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Christine PJ, Goldman AL, Morgan JR, Yan S, Chatterjee A, Bettano AL, Binswanger IA, LaRochelle MR. Insurance Instability for Patients With Opioid Use Disorder in the Year After Diagnosis. JAMA HEALTH FORUM 2024; 5:e242014. [PMID: 39058507 PMCID: PMC11282441 DOI: 10.1001/jamahealthforum.2024.2014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/21/2024] [Indexed: 07/28/2024] Open
Abstract
Importance Transitions in insurance coverage may be associated with worse health care outcomes. Little is known about insurance stability for individuals with opioid use disorder (OUD). Objective To examine insurance transitions among adults with newly diagnosed OUD in the 12 months after diagnosis. Design, Setting, and Participants Longitudinal cohort study using data from the Massachusetts Public Health Data Warehouse. The cohort includes adults aged 18 to 63 years diagnosed with incident OUD between July 1, 2014, and December 31, 2014, who were enrolled in commercial insurance or Medicaid at diagnosis; individuals diagnosed after 2014 were excluded from the main analyses due to changes in the reporting of insurance claims. Data were analyzed from November 10, 2022, to May 6, 2024. Exposure Insurance type at time of diagnosis (commercial and Medicaid). Main Outcomes and Measures The primary outcome was the cumulative incidence of insurance transitions in the 12 months after diagnosis. Logistic regression models were used to generate estimated probabilities of insurance transitions by insurance type and diagnosis for several characteristics including age, race and ethnicity, and whether an individual started medication for OUD (MOUD) within 30 days after diagnosis. Results There were 20 768 individuals with newly diagnosed OUD between July 1, 2014, and December 31, 2014. Most individuals with newly diagnosed OUD were covered by Medicaid (75.4%). Those with newly diagnosed OUD were primarily male (67% in commercial insurance, 61.8% in Medicaid). In the 12 months following OUD diagnosis, 30.4% of individuals experienced an insurance transition, with adjusted models demonstrating higher transition rates among those starting with Medicaid (31.3%; 95% CI, 30.5%-32.0%) compared with commercial insurance (27.9%; 95% CI, 26.6%-29.1%). The probability of insurance transitions was generally higher for younger individuals than older individuals irrespective of insurance type, although there were notable differences by race and ethnicity. Conclusions and Relevance This study found that nearly 1 in 3 individuals experience insurance transitions in the 12 months after OUD diagnosis. Insurance transitions may represent an important yet underrecognized factor in OUD treatment outcomes.
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Affiliation(s)
- Paul J. Christine
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
- Department of General Internal Medicine, Denver Health and Hospital Authority, Denver, Colorado
| | - Anna L. Goldman
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
- Section of General Internal Medicine, Department of Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Jake R. Morgan
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Shapei Yan
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
| | - Avik Chatterjee
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
- Section of General Internal Medicine, Department of Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
| | - Amy L. Bettano
- Office of Population Health, Massachusetts Department of Public Health, Boston
| | - Ingrid A. Binswanger
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora
- Institute for Health Research, Kaiser Permanente Colorado, Aurora
- Colorado Permanente Medical Group, Denver
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California
| | - Marc R. LaRochelle
- Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, Massachusetts
- Section of General Internal Medicine, Department of Medicine, Chobanian and Avedisian School of Medicine, Boston University, Boston, Massachusetts
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Kovács N, Shahin B, Andrade CAS, Mahrouseh N, Varga O. Lifestyle and metabolic risk factors, and diabetes mellitus prevalence in European countries from three waves of the European Health Interview Survey. Sci Rep 2024; 14:11623. [PMID: 38773149 PMCID: PMC11109107 DOI: 10.1038/s41598-024-62122-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
Population shift towards healthier lifestyles can help reduce the burden of type 2 diabetes mellitus (DM), therefore understanding and monitoring the lifestyle-related risk factors are crucial for setting up effective preventive strategies and disease management. The present study aimed to explore the changes in prevalence of DM and major risk factors including smoking, physical activity, fruit and vegetable consumption, as well as body mass index (BMI) over three waves of European Health Interview Survey, and to investigate the association between risk factors and presence of DM across 11 European Union member states. Poisson regression models were used to evaluate the association between risk factors and DM, adjusted for demographic and socioeconomic variables. The estimated age-standardized prevalence of DM increased from 7.01% in 2009 to 7.96% in 2019, with substantial increase in subgroups with higher BMI and unhealthy lifestyle including physically inactive people, or current smokers. Obesity and overweight and physical inactivity were significantly associated with DM in all survey waves. Our findings underline that obesity prevention and weight loss promotion along with physical activity promotion are the subject of lifestyle interventions to reduce the burden of DM in EU member states.
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Affiliation(s)
- Nóra Kovács
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Balqees Shahin
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Carlos Alexandre Soares Andrade
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Nour Mahrouseh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
- Syreon Research Institute, Budapest, Hungary.
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Montagna C, Zangelidis A. Labour market implications of thyroid dysfunctions. ECONOMICS AND HUMAN BIOLOGY 2023; 50:101247. [PMID: 37148629 DOI: 10.1016/j.ehb.2023.101247] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/17/2023] [Accepted: 04/19/2023] [Indexed: 05/08/2023]
Abstract
This paper aims to shed some light on the labour market implications of thyroid disease. Undetected hypothyroidism has adverse effects on wages for female workers,thus widening the existing gender wage gap. However, once female individuals are diagnosed (and therefore assumed to be treated) with hypothyroidism, they experience wage gains and have a higher employment probability. In relation to other labour market outcomes, thyroid disease does not appear to play a significant role on individuals' labour force participation decision and their working hours. Results suggest that productivity gains may drive the improvement in wages.
