The impact of diabetes on workforce participation: results from a national household sample

Abstract

Objective: Diabetes is a highly prevalent condition that results in substantial morbidity and premature mortality. We investigated how diabetes-associated mortality, disability, early retirement, and work absenteeism impacts workforce participation.

Data source: We used the Health and Retirement Study (HRS), a national household sample of adults aged 51-61 in 1992, as a data source.

Study design: We conducted cross-sectional analyses on the baseline HRS data, and longitudinal analyses using data from eight years of follow-up. We used two-part regression models to estimate the adjusted impact of diabetes on workforce participation, and then estimated the economic impact of diabetes-related losses in productivity.

Principal findings: Diabetes is a significant predictor of lost productivity. The incremental lost income due to diabetes by 1992 was 60.0 billion US dollars over an average diabetes duration of 9.7 years. From 1992 to 2000, diabetes was responsible for 4.4 billion US dollars in lost income due to early retirement, 0.5 billion US dollars due to increased sick days, 31.7 billion US dollars due to disability, and 22.0 US dollars billion in lost income due to premature mortality, for a total of 58.6 billion dollars in lost productivity, or 7.3 billion US dollars per year.

Conclusions: In the U.S. population of adults born between 1931 and 1941, diabetes is associated with a profound negative impact on economic productivity. By 1992, an estimated 60 billion US dollars in lost productivity was associated with diabetes; additional annual losses averaged 7.3 billion US dollars over the next eight years, totaling about 120 billion US dollars by the year 2000. Given the rising prevalence of diabetes, these costs are likely to increase substantially unless countered by better public health or medical interventions.

Figure 1

Study Timeline and Cohort Descriptions Retrospective analysis of productivity losses associated with diabetes. The cohort includes all study subjects alive in 1992, and the analysis examines retrospectively the diabetes-associated incremental losses in productivity due to disability, sick time, and early retirement. Prospective analysis of productivity losses associated with diabetes. This cohort is a subset of the retrospective cohort, including only those who were working at cohort inception (1992), and excluding from the diabetes cohort those who had new diagnoses of diabetes made after cohort inception. The analyses examine prospectively, from 1992–2000, the diabetes-associated incremental losses in productivity due to disability, sick time, early retirement, and mortality. Closed circle indicates date of death; arrow indicates subject is alive. People with only a “thin line” are not included in either analysis and include two major groups: those who died prior to 1992 and those who developed diabetes after 1992. Diamond indicates the date at which someone with diabetes drops out of the labor force. These people are included in the retrospective study (as long as they are still alive in 1992) but are not included in the prospective studies.