and Eastern Europe (countries like Poland, Hungary, Romania), Heart Disease is still the bigger money-killer. In the rest of Europe (West, North, South), Cancer is the bigger money-killer.

3. The "What If" Calculation: The Lifecycle Model

How did they get these numbers? They didn't just count the salary of the person who died that year. They used a Time-Travel Calculator.

• The Old Way: "This person died at 50. They earned €40,000 that year. That's the loss."
• This Paper's Way: "This person died at 50. If they had lived, they would have worked for another 24 years. Their salary would have gone up every year as they got more experienced. We need to count all that future money they would have earned."

They also adjusted for the fact that people are working longer now. Instead of stopping the clock at age 65 (the old retirement age), they counted up to 74, because many people are still working hard past 65.

4. The Gender Gap: The "Double Whammy" for Men

The paper found a significant gap between men and women.

• The Ratio: For every €1 of productivity lost by a woman, about €2.5 was lost by a man due to heart disease. For cancer, it was about €1.6.
• Why? Two reasons:
  1. More men die from these diseases.
  2. Men generally earn more and are more likely to be in the workforce.
• The Analogy: Imagine a factory where the men are the heavy-lifters earning the highest wages, and the women are also working but often in different roles or earning less. If the heavy-lifters get sick and leave early, the financial hole is much deeper.

5. The Regional Map: A Tale of Two Europes

The damage isn't spread evenly.

• Central & Eastern Europe: Here, Heart Disease is the main money-drainer. It's like a leak in the foundation of the building.
• Western, Northern, & Southern Europe: Here, Cancer is the main money-drainer. It's like a leak in the roof, taking out the most valuable assets (the experienced workers).
• The GDP Hit: In some countries (like Bulgaria), the cost of these deaths is nearly 2.4% of the country's entire yearly income. That's a massive chunk of the budget gone just because people died too soon.

6. Why This Matters (The "So What?")

The authors are saying: "Stop thinking of this just as a health tragedy; it's also an economic disaster."

• Prevention is an Investment: If we stop smoking, eat better, and control blood pressure, we aren't just saving lives; we are plugging the holes in the piggy bank.
• The Future is Aging: Europe's population is getting older. There are fewer young workers to replace the ones who leave. If we lose more workers to these diseases, the economy will shrink even faster.
• The Bottom Line: Investing in preventing these diseases isn't just "nice to have" for health reasons; it's a smart financial move to keep the European economy growing.

In short: Cancer and Heart Disease are stealing billions of euros from Europe's future every year. By understanding exactly how much money is lost, governments can make smarter decisions to stop the bleeding and keep the economy strong.

Technical Summary

1. Problem Statement

Non-communicable diseases (NCDs), specifically cardiovascular disease (CVD) and cancer, account for approximately 90% of deaths in Europe. While the health burden of these diseases is well-documented, there is a significant lack of comparative, multinational estimates regarding their productivity costs (indirect economic losses) across different European regions, diseases, and sexes.

Existing literature often focuses on a single disease or a single country, fails to account for the extended working lives of older populations (beyond the traditional retirement age of 65), and frequently neglects the impact of lifetime wage progression. Given Europe's aging workforce and stagnating economic growth, precise estimates of the human capital lost due to premature NCD mortality are critical for informing policy, resource allocation, and evaluating the economic potential of meeting Sustainable Development Goal (SDG) target 3.4 (reducing premature NCD mortality by one-third by 2030).

2. Methodology

The study employed a Human Capital Approach using a lifecycle simulation model to estimate productivity losses for 30 European countries (27 EU members plus Norway, Switzerland, and Iceland) for the year 2021.

• Data Sources:
  • Mortality Data: Sex- and age-specific (10-year bands from 15–24 to 65–74) death counts for cancer (ICD-10: C00–C97) and CVD (ICD-10: I00–I99) from the WHO Mortality Database.
  • Economic Data: Wages, unemployment rates, and labor force participation rates from Eurostat (Structure of Earnings Survey 2018 and European Labour Force Survey 2021). Data were adjusted to 2021 prices.
• Key Modeling Innovations:
  • Extended Age Cutoff: The study defined the working-age population as 15–74 years, acknowledging that 3–22% of the European workforce remains active beyond age 65.
  • Lifecycle Wage Progression: Unlike traditional models that use static wages, this model incorporated future wage progression. It simulated the hypothetical career trajectory of deceased individuals, accounting for age-related wage increases and experience had they not died prematurely.
  • Discounting: Future costs were discounted at 3.5% per annum.
  • Calculation: Productivity costs were calculated by multiplying Years of Potential Productive Life Lost (YPPLL) by country-, sex-, and age-specific wages, adjusted for labor market participation and unemployment.
• Sensitivity Analysis: The study tested robustness using gender-neutral wages, a 65-year age cutoff, Purchasing Power Parity (PPP) adjustments, and discount rates of 0% and 6%.