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Affiliation(s)
- Catia Montagna
- Economics, Centre for Labour Market Research, Business School, University of Aberdeen, Aberdeen, AB24 3QY, Scotland, UK
| | - Alexandros Zangelidis
- Economics, Centre for Labour Market Research, Business School, University of Aberdeen, Aberdeen, AB24 3QY, Scotland, UK.
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4
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Fu HNC, Wyman JF, Peden-McAlpine CJ, Draucker CB, Schleyer T, Adam TJ. App Design Features Important for Diabetes Self-management as Determined by the Self-Determination Theory on Motivation: Content Analysis of Survey Responses From Adults Requiring Insulin Therapy. JMIR Diabetes 2023; 8:e38592. [PMID: 36826987 PMCID: PMC10007004 DOI: 10.2196/38592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/11/2022] [Accepted: 12/01/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Using a diabetes app can improve glycemic control; however, the use of diabetes apps is low, possibly due to design issues that affect patient motivation. OBJECTIVE This study aimed to describes how adults with diabetes requiring insulin perceive diabetes apps based on 3 key psychological needs (competence, autonomy, and connectivity) described by the Self-Determination Theory (SDT) on motivation. METHODS This was a qualitative analysis of data collected during a crossover randomized laboratory trial (N=92) testing 2 diabetes apps. Data sources included (1) observations during app testing and (2) survey responses on desired app features. Guided by the SDT, coding categories included app functions that could address psychological needs for motivation in self-management: competence, autonomy, and connectivity. RESULTS Patients described design features that addressed needs for competence, autonomy, and connectivity. To promote competence, electronic data recording and analysis should help patients track and understand blood glucose (BG) results necessary for planning behavior changes. To promote autonomy, BG trend analysis should empower patients to set safe and practical personalized behavioral goals based on time and the day of the week. To promote connectivity, app email or messaging function could share data reports and communicate with others on self-management advice. Additional themes that emerged are the top general app designs to promote positive user experience: patient-friendly; automatic features of data upload; voice recognition to eliminate typing data; alert or reminder on self-management activities; and app interactivity of a sound, message, or emoji change in response to keeping or not keeping BG in the target range. CONCLUSIONS The application of the SDT was useful in identifying motivational app designs that address the psychological needs of competence, autonomy, and connectivity. User-centered design concepts, such as being patient-friendly, differ from the SDT because patients need a positive user experience (ie, a technology need). Patients want engaging diabetes apps that go beyond data input and output. Apps should be easy to use, provide personalized analysis reports, be interactive to affirm positive behaviors, facilitate data sharing, and support patient-clinician communication.
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Affiliation(s)
- Helen N C Fu
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States
- Richard M Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - Jean F Wyman
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | | | | | - Titus Schleyer
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States
- School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Terrence J Adam
- College of Pharmacy, Department of Pharmaceutical Care & Health Systems, University of Minnesota, Minneapolis, MN, United States
- Institute of Health Informatics, University of Minnesota, Minneapolis, MN, United States
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Lavaysse LM, Imrisek SD, Lee M, Osborn CY, Hirsch A, Hoy-Rosas J, Nagra H, Goldner D, Dachis J, Sears LE. One Drop Improves Productivity for Workers With Type 2 Diabetes: One Drop for Workers With Type 2 Diabetes. J Occup Environ Med 2022; 64:e452-e458. [PMID: 35672921 PMCID: PMC9377500 DOI: 10.1097/jom.0000000000002577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Diabetes research on work productivity has been largely cross-sectional and retrospective, with only one known randomized controlled trial (RCT) published, to our knowledge. Secondary analysis of the Fit-One RCT tested the effect of One Drop's digital health program on workplace productivity outcomes, absenteeism, and presenteeism, for employees and specifically for older workers with type 2 diabetes. METHODS Analysis of the 3-month Fit-One trial data from employees who have type 2 diabetes explored productivity using logistic analyses and generalized estimating equations. RESULTS Treatment and control group comparisons showed that workers ( N = 125) using One Drop see direct benefits to workplace productivity, which leads to productivity savings for employers. CONCLUSION This was the first RCT to demonstrate that a mobile health application for managing type 2 diabetes can positively affect productivity at work.
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Having Type 2 Diabetes Does Not Imply Retirement before Age 65 in Europe. JOURNAL OF POPULATION AGEING 2022. [DOI: 10.1007/s12062-020-09306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pourat N, Chen X, Lu C, Zhou W, Hair BY, Bolton J, Sripipatana A. The Relative Contribution of Social Determinants of Health Among Health Resources and Services Administration-Funded Health Centers. Popul Health Manag 2022; 25:199-208. [PMID: 35442786 DOI: 10.1089/pop.2021.0293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Frameworks for identifying and assessing social determinants of health (SDOH) are effective for developing long-term societal policies to promote health and well-being, but may be less applicable in clinical settings. The authors compared the relative contribution of a specific set of SDOH indicators with several measures of health status among patients served by health centers (HCs). The 2014 Health Center Patient Survey was used to identify a sample of HC patient adults 18 years and older that reported the HC as their usual source of care (n = 5024). The authors examined the relationship between SDOH indicators organized in categories (health behaviors, access and utilization, social factors, economic factors, quality of care, physical environment) with health status measures (fair or poor health, diabetes, hypertension, cardiovascular disease, depression, or anxiety) using logistic regressions and predicted probabilities. Findings indicated that access to care and utilization indicators had the greatest relative contribution to all health status measures, but the relative contribution of other SDOH indicators varied. For example, access indicators had the highest predicted probability in the model with fair or poor health as the dependent variable (72.4%) and the model with hypertension as the dependent variable (47.4%). However, the second highest predicted probability was for social indicators (54.1%) in the former model and physical environment (44.7%) indicators in the latter model. These findings have implications for HCs that serve as the primary point of access to medical care in underserved communities and to mitigate SDOH particularly for patients with diabetes, depression, or anxiety.
