ArticleBMJ open2026
Association between non-communicable diseases and work productivity and health-related quality of life among Japanese workers: a cross-sectional study using a claims database and survey data.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesTo assess the impact of non-communicable diseases (NCDs) by number and pattern on productivity loss costs (PLCs) and health-related quality of life (HRQoL) in a large working-age population in Japan.
designCross-sectional analysis of linked claims-survey data with sex-stratified multivariable regression.
settingEmployment-Based Health Insurance Associations in Japan. Administrative claims using International Classification of Diseases, Tenth Revision codes were linked to an online questionnaire (November 2022).
participantsInsured workers and families aged 18-65 years who completed the survey (n=18 236; mean age 48.7 years; 66.2% men). PRIMARY AND SECONDARY OUTCOME MEASURES: Primary: PLC, estimated from the Work Productivity and Activity Impairment instrument using the Human Capital Method (annual US$). SECONDARY: HRQoL measured using the EuroQoL 5-Dimension 5-Level index. Exposures were NCD categories, multimorbidity counts and high-impact disease combinations. Models adjusted for sex, age and the number of other conditions.
resultsMultimorbidity (≥2 conditions) was present in 58.4% (56.3% men; 62.5% women); 29.3% had ≥5 conditions. Women had higher NCD prevalence (76.9% vs 70.0%), higher median PLC (US$3683 vs US$117) and lower median HRQoL (0.89 vs 1.00) than men. In adjusted analyses, neuropsychiatric conditions were associated with higher PLC in both sexes (men: US$2393 (95% CI 1966 to 2820); women: US$2097 (US$1442 to US$2751)). Musculoskeletal disorders were statistically significant in men but not in women (US$809 (US$381 to US$1236)), whereas genitourinary disorders were statistically significant in women but not in men (US$701 (US$121 to US$1282)). Neuropsychiatric disorders were associated with lower HRQoL in both sexes (men: -0.040 (-0.045 to -0.034); women: -0.044 (-0.053 to -0.035)); musculoskeletal disorders showed similar decrements (men: -0.031 (-0.037 to -0.025); women: -0.040 (-0.049 to -0.031)). Combinations involving sleep and neuropsychiatric disorders produced the highest PLC (eg, depressive episode and sleep disorder: men: US$5219.9 (US$3646.4 to US$6793.4); women: US$5858.5 (US$2634.4 to US$9082.5)). Each additional condition was independently associated with higher PLC and lower HRQoL.
conclusionsIn this cross-sectional study of Japanese workers, specific combinations of chronic conditions, particularly neuropsychiatric conditions co-occurring with sleep disorders and musculoskeletal disorders, were associated with greater productivity loss and lower HRQoL than predicted by the number of co-occurring diseases alone. These findings suggest that workplace health strategies addressing high-impact disease combinations may warrant further investigation in longitudinal studies.
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