3. Key Contributions

• First Comparative Multinational Study: This is the first study to directly compare the productivity costs of cancer and CVD across 30 European countries using a standardized methodology.
• Refined Human Capital Modeling: By extending the retirement age to 74 and incorporating dynamic wage progression, the study provides a more realistic and higher-fidelity estimate of economic loss than previous static models.
• Regional and Gender Granularity: The analysis provides a detailed breakdown of costs by region (Western, Northern, Southern, Central-Eastern), country, sex, and age group, revealing distinct patterns often masked in aggregate data.

4. Key Results

Overall Economic Burden:

• Total productivity losses from cancer and CVD mortality in the working-age population were estimated at €195.7 billion in 2021, equivalent to 1.24% of European GDP.
• Cancer accounted for the majority of the burden: €122.2 billion (62.5%).
• CVD accounted for: €73.5 billion (37.5%).

Regional Disparities:

• Western, Northern, and Southern Europe: Cancer productivity costs significantly exceeded CVD costs (e.g., Cancer/CVD cost ratio of 1.74 in Western Europe and 2.04 in Southern Europe).
• Central-Eastern (C-E) Europe: This region was the exception where CVD costs exceeded cancer costs (Ratio: 0.93). C-E Europe also bore the highest relative burden as a percentage of GDP (1.5%).
• GDP Impact: The burden ranged from 0.4% of GDP in Luxembourg to 2.4% in Bulgaria.

Cost Per Death:

• Mean productivity cost per death was slightly higher for CVD (€219,848) than for Cancer (€217,744) across Europe.
• However, the highest absolute costs per death were found in wealthy nations with high wages (e.g., Switzerland, Iceland, Luxembourg), while the lowest were in Bulgaria.

Gender Inequality:

• Total Costs: Male productivity costs were significantly higher than female costs for both diseases.
  • Cancer: Male costs were 1.6 times female costs (€76.0B vs. €46.2B).
  • CVD: Male costs were 2.5 times female costs (€52.6B vs. €20.9B).
• Per Death: The gender gap narrowed when looking at cost per death but remained significant, particularly for CVD (Male/Female ratio of 1.7 for CVD vs. 1.2 for cancer). This disparity is driven by higher male mortality rates, higher male labor force participation, and higher male wages.

Age Distribution:

• The 50–64 age group contributed the most to the total cost (72.5% for cancer, 69.7% for CVD).
• The greatest divergence between cancer and CVD costs occurred in the 15–29 age group, where cancer costs were 1.9 times higher than CVD costs, reflecting the higher incidence of cancer at younger ages compared to CVD.

5. Significance and Implications

• Policy Prioritization: The findings challenge the traditional view that CVD is the dominant economic burden. In most of Europe, cancer is the larger driver of productivity loss among the working-age population, suggesting a need to rebalance prevention and treatment funding.
• Regional Inequality: The study highlights a "North-South" vs. "East-West" divide. While Western/Southern Europe faces a high cancer burden, Central-Eastern Europe faces a disproportionately high CVD burden relative to its GDP, likely due to risk factors (smoking, hypertension) and lower access to early detection.
• Economic Savings: The estimated €195.7 billion represents potential economic savings achievable through effective prevention and treatment strategies. Reducing premature mortality is not just a health goal but a critical economic imperative for sustaining Europe's growth and competitiveness.
• Methodological Shift: The study advocates for the adoption of lifecycle wage progression models and extended age cutoffs in future economic evaluations to avoid underestimating the true cost of NCDs.

In conclusion, this study provides a robust, standardized economic baseline demonstrating that premature NCD mortality imposes a massive, yet often overlooked, drag on the European economy, with distinct regional and gender-specific patterns that require targeted policy interventions.