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Affiliation(s)
- Nadereh Pourat
- Health Economics and Evaluation Research Program, UCLA Center for Health Policy Research, Los Angeles, California, USA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
| | - Xiao Chen
- Health Economics and Evaluation Research Program, UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Connie Lu
- Health Economics and Evaluation Research Program, UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Weihao Zhou
- Health Economics and Evaluation Research Program, UCLA Center for Health Policy Research, Los Angeles, California, USA
| | - Brionna Y Hair
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland, USA
| | - Joshua Bolton
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland, USA
| | - Alek Sripipatana
- Office of Quality Improvement, Bureau of Primary Health Care, Health Resources and Services Administration, US Department of Health and Human Services, Rockville, Maryland, USA
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Workforce participation, health and wealth inequality among older Australians between 2001 and 2015. Arch Public Health 2022; 80:104. [PMID: 35361261 PMCID: PMC8969371 DOI: 10.1186/s13690-022-00852-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/14/2022] [Indexed: 11/25/2022] Open
Abstract
Background Australians born in 2012 can expect to live about 33 years longer than those born 100 years earlier. However, only seven of these additional years are spent in the workforce. Longer life expectancy has driven policies to extend working life and increase retirement age; the current Australian policy, which has increased the eligibility for the pension from 65 to 67 by 2023, assumes that an improvement in longevity corresponds with an improvement in healthy life expectancy. However, there is mixed evidence of health trends in Australia over the past two decades. Although some health outcomes are improving among older age groups, many are either stable or deteriorating. This raises a question of how health trends intersect with policy for older Australians aged from 50 to 70. This paper considers the interplay between older workers’ health and workforce participation rates over the past 15 years when extended workforce participation has been actively encouraged. Methods We compared health and economic outcomes of the older people in following years with the base year (start of the study period), adjusting for some key socio-economic characteristics such as age, sex, ethnicity, education and equivalized household income by applying the Random effects estimator with maximum likelihood estimation technique. Results We find that regardless of increasing longevity, the health of older adults aged between 50 and 70 has slightly deteriorated. In addition, health gaps between those who were working into their older age and those who were not have widened over the 15-year period. Finally, we find that widening health gaps linked to workforce participation are also accompanied by rising economic inequality in incomes, financial assets and superannuation. With the exception of a small group of healthy and very wealthy retirees, the majority of the older Australians who were not working had low incomes, assets, superannuation, and poor health. Conclusions The widening economic and health gap within older population over time indicates a clear and urgent need to add policy actions on income and health, to those that seek to increase workforce participation among older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-022-00852-z.
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Lovas S, Mahrouseh N, Bolaji OS, Nellamkuzhi NJ, Andrade CAS, Njuguna DW, Varga O. Impact of Policies in Nutrition and Physical Activity on Diabetes and Its Risk Factors in the 28 Member States of the European Union. Nutrients 2021; 13:3439. [PMID: 34684440 PMCID: PMC8537865 DOI: 10.3390/nu13103439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/31/2021] [Accepted: 09/25/2021] [Indexed: 11/16/2022] Open
Abstract
Since healthy eating and physically active lifestyles can reduce diabetes mellitus (DM) risk, these are often addressed by population-based interventions aiming to prevent DM. Our study examined the impact of nutritional and physical activity policies, national diabetes plans and national diabetes registers contribute to lower prevalence of DM in individuals in the member states of the European Union (EU), taking into account the demographic and socioeconomic status as well as lifestyle choices. Datasets on policy actions, plans and registers were retrieved from the World Cancer Research Fund International's NOURISHING and MOVING policy databases and the European Coalition for Diabetes report. Individual-based data on DM, socioeconomic status and healthy behavior indicators were obtained via the European Health Interview Survey, 2014. Our results showed variation in types and numbers of implemented policies within the member states, additionally, the higher number of these actions were not associated with lower DM prevalence. Only weak correlation between the prevalence of DM and preventive policies was found. Thus, undoubtedly policies have an impact on reducing the prevalence of DM, its increasing burden could not be reversed which underlines the need for applying a network of preventive policies.
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Affiliation(s)
- Szabolcs Lovas
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028 Debrecen, Hungary; (S.L.); (N.M.); (C.A.S.A.); (D.W.N.)
| | - Nour Mahrouseh
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028 Debrecen, Hungary; (S.L.); (N.M.); (C.A.S.A.); (D.W.N.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | | | | | - Carlos Alexandre Soares Andrade
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028 Debrecen, Hungary; (S.L.); (N.M.); (C.A.S.A.); (D.W.N.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Diana Wangeshi Njuguna
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028 Debrecen, Hungary; (S.L.); (N.M.); (C.A.S.A.); (D.W.N.)
