Diabetes Care study estimates that diabetes reduces productivity by >10%; Greater adverse impact in younger people – April 27, 2018

A fascinating new study published in the May issue of Diabetes Care assesses the productivity burden of diabetes, which has never before been quantified at the population level, independent of direct medical costs. The study estimated that diabetes reduces an individual’s productivity-adjusted life years (PALYs) by >10%.

Among adults age 20-69 in Australia, diabetes was associated with an 11.6% and 10.5% reduction in PALYs for men and women, respectively. As expected, the adverse impact of diabetes on productivity was higher among younger people, since they have more years left in the workforce. Among people age 20-24 years, diabetes reduced PALYs by 12.2% for men and 11.0% for women; among 65-69 year-olds, diabetes reduced PALYs by 9.4% and 9%, respectively.

Based on this data, the researchers projected that if diabetes did not exist, Australia’s GDP would improve by 80 billion AUD (~$60.6 billion), under conservative assumptions. This was astounding to us, and we wonder what the GDP per capital impact would be if diabetes diminished in the US. Prevalence of diagnosed + undiagnosed diabetes is ~10% in both countries, but this amounts to 30.3 million people in the US vs. 2.4 million people in Australia.

We imagine the effect of diabetes on productivity (and lifespan – discussed below) would follow similar trends in the US, Canada, and Europe, but we still see value in specific analyses in these populations as well.

Estimated loss in PALYs by sex and age group

Source: Diabetes Care, May 2018

As if the surging medical costs of diabetes weren’t enough ($727 billion globally in 2017, according to the most recent IDF Diabetes Atlas), this view into the indirect burden of lost productivity (absenteeism, presenteeism, etc.) enhances the economic incentive for national health systems to address the rising tide of diabetes. ADA recently estimated direct + indirect costs of diabetes in the US at $327 billion in 2017, up 26% (inflation-adjusted) from $245 billion in 2012. Indirect costs grew from $68 billion in 2007, to $73 billion in 2012, to $90 billion in 2017, driven by increasing prevalence.

The potential ROI is huge for diabetes prevention, both primary and secondary. We would love to see governments and other stakeholders prioritize access to diabetes prevention programs and diabetes self-management education. Perhaps most importantly, we need to create environments that facilitate physical activity and healthy eating.

This paper calls attention to the problems associated with earlier onset of type 2 diabetes, since productivity loss imposes a greater burden in younger patient populations. For this reason, we think these new findings are particularly compelling in the movement to treat prediabetes and prevent (or at least delay) type 2. (We’d be interested in an analysis of how prediabetes influences absenteeism and presenteeism as well, though we imagine the impact is smaller in magnitude compared to diabetes. Prediabetes was noticeably absent from ADA’s 2017 cost of diabetes analysis.)

Impact of Diabetes on Lifespan

• The analysis also found that diabetes in Australia is associated with a ~3% reduction in total years of life (3.0% for men, 2.5% for women). As with productivity, the impact of diabetes on lifespan was greatest for younger people – a not wholly unexpected trend, given that more years lived with a chronic progressive disease would translate to a greater health burden overall. Among 20-24 year-olds, diabetes was estimated to reduce lifespan by 3.8% for men and 2.7% for women, vs. 0.7% and 0.3%, respectively, for 65-69 year-olds. The authors attribute the greater impact of diabetes on male life expectancy to the slightly higher incidence of diabetes in men vs. women, as well as the fact that men have a shorter life expectancy than women to begin with.

-- by Abigail Dove, Payal Marathe, and Kelly Close