Performance of people with diabetes in the labor market: An empirical approach controlling for complications

Retirement status and physical activity in US adults with type 2 diabetes mellitus: Influence of sex, race/ethnicity and acculturation level

AIMS

We aimed to assess the association between retirement status and recreational physical activity (rPA) in US adults with Type 2 diabetes mellitus (T2DM), while accounting for potential modification effects.

METHODS

We extracted data from the 2007-2014 National Health and Nutrition Examination Survey. We used logistic regression models to evaluate the association between self-reported retirement status and high rPA (i.e., at least 150 min/week). We reported adjusted odds ratio (aOR) and 95% confidence intervals (95% CI). We estimated the modification effect of sex, race/ethnicity, and acculturation level by including interaction terms into the models.

RESULTS

Of the 992 U.S. adults with T2DM, 34.8% was retired. As a whole, retirement was associated with high rPA (aOR=1.87 [95% CI: 1.16-3.00]; P = 0.0110). Retirement was associated with high odds of rPA in females (aOR=2.07 [95% CI, 1.14, 3.73], P = 0.0171), in non-Hispanic whites (aOR=2.57 [95% CI, 1.32, 5.00], P = 0.0062), and in those with high acculturation level (aOR=1.85 [95% CI, 1.07, 3.19], P = 0.0273). We observed no significant statistical interactions.

CONCLUSIONS

Retirement is associated with a high participation to rPA in US adults with T2DM, and the amplitude varies by sex, race/ethnicity and acculturation level. Intervention for improving rPA in adults with T2DM should collect and consider information on retirement status.

Association of diabetes type and chronic diabetes complications with early exit from the labour force: register-based study of people with diabetes in Finland

AIMS/HYPOTHESIS

Diabetes and diabetes complications are a cause of substantial morbidity, resulting in early exits from the labour force and lost productivity. The aim of this study was to examine differences in early exits between people with type 1 and 2 diabetes and to assess the role of chronic diabetes complications on early exit. We also estimated the economic burden of lost productivity due to early exits.

METHODS

People of working age (age 17-64) with diabetes in 1998-2011 in Finland were detected using national registers (Ntype 1 = 45,756, Ntype 2 = 299,931). For the open cohort, data on pensions and deaths, healthcare usage, medications and basic demographics were collected from the registers. The outcome of the study was early exit from the labour force defined as pension other than old age pension beginning before age 65, or death before age 65. We analysed the early exit outcome and its risk factors using the Kaplan-Meier method and extended Cox regression models. We fitted linear regression models to investigate the risk factors of lost working years and productivity costs among people with early exit.

RESULTS

The difference in median age at early exit from the labour force between type 1 (54.0) and type 2 (58.3) diabetes groups was 4.3 years. The risk of early exit among people with type 1 diabetes increased faster after age 40 compared with people with type 2 diabetes. Each of the diabetes complications was associated with an increase in the hazard of early exit regardless of diabetes type compared with people without the complication, with eye-related complications as an exception. Diabetes complications partly but not completely explained the difference between diabetes types. The mean lost working years was 6.0 years greater in the type 1 diabetes group than in the type 2 diabetes group among people with early exit. Mean productivity costs of people with type 1 diabetes and early exit were found to be 1.4-fold greater compared with people with type 2 diabetes. The total productivity costs of incidences of early exits in the type 2 diabetes group were notably higher compared with the type 1 group during the time period (€14,400 million, €2800 million).

CONCLUSIONS/INTERPRETATION

We found a marked difference in the patterns of risk of early exit between people with type 1 and type 2 diabetes. The difference was largest close to statutory retirement age. On average, exits in the type 1 diabetes group occurred at an earlier age and resulted in higher mean lost working years and mean productivity costs. The potential of prevention, timely diagnosis and management of diabetes is substantial in terms of avoiding reductions in individual well-being and productivity.

Socioeconomic differences in the associations between diabetes and hospital admission and mortality among older adults in Europe

The aim of this study is to explain the trends in socioeconomic inequality and diabetes outcomes in terms of hospital admission and death in old European people. The sample includes 73,301 individuals, across 16 European countries taken from the Survey of Health, Ageing and Retirement in Europe (SHARE). People being diagnosed of diabetes were more likely to be admitted to hospital than those without diabetes, although its effect dropped after controlling for clinical and functional complications. Largest asscociations were observed in women, people aged 50-65 years old, with medium educational level and medium household income. Diabetes was significant and positively related to mortality in the whole sample. Diabetes is significantly associated with mortality risk especially in males, oldest old people, low education and medium income people. These findings have important implications for public policies to reduce socioeconomic-related health inequalities.

The effects of chronic non-communicable diseases on labour force outcomes: Quasi experimental evidence from Sri Lanka

We investigate the effects of experiencing non-communicable diseases (NCDs) on labour force outcomes of working-age individuals and their households in Sri Lanka. For this, quasi-experimental evidence, including average treatment effects on those treated (ATT), are generated by using the self-reported health survey of the labour force of Sri Lanka. According to the analysis, individuals with at least one NCD account for approximately 19.15% of the working-age population. On average, employment probability, labour supply, and labour earnings of them are significantly lower than those of non-NCD individuals by 9.5% (ATT=-0.102, P < 0.001), 44.6% (ATT=-0.590, P < 0.001), and 47.9% (ATT=-0.652, P < 0.001), respectively. The negative impacts on labour force outcomes are notably larger in the cases of paralysis and mental illness. These NCDs reduce individual labour supply by more than 80% and labour earnings by more than 90%. The employment probability of individuals with paralysis and mental illnesses is also relatively lower by more than 60%. Apart from these individual-level effects, the paper provides evidence on how labour force outcomes at the household level are influenced by NCDs. Our findings demonstrate that the association between individuals' NCD-prevalence and labour force outcomes is relatively stronger for males, informal sector employees, and elderly people. The results suggest several social inclusion policies.