- Doctoral School of Health Sciences, University of Debrecen, 4032 Debrecen, Hungary
| | - Orsolya Varga
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, 26 Kassai Street, 4028 Debrecen, Hungary; (S.L.); (N.M.); (C.A.S.A.); (D.W.N.)
- Eötvös Loránd Research Network, 1052 Budapest, Hungary
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Diabetes Mellitus and Associated Factors in Slovakia: Results from the European Health Interview Survey 2009, 2014, and 2019. Nutrients 2021; 13:nu13072156. [PMID: 34201793 PMCID: PMC8308286 DOI: 10.3390/nu13072156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 01/04/2023] Open
Abstract
Diabetes mellitus (DM) is a high-risk non-communicable disease with an emerging burden for the European Union (EU) member states in the past decades. The unfavorable trend of the burden is striking compared to the declining disease burden due to cardiovascular diseases or stagnation of neoplasms. The goal of this study is to describe the temporal changes of diabetes in the adult population of Slovakia through the three European Health Interview Survey (EHIS) waves and to assess the association between DM and socioeconomic and/or lifestyle characteristics. These cross-sectional studies were carried out using microdata derived from Slovakia’s EHISs conducted in the years 2009 (n = 4972), 2014 (n = 5490), and 2019 (n = 5527). The DM variable was compared to the independent variables such as sociodemographic and lifestyle characteristics including dietary patterns and physical activity. DM prevalence for the EHIS in 2009, 2014, and 2019 were 6.1%, 8.2%, and 9.8%, respectively. In bivariate analysis, the relationship between DM and age, education level, job status, BMI, walking for at least 10 min, and physical activity was significant in the three EHISs. In 2014 and 2019, there was an inverse association between the risk of DM and walking regularly. There was no association between the frequency of eating fruits or vegetables and DM, with the exception of 2009, where a negative association between eating vegetables one to six times a week and DM was observed. Present health policies and activities in Slovakia were unable to reverse the increasing DM burden, indicating that a more systematic approach is needed. Complex policy strategies and legislative measures must be developed and implemented at both the national and EU levels.
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Rodriguez-Sanchez B, Aranda-Reneo I, Oliva-Moreno J, Lopez-Bastida J. Assessing the Effect of Including Social Costs in Economic Evaluations of Diabetes-Related Interventions: A Systematic Review. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:307-334. [PMID: 33953579 PMCID: PMC8092852 DOI: 10.2147/ceor.s301589] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/09/2021] [Indexed: 01/04/2023] Open
Abstract
Background The economic burden of diabetes from a societal perspective is well documented in the cost-of-illness literature. However, the effect of considering social costs in the results and conclusions of economic evaluations of diabetes-related interventions remains unknown. Objective To investigate whether the inclusion of social costs (productivity losses and/or informal care) might change the results and conclusions of economic evaluations of diabetes-related interventions. Methods A systematic review was designed and launched on Medline and the Cost-Effectiveness Analysis Registry from the University of Tufts, from the year 2000 until 2018. Included studies had to fulfil the following criteria: i) being an original study published in a scientific journal, ii) being an economic evaluation of an intervention on diabetes, iii) including social costs, iv) being written in English, v) using quality-adjusted life years as outcome, and vi) separating the results according to the perspective applied. Results From the 691 records identified, 47 studies (6.8%) were selected. Productivity losses were included in 45 of the selected articles (73% used the human capital approach) whereas informal care costs in only 13 (when stated, the opportunity cost method was used in seven studies and the replacement cost in one). The 47 studies resulted in 110 economic evaluation estimations. The inclusion of social costs changed the conclusions in 8 estimations (17%), 6 of them switching from not cost-effective from the healthcare perspective to cost-effective or dominant from the societal perspective. Considering social costs altered the results from cost-effective to dominant in 9 estimations (19%). Conclusion When social costs are considered, the results and conclusions of economic evaluations performed in diabetes-related interventions can alter. Wide methodological variations have been observed, which limit the comparability of studies and advocate for the inclusion of a wider perspective via the consideration of social costs in economic evaluations and methodological guidelines relating to their estimation and valuation.
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Affiliation(s)
| | - Isaac Aranda-Reneo
- University of Castilla-La Mancha, Faculty of Social Science, Economics and Finance Department, Toledo, Spain
| | - Juan Oliva-Moreno
- University of Castilla-La Mancha, Faculty of Law and Social Science, Economics and Finance Department, Toledo, Spain
| | - Julio Lopez-Bastida
- University of Castilla-La Mancha, Faculty of Health Sciences, Talavera de la Reina, Toledo, Spain
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Guo J, Wu Y, Deng X, Liu Z, Chen L, Huang Y. Association between social determinants of health and direct economic burden on middle-aged and elderly individuals living with diabetes in China. PLoS One 2021; 16:e0250200. [PMID: 33857252 PMCID: PMC8049277 DOI: 10.1371/journal.pone.0250200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/02/2021] [Indexed: 12/14/2022] Open
Abstract
Aims The aim of this study was to determine the association between social determinants of health and direct economic burden on Chinese middle-aged and elderly individuals living with diabetes in China. Methods This study used data from the baseline wave of The China Health and Retirement Longitudinal Study (CHARLS) database, covering 17,708 middle-aged and elderly residents in China. The population with diabetes was grouped into those diagnosed with diabetes mellitus (DDM) and those undiagnosed with diabetes mellitus (UDM). Direct economic cost data, including total direct medical costs (TC) and out-of-pocket (OOP) payments, were extracted as outcome variables. A two-part model was applied to analyze the association between social determinants of health and direct economic burden. Results In our analysis, we included 958 patients with DDM and 1,285 patients with UDM. The mean TC and OOP payments were 11,193 CNY (US $1,733; 6.46 CNY = 1 USD) and 7,266 CNY (US $1,125) in DDM patients, and 3,700 CNY (US $573) and 3,060 CNY (US $474) in UDM patients. Rural-urban status (p<0.05), regional status (p<0.05), household personal consumption expenditures (p<0.05), and comorbidities(p<0.05) were crucial factors associated with medical costs in people with diabetes. Conclusion Although progress has been made in the development of current health policies intended to contain the direct economic burden of diabetes, the gaps in that burden in populations with different social characteristics remains a burning issue. More policy breakthroughs are needed to achieve health equity.
