美國心血管疾病與代謝症候群對於就業的影響

近年來，因心血管疾病及相關危險因素的上升，加上社會變遷人口老齡化的人口變化，心血管疾病的患病率會呈現持續增長的趨勢，除了社會必須負擔龐大的醫療費用支出，也對個人生產力可能造成嚴重的負面影響，而代謝症候群是觀察一個人是否屬於罹患心血管疾病高風險族群的強烈指標，因此對於代謝症候群、心血管疾病與就業進行研究分析是有其必要。有鑑於此，本文利用美國國家健康與營養調查(National Health and Nutrition Examination Survey) 2013-2014 的資料，按男女分組估計，研究對象為18~65歲的受訪者，按勞動力定義區分為四種，分析其心血管疾病對於美國就業是否存在顯著的負面影響以及探討代謝症候群如何影響心血管疾病，進而影響就業。考量到心血管疾病及代謝症候群的潛在內生性，使用帶有工具變數的Trivariate probit 模型來估計，而所使用的工具變數為近親的遺傳因素及疾病盛行率。　　實證結果顯示: 在就業定義Ⅰ、Ⅳ下的男性樣本中，心血管疾病對於就業有負向顯著影響，一旦罹患心血管疾病將使男性就業率與勞參率分別降低至41.23%與43.26%；但在女性樣本中，心血管疾病對於就業無顯著影響。同時，我們也發現，若患有代謝症候群會使男性和女性心血管疾病的患病率提高6.43%以及4.40%，而若能避免代謝症候群的發生，將可緩和男性1.07 百分點間接因心血管疾病而導致的失業率，但不管是男性與女性在代謝症候群對於心血管疾病是否存在明顯的正向影響，雖初步t檢定支持，但Trivariate probit 模型仍未能在本文實證結果證實。　　此外，結果也支持不論是男性或女性若教育程度越高，其罹患心血管疾病的機率皆會降低的假說，而女性若教育程度越高，其罹患代謝症候群的機率皆會顯著降低，透過教育程度的提升，預期將具備較多健康生活的知識，可以降低代謝症候群及心血管疾病的發生，進而促進勞動生產力提升。

關鍵字

心血管疾病；代謝症候群；就業

並列摘要

In recent years, due to the rise of cardiovascular diseases and related risk factors, as well as the aging population, the prevalence of cardiovascular diseases continue to grow, in addition to the huge medical expenses that the society must pay. It may have a seriously negative impact on personal productivity, and metabolic syndrome is a strong indicator of whether a person is in a high-risk group who may suffer from cardiovascular disease. Therefore, it of interest to analyze the impact of metabolic syndrome and cardiovascular disease on employment. In view of this, this study analyzes the National Health and Nutrition Examination Survey data of 2013-2014 wave, by gender. The study subjects are 18 to 65 years old. It anaylzes the impacts under various definitions of labor force. It investigates whether cardiovascular disease has a significant negative impact on employment in the U.S. and how metabolic syndrome affects cardiovascular disease, which in turn affects employment. It uses an trivariate probit model with the instrumental variables, including prevalence rate of diseases and genetic factors. The results show that cardiovascular disease has a negative impact on employment under labor force definitions I and IV for the male samples. Once suffering from cardiovascular disease, the male employment rate and the labor participation rate will have a 41.23 percentage point and a 43.26 percentage point decrease respectively; However, for the female sample, cardiovascular disease has no significant effect on employment. We also fing that if a person has metabolic syndrome, the prevalence of cardiovascular disease in men and women will increase by 6.43 percentage point and 4.40 percentage point, and if a persone can avoid the occurrence of metabolic syndrome, it will alleviate 1.07 percentage point of the negateive effect of cardiovascular disease on employment for men. Both for men and women, the significant positive impact of metabolic syndrome on cardiovascular disease has been confirmed by a t test but has not been confirmed by the trivariate probit model. In addition, the results also support the hypothesis if men or women have a higher level of education, their chances of suffering cardiovascular disease will decrease. If women have a higher level of education, their chances of having metabolic syndrome will be significantly reduced. Through the improvement of education level, it is expected that they will be equipped with more health knowledge, which can reduce the occurrence of metabolic syndrome and cardiovascular disease, and thus improve their labor productivity.