Implications of Chronic Health Conditions on Work-Force Participation: Disability, Retirement, Caregiving, and Lost Productivity

Published: 2001
Project ID: UM01-11


Abstract from first paper: Little is known regarding the amount of time spent by unpaid caregivers providing help to elderly individuals for disabilities associated with diabetes mellitus (DM). We sought to obtain nationally representative estimates of the time, and associated cost, of informal caregiving provided to the elderly with diabetes, and to determine the complications of DM that contribute most significantly to the subsequent need for informal care. We estimated multivariable regression models using data from the 1993 Asset and Health Dynamics (AHEAD) Study, a nationally representative survey of people aged 70 or older (n=7,443), to determine the weekly hours of informal caregiving and imputed cost of caregiver time for community-dwelling elderly with and without a diagnosis of DM. Those without DM received an average of 6.1 hours per week of informal care, those with DM taking no medications received 10.5 hours, those with DM taking oral medications received 10.1 hours, and those with DM taking insulin received 14.4 hours of care (p<.01). Disabilities related to heart disease, stroke, and visual impairment were important predictors of diabetes-related informal care. The total cost of informal caregiving for elderly individuals with diabetes in the U.S. was between $3 and $6 billion per year, similar to prior estimates of the annual paid long-term care costs attributable to DM. Diabetes imposes a substantial burden on elderly individuals, their families, and society, both through increased rates of disability and the significant time that informal caregivers must spend helping address the associated functional limitations. Future evaluations of the costs of diabetes, and the cost-effectiveness of diabetes interventions, should consider the significant informal caregiving costs associated with the disease. Abstract from second paper: Diabetes is a highly prevalent condition with substantial associated morbidity. The economic impact of diabetes is dramatic, with estimated total costs of $98 billion in 1997. We sought to investigate the effects of diabetes on work-force participation, including absenteeism, retirement, and disability. We used the first wave of the Health and Retirement Study (HRS) as a data source. The likelihood of falling into various work-related categories, by diabetes status, was estimated using logistic regression; duration of being in different states of participation was estimated using OLS regression. We then estimated the economic impact of diabetes using the estimates of lost time due to disability, absenteeism, and early retirement combined with median salaries in the HRS sample. Diabetes is a significant predictor of self-rated disability (OR = 3.1), of not working due to health impairments (OR = 2.4), and of receiving Social Security Disability or VA disability (OR = 2.6 and 3.0, respectively). Subjects with diabetes also missed more work time than those without (incremental missed days per year = 2.7). These changes in work-force participation equate to (up until wave 1 of the HRS) to an incremental loss of $57.8 billion in income, and another $7.8 billion in disability payments. Diabetes has a profound economic impact in the US. These figures should be considered when evaluating the cost-effectiveness of diabetes interventions and to inform and improve the allocation of resources for chronic disease management.