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Affiliation(s)
- Jianwei Guo
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yun Wu
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Xinlei Deng
- Department of Environmental Health Sciences, University at Albany, the State University of New York, Rensselaer, New York, United States of America
| | - Zifeng Liu
- Department of Clinical Data Center, the 3rd Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lijin Chen
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
| | - Yixiang Huang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, P. R. China
- * E-mail:
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Elek P, Bíró A. Regional differences in diabetes across Europe - regression and causal forest analyses. ECONOMICS AND HUMAN BIOLOGY 2021; 40:100948. [PMID: 33276258 DOI: 10.1016/j.ehb.2020.100948] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/04/2020] [Accepted: 11/10/2020] [Indexed: 06/12/2023]
Abstract
We examine regional differences in diabetes within Europe, and relate them to variations in socio-economic conditions, comorbidities, health behaviour and diabetes management. We use the SHARE (Survey of Health, Ageing and Retirement in Europe) data of 15 European countries and 28,454 individuals, who participated both in the 4th and 7th (year 2011 and 2017) waves of the survey. First, we estimate multivariate regressions, where the outcome variables are diabetes prevalence, diabetes incidence, and weight loss due to diet as an indicator of management. Second, we study the heterogeneous impact of demographic, socio-economic, health and lifestyle indicators on the regional differences in diabetes incidence with causal random forests. Compared to Western Europe, the odds of a new diabetes diagnosis over a six-year horizon is 2.2-fold higher in Southern and 2.6-fold higher in Eastern Europe. Adjusting for individual characteristics, the odds ratio decreases to 1.8 in the South-West and to 2.0 in the East-West dimension. These remaining differences are mostly explained by country-specific healthcare indicators. Based on the causal forest approach, the adjusted East-West difference is essentially zero for the lowest risk groups (tertiary education, employment, no hypertension, no overweight) and increases substantially with these risk factors, but the South-West difference is much less heterogeneous. The prevalence of diet-related weight loss around the time of diagnosis also exhibits regional variation. The results suggest that the regional differences in diabetes incidence could be reduced by putting more emphasis on diabetes prevention among high-risk individuals in Eastern and Southern Europe.
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Affiliation(s)
- Péter Elek
- Health and Population "Lendület" Research Group, Centre for Economic and Regional Studies, Budapest, Hungary; Institute of Economics, Corvinus University of Budapest, Hungary; Department of Economics, Eötvös Loránd University (ELTE), Budapest, Hungary.
| | - Anikó Bíró
- Health and Population "Lendület" Research Group, Centre for Economic and Regional Studies, Budapest, Hungary.
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Brandão MP, Fonseca Cardoso M. Associations between depressive symptoms and being employed or retired in older adults with type 2 diabetes. Prim Care Diabetes 2020; 14:464-468. [PMID: 32057725 DOI: 10.1016/j.pcd.2020.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/13/2020] [Accepted: 01/20/2020] [Indexed: 11/26/2022]
Abstract
AIMS Analyse the association of depression with retirement in older adults with type 2 diabetes(T2D). METHODS Data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) was used to analyse 1100 T2D aged 51-74, employed or retired. Multilevel logistic models examined the relationships of health and socio-demographic characteristics with depression. RESULTS The proportion of females was significantly higher among those with depression. Around half of those aged between 51 and 64 were employed, and less than 5% among those aged between 65 and 74 years. Female, employment, more chronic diseases and not perceiving their health as healthy were associated with depression among those aged 51-64. Among women, the odds of being depressed was significantly higher among those employed than among those who had retired. Among men, being employed or retired was not significantly associated with depression. CONCLUSIONS Depression was associated to more limitations of daily living and chronic diseases, and worst perception of health. The majority of those with depression were women, and being retired seems to have a protective effect on women.
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Affiliation(s)
- Maria Piedade Brandão
- ESSUA - Health School, University of Aveiro, Aveiro, Portugal; CINTESIS - Center for Health Technology and Services Research, University of Porto, Porto, Portugal.
| | - Margarida Fonseca Cardoso
- ICBAS - Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal; CIIMAR - Interdisciplinary Centre of Marine and Environmental Research, University of Porto, Porto, Portugal.
