From the New York Times . . .
Economic Toll of Diabetes Begins Early
By ANAHAD O'CONNOR
Diabetes may be more than a hazard to health. A new study shows that young adults with the disease have lower lifetime earnings and fewer job prospects than their peers.
The new research helps quantify the nonmedical costs of a burdensome disease that afflicts nearly 10 percent of Americans. The study did not distinguish between Type 2 diabetes, which is closely linked to obesity and inactivity and is by far the most common form of the disease, and Type 1, sometimes called juvenile diabetes, which may be linked to immune, genetic and environmental factors. But both types of diabetes are on the rise in young people: About 215,000 Americans younger than 20 have Type 1 or Type 2 disease.
The study, which tracked 15,000 people over a period of 14 years, from high school through their early 30s, found that people with diabetes could expect $160,000 less in earnings over the course of their lifetimes compared with those without the disease. They had lower rates of finishing high school and were less likely to move on to college than young adults who were not diabetic. By age 30, a person with diabetes is 10 percent less likely to have a job, in part because of reduced education.
The findings, published in the journal Health Affairs, “are important because they reflect that diabetics may be having some negative consequences pretty early on in the course of life,” said Dr. Michael Richards, a physician and doctoral candidate in the department of health policy and administration at Yale and an author of the study. They “also beg the question of what the underlying influences that are driving these associations may be.”
One driving force, Dr. Richards suspects, may be the difficulty in balancing school or job demands with the management of a chronic disease. Employers may also be less likely to hire someone with diabetes because they fear they will take more sick days or be less productive or more of an insurance burden than other workers. People with diabetes themselves may also be reluctant to seek out better-paying jobs for fear of losing health benefits, a phenomenon known as job lock.
“Diabetes could also affect the incentives for people in terms of how much schooling they want to acquire, and it could also change incentives for employers who might expect larger medical spending for their diabetic employees,” Dr. Richards said. “Probing further into these potential mechanisms is going to be a goal of future work.”
Earlier studies have shown that chronic disease and other aspects of a person’s health can pose barriers in the job market. The overweight and obese, for example, face job discrimination and often earn less than their thinner counterparts. And researchers have previously shown that diabetes can hamper productivity and hurt employment prospects among older Americans. But Dr. Richards and his colleagues wanted to work backward to see if a similar pattern might occur with younger patients.
They found that high school students with diabetes had a dropout rate 6 percent greater than that of their peers, and were 10 percent less likely than others to find a job when looking for employment. The study controlled and adjusted for the effect of being overweight, a factor in Type 2 diabetes, as well as other family, environmental and demographic factors — and diabetes was still shown to have a direct and independent effect.
The researchers were surprised to find that diabetes also had an intergenerational effect. Young people in the study, regardless of whether they had diabetes, were 6 percent less likely to attend college if they had a parent with the disease. One explanation is that parents with diabetes might have fewer financial resources and less time and energy to devote to their children because of the encumbrance of managing the disease, Dr. Richards said. “It’s a novel and intriguing finding,” he said, “and if it is indeed a real phenomenon, then it suggests that the societal burden of diabetes has perhaps been underestimated.”