Why childhood-onset type 1 diabetes impacts labour market outcomes: a mediation analysis

Abstract

Aims/hypothesis Previous studies show a negative effect of type 1 diabetes on labour market outcomes such as employment and earnings later in life. However, little is known about the mechanisms underlying these effects. This study aims to analyse the mediating role of adult health, education, occupation and family formation. Methods A total of 4179 individuals from the Swedish Childhood Diabetes Register and 16,983 individuals forming a population control group born between 1962 and 1979 were followed between 30 and 50 years of age. The total effect of having type 1 diabetes was broken down into a direct effect and an indirect (mediating) effect using statistical mediation analysis. We also analysed whether type 1 diabetes has different effects on labour market outcome between the sexes and across socioeconomic status. Results Childhood-onset type 1 diabetes had a negative impact on employment (OR 0.68 [95% CI 0.62, 0.76] and OR 0.76 [95% CI 0.67, 0.86]) and earnings (−6%, p < 0.001 and −8%, p < 0.001) for women and men, respectively. Each of the mediators studied contributed to the total effect with adult health and occupational field accounting for the largest part. However, some of the effect could not be attributed to any of the mediators studied and was therefore likely related to other characteristics of the disease that hamper career opportunities. The effect of type 1 diabetes on employment and earnings did not vary significantly according to socioeconomic status of the family (parental education and earnings). Conclusions/interpretation A large part of the effect of type 1 diabetes on the labour market is attributed to adult health but there are other important mediating factors that need to be considered to reduce this negative effect.

Low health-related quality of life is strongly linked to upper extremity impairments in type 1 diabetes with a long duration

“…Corresponding general data concerning work incapacity in Sweden in the year 2010 indicated a mean 5.7% prevalence [30]. Earlier studies have mostly addressed the financial aspects of impaired work ability [13,15,16,18]. Additionally, earlier reports often lack direct comparisons with the general population.…”

“…However, data concerning type 1 diabetes and the relationships between musculoskeletal disorders and work ability are limited [11,12]. Previous comparative reports of work ability in diabetes patients and the general population focus on financial aspects of occupational status rather than possible explanatory factors [16][17][18]. A Danish population-based study reported 12% higher sick leave per year in patients with type 1 diabetes compared with the general population, and additionally impaired HRQOL in type 1 diabetes patients.…”

The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research

“…The incidence of type 1 diabetes is increasing in children and youth, suggesting that environmental factors are influencing those with a genetic predisposition [ 68 ]. Linking the Swedish Child Diabetes Register and socioeconomic data, researchers have studied the association between education, employment, and earnings [ 69 – 72 ]. Adult type 1 diabetes is associated with employment and salary development [ 73 ].…”

Costs of diabetes complications: hospital-based care and absence from work for 392,200 people with type 2 diabetes and matched control participants in Sweden

“…Some examples include studies on total costs of care for people with diabetes [7][8][9][10], on prevalence and incidence of diabetes [11,12] and on types of glucoselowering medication and clinical outcomes [13]. Similar topics have also been addressed using patient cohorts registered in quality registers or incidence registers and using outcome data from national health registers in Sweden [14][15][16][17][18][19][20][21].…”