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Kim JH, Lee WY, Lim SS, Kim YT, Hong YP. Gender Differences in the Relationship between Type 2 Diabetes Mellitus and Employment: Evidence from the Korea Health Panel Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197040. [PMID: 32993053 PMCID: PMC7579632 DOI: 10.3390/ijerph17197040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
Previous studies have analyzed the impact of diabetes mellitus on labor market participation by men and women, but gender difference between type 2 diabetes mellitus (T2DM) and employment has not been the focus. This study aims to explore gender differences between T2DM and employment status. Data from the Korea Health Panel Study, 2013-2015 were analyzed by distinguishingT2DM and non-diabetes (N = 11,216). The empirical model was established and the generalized two-stage least squares (2SLS) was estimated, controlling for endogeneity. A family history of diabetes, as an instrumental variable, was related to an individual's genetic predisposition to develop diabetes. The estimated results for the 2SLS showed the interaction effects between T2DM and employment. T2DM had a statistically significant and negative effect on employment for women only. The comparison with non-diabetes showed that women with T2DM had a lower probability of employment by 51.9% (p < 0.05). Exposing gender bias in employment suggests that healthcare policies and disease management programs for diabetic patients should adopt gender-specific remedies.
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Affiliation(s)
- Jeung-Hee Kim
- Division of Chronic Disease Control, Korea Disease Control and Prevention Agency, 187 Osongsaengmyeong 2-ro, Osong-eup, Heungdeok-gu, Cheongju-si, Chungcheongbuk-do 28159, Korea;
- Department of Food and Resource Economics, College of Life Science and Biotechnology, Korea University Graduate School, 145 Anamro, Seongbuk-gu, Seoul 02841, Korea
| | - Weon-Young Lee
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Korea;
| | - Song Soo Lim
- Department of Food and Resource Economics, College of Life Science and Biotechnology, Korea University Graduate School, 145 Anamro, Seongbuk-gu, Seoul 02841, Korea
| | - Young Taek Kim
- Public Health Medical Service Office, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea;
| | - Yeon-Pyo Hong
- Department of Preventive Medicine, College of Medicine, Chung-Ang University, 84 Heukseok-ro, Dongjak-gu, Seoul 06974, Korea;
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Varanka-Ruuska T, Tolvanen M, Vaaramo E, Keinänen-Kiukaanniemi S, Sebert S, Rautio N, Ala-Mursula L. Glucose metabolism in midlife predicts participation in working life: a Northern Finland Birth Cohort 1966 study. Occup Environ Med 2020; 77:324-332. [DOI: 10.1136/oemed-2019-106170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/19/2019] [Accepted: 01/01/2020] [Indexed: 12/25/2022]
Abstract
ObjectiveTo evaluate how clinically measured glucose metabolism categories predict registered participation in working life.MethodsIn the 46-year follow-up of Northern Finland Birth Cohort 1966 (n=5328, 2342 men and 2986 women), we used oral glucose tolerance tests, surveys and glycated haemoglobin to determine glucose metabolism categorised as normal, pre-diabetes, screen-detected and previous type 2 diabetes (T2D). Consequent participation in working life during the 2-year follow-up period was measured as registered disability, unemployment and employment days, for which incidence rate ratios (IRRs) with 95% CIs were calculated using Poisson regression, adjusted for baseline employment and socioeconomic, health-related and behavioural factors.ResultsIn comparison to normal glucose, all categories of impaired glucose metabolism were associated with poorer participation in working life in the unadjusted models. After adjustments, the risks (IRR (95% CI)) of disability days remained heightened by both screen-detected and previous T2D among men (1.3 (1.3 to 1.4) and 1.5 (1.4 to 1.5), respectively), whereas among women the risks were lowered (0.9 (0.8 to 0.9) and 0.9 (0.9 to 1.0), respectively). The risks of unemployment were consistently higher in all categories of impaired glucose metabolism, and were the highest among women with previous T2D (1.6 (1.5 to 1.6)). Correspondingly, the rates of total employment days were lower in relation to screen-detected T2D among men and women (5% and 6%, respectively), and previous T2D (6% and 3%).ConclusionsOverall, impaired glucose metabolism associated with deteriorated working life participation already in middle age. The high prevalence of impaired glucose metabolism emphasises the need for actions to support sustainable working careers.
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Graham EA, Thomson KH, Bambra CL. The association between diabetes and depressive symptoms varies by quality of diabetes care across Europe. Eur J Public Health 2019; 28:872-878. [PMID: 29617999 PMCID: PMC6148969 DOI: 10.1093/eurpub/cky050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Depressive symptoms are more common in adults with diabetes and may arise from the physical and psychosocial burden of disease. Better quality of diabetes care may be associated with a reduced disease burden and fewer depressive symptoms. Methods This cross-sectional study included 34 420 participants from 19 countries in the European Social Survey Round 7 (2014-2015). Countries were grouped into quartiles based on their quality of diabetes care as measured in the Euro Diabetes Index 2014. Individual-level depressive symptoms were measured using the 8-item Center for Epidemiologic Studies-Depression Scale. Negative binomial regression was used to compare the number of depressive symptoms between adults with and without diabetes in each quartile of diabetes care quality. Analyses included adjustment for covariates and survey weights. Results In countries with the highest quality of diabetes care, having diabetes was associated with only a 3% relative increase in depressive symptoms (95% CI 1.00-1.05). In countries in the second, third and fourth (lowest) quartiles of diabetes care quality, having diabetes was associated with a 13% (95% CI 1.08-1.17), 13% (1.08-1.19) and 22% (1.14-1.31) relative increase in depressive symptoms, respectively. Conclusion The association between diabetes and depressive symptoms appears stronger in European countries with lower quality of diabetes care. Potential pathways for this association include the financial aspects of diabetes care, access to services and differential exposure to the social determinants of heath. Further research is needed to unpack these mechanisms and improve the quality of life of people with diabetes across Europe.
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Affiliation(s)
- Eva A Graham
- Department of Epidemiology, Biostatistics, and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Katie H Thomson
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clare L Bambra
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Pedron S, Emmert-Fees K, Laxy M, Schwettmann L. The impact of diabetes on labour market participation: a systematic review of results and methods. BMC Public Health 2019; 19:25. [PMID: 30616606 PMCID: PMC6323654 DOI: 10.1186/s12889-018-6324-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 12/14/2018] [Indexed: 05/04/2023] Open
Abstract
Background Diabetes mellitus is a major chronic disease, which is connected to direct and indirect costs and productivity losses. However, its effects on labour market participation are not straightforward to identify, nor are they consistently included in cost-of-illness studies. First, this study aims to synthesise existing evidence regarding the impact of diabetes on labour market outcomes that imply a complete absence of work. Second, the analysis takes a particular look at relevant methodological choices and the resulting quality of the studies included. Methods We conducted a systematic literature research (PubMed, Embase, PsychINFO), by applying a standard screening, selection and results extraction process, which considered all types of studies including cross-sectional and longitudinal approaches. Risk-of-bias and quality within the studies were assessed and results were compared. We dedicated special attention to the modelling of potential reverse causality between diabetes and labour market outcomes and the consideration of comorbidities and complications. Results Overall, 30 studies satisfied our inclusion criteria. We identified four main labour participation outcomes: absence of employment, unemployment, early retirement, and disability pension. The studies reviewed show a negative impact of diabetes on the labour market participation outcomes considered. However, only a few studies controlled for endogeneity, differentiated between type 1 and type 2 diabetes or modelled the impact of comorbidities. We report how modelling choices affect the directions and interpretations of the effects. Conclusions The available evidence mainly suggests a negative impact of diabetes on several outcomes indicating labour market participation. The methodological limitations identified can guide future research with respect to both outcomes and methods. This study provides therefore an empirical contribution to the discussion on how to model the economic impact of diabetes. Electronic supplementary material The online version of this article (10.1186/s12889-018-6324-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sara Pedron
- Helmholtz Zentrum München (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany. .,German Center for Diabetes Research (DZD), Neuherberg, Germany.
| | - Karl Emmert-Fees
- Helmholtz Zentrum München (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
| | - Michael Laxy
- Helmholtz Zentrum München (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Lars Schwettmann
- Helmholtz Zentrum München (GmbH), Institute of Health Economics and Health Care Management, Ingolstädter Landstraße 1, 85764, Neuherberg, Germany
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The impact of health on economic and social outcomes in the United Kingdom: A scoping literature review. PLoS One 2018; 13:e0209659. [PMID: 30596730 PMCID: PMC6312330 DOI: 10.1371/journal.pone.0209659] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 12/09/2018] [Indexed: 12/18/2022] Open
Abstract
This is the first review of the evidence, based on longitudinal studies in the United Kingdom, on the association of ill health at any life stage and later social and economic outcomes. The review included a wide range of physical and mental health exposures, both self-reported and objectively measured, as well as social (e.g. life satisfaction) and economic (e.g. employment) outcomes. We searched the Web of Science, key longitudinal datasets based in the UK, major economic journals, Google Scholar and reference lists of relevant publications. The review includes 80 studies. There was strong evidence for the association between early mental health, mainly attention deficit hyperactivity disorder, and lifetime educational, occupational and various social outcomes. Also, both poor physical and mental health in early and middle adulthood, tended to be associated with unemployment and lower socioeconomic status. Among older adults, the evidence quite consistently indicated an association between mental health, chronic conditions, disability/functional limitations, self-rated general health and quality of life, life satisfaction and early retirement. Overall, mental health was consistently found to be associated with a range of social and economic outcomes throughout the lifespan. The evidence for the association between physical health and later outcomes is more inconsistent. A number of methodological challenges need to be addressed, particularly related to causal inference, to produce robust evidence with potential to inform public health policy.
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Kumara AS, Samaratunge R. The effects of chronic non-communicable diseases on labour force outcomes: Quasi experimental evidence from Sri Lanka. ECONOMICS AND HUMAN BIOLOGY 2018; 31:40-53. [PMID: 30170296 DOI: 10.1016/j.ehb.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/29/2018] [Accepted: 08/06/2018] [Indexed: 06/08/2023]
Abstract
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.
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Affiliation(s)
- Ajantha Sisira Kumara
- Department of Public Administration, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka; Department of Management, Monash Business School, Monash University, Menzies Building, Level 11, Clayton Campus, Victoria, 3800, Australia.
| | - Ramanie Samaratunge
- Department of Management, Monash Business School, Monash University, Menzies Building, Level 11, Clayton Campus, Victoria, 3800, Australia.
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Rodriguez-Sanchez B, Alessie RJM, Feenstra TL, Angelini V. The relationship between diabetes, diabetes-related complications and productive activities among older Europeans. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2018; 19:719-734. [PMID: 28656544 PMCID: PMC5948290 DOI: 10.1007/s10198-017-0911-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/06/2017] [Indexed: 06/07/2023]
Abstract
AIMS To assess the impact of diabetes and diabetes-related complications on two measures of productivity for people in the labour force and out of it, namely "being afraid health limits ability to work before retirement" and "volunteering". METHODS AND DATA Logistic regressions were run to test the impact of diabetes and its complications on the probability of being afraid health limits work and being a formal volunteer. The longitudinal sample for the former outcome includes 53,631 observations, clustered in 34,393 individuals, aged 50-65 years old whereas the latter consists of 45,384 observations, grouped in 29,104 individuals aged 65 and above across twelve European countries taken from the Survey of Health, Ageing and Retirement in Europe, from 2006 to 2013. RESULTS Diabetes increased the probability of being afraid health limited work by nearly 11% points, adjusted by clinical complications, and reduced the likelihood of being a formal volunteer by 2.7% points, additionally adjusted by mobility problems. We also found that both the probability of being afraid health limits work and the probability of being a formal volunteer increased during and after the crisis. Moreover, having diabetes had a larger effect on being afraid health limits work during the year 2010, possibly related to the financial crisis. CONCLUSIONS Our findings show that diabetes significantly affects the perception of people regarding the effects of their condition on work, increasing the fear that health limits their ability to work, especially during the crisis year 2010, as well as the participation in volunteering work among retired people.
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Affiliation(s)
- B Rodriguez-Sanchez
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, Zernike Campus, University of Groningen, Duisenberg Building, Nettelbosje 2, 9747AE, Groningen, The Netherlands.
| | - R J M Alessie
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, Zernike Campus, University of Groningen, Duisenberg Building, Nettelbosje 2, 9747AE, Groningen, The Netherlands
| | - T L Feenstra
- Department of Epidemiology, Faculty of Medical Sciences, University Medical Centrum of Groningen, Hanzeplein 1, 9713GZ, Groningen, The Netherlands
| | - V Angelini
- Department of Economics, Econometrics and Finance, Faculty of Economics and Business, Zernike Campus, University of Groningen, Duisenberg Building, Nettelbosje 2, 9747AE, Groningen, The Netherlands
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Rodríguez-Sánchez B, Cantarero-Prieto D. Performance of people with diabetes in the labor market: An empirical approach controlling for complications. ECONOMICS AND HUMAN BIOLOGY 2017; 27:102-113. [PMID: 28575714 DOI: 10.1016/j.ehb.2017.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 03/12/2017] [Accepted: 05/15/2017] [Indexed: 06/07/2023]
Abstract
This paper introduces a framework for modelling the impact that diabetes has on employment status and wages, improving the existing literature by controlling for diabetes-related complications. Using the last wave of the Spanish National Health Survey, we find that 1710 adults out of the original sample of 36,087 have diabetes, reporting higher rates of unemployment. Our empirical results suggest that persons with diabetes, compared with non-diabetic persons, have poorer labor outcomes in terms of length of unemployment and lower income. However, diabetes is not significantly associated with unemployment probabilities, suggesting that the burden of diabetes on employment is mediated by lifestyle factors and clinical and functional complications. In addition, there are mixed outcomes to this econometric approach, depending on age and gender, among other factors. This interesting finding has several implications for research and policy on strategies to get lower health inequalities.
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Affiliation(s)
- Beatriz Rodríguez-Sánchez
- Department of Economics, Econometrics and Finance, Zernike Campus, University of Groningen, Nettelbosje 2, 9747AE Groningen, The Netherlands.
| | - David Cantarero-Prieto
- Department of Economics and GEN, University of Cantabria, Avenue, Los Castros, s/n, Santander CP 39005, Spain.
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Dong L, Agnew J, Mojtabai R, Surkan PJ, Spira AP. Insomnia as a predictor of job exit among middle-aged and older adults: results from the Health and Retirement Study. J Epidemiol Community Health 2017; 71:750-757. [DOI: 10.1136/jech-2016-208630] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 02/01/2017] [Accepted: 02/23/2017] [Indexed: 11/03/2022]
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Demographic, lifestyle, and health characteristics of older adults with prediabetes in England. Prev Med 2015; 77:74-9. [PMID: 25976519 DOI: 10.1016/j.ypmed.2015.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 03/19/2015] [Accepted: 05/05/2015] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To describe the demographic, lifestyle, and health characteristics of older adults with prediabetes compared to those with normal glucose levels or diabetes. METHOD Participants were from the English Longitudinal Study of Aging 2004-2005 (n=4168). Statistical analyses examined differences between people with prediabetes and 1) people with normal glucose levels and 2) people with diabetes. Design-based F-statistics and t-tests tested differences for each characteristic individually and multinomial logistic regression examined adjusted associations. Survey weighting and cluster information was used to generalize to the older English population. RESULTS Compared to people with normal glucose levels, people with prediabetes were older (RR=1.05 95% CI 1.04-1.07), more likely to be employed (RR=1.27 95% CI 1.01-1.60), more likely to smoke (RR=2.21 95% CI 1.74-2.80), and had higher BMIs (RR=1.08 95% CI 1.06-1.10). Compared to people with diabetes, people with prediabetes were more likely to be women (RR=2.12 95% CI 1.57-2.86), more likely to be employed (RR=1.54 95% CI 1.02-2.33), had lower BMIs (RR=0.95 95% CI 0.93-0.98), were less likely to have a cardiovascular condition (RR=0.34 95% CI 0.24-0.47), and had higher self-rated health (χ(2)=26.08, p<0.001). CONCLUSION Older adults with prediabetes have a unique set of characteristics that may inform prevention or intervention schemes.
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