Increased risk of long-term sickness absence, lower rate of return to work and higher risk of disability pension among people with type 1 and type 2 diabetes mellitus: a Danish retrospective cohort study with up to 17 years' follow-up.

AIM: To evaluate labour market outcomes in type 1 or type 2 diabetes. METHODS: Individuals with type 1 (n = 431) and type 2 diabetes (n = 4047) were identified in Danish national registers from 1994 to 2011 and compared with individuals without diabetes (n = 101 295). Multi-state Cox proportional hazards analyses estimated hazard ratios (HR) with 95% confidence intervals (CI) for transitions between work, sickness absence, unemployment and disability pension. RESULTS: We observed significantly higher HR of sickness absence in type 1 diabetes (women: 1.34, 95% CI 1.12-1.62; men: 1.43, 1.01-2.03) and type 2 diabetes (women: 1.46, 95% CI 1.35-1.58; men: 1.64, 1.46-1.85) compared with people without diabetes. HR of unemployment was higher for men with type 1 diabetes (1.25, 95% CI 1.01-1.53) and women with type 2 diabetes (1.09, 95% CI 1.03-1.16) and men with type 2 diabetes (1.17, 95% CI 1.08-1.27). HR of disability pension was higher in type 1 diabetes (women: 1.90, 95% CI 1.46-2.46; men: 2.09, 1.38-3.18) and type 2 diabetes (women: 1.78, 95% CI 1.62-1.96; men: 2.11, 1.86-2.40). Only women with type 2 diabetes were less likely to return to work from sickness absence (HR 0.91, 95% CI 0.86-0.98) or unemployment (0.89, 95% CI 0.85-0.94). We found no significant difference between the two types of diabetes. Hazard ratios for diabetes regarding unemployment, sickness absence while unemployed and disability pension were significantly higher for men than for women. CONCLUSIONS: Both type 1 and type 2 diabetes affect labour market outcomes, but future studies should also consider comorbidity and social gradient.

Willingness to pay for flexible working conditions of people with type 2 diabetes: discrete choice experiments.

BACKGROUND: The increasing number of people with chronic diseases challenges workforce capacity. Type 2 diabetes (T2D) can have work-related consequences, such as early retirement. Laws of most high-income countries require workplaces to provide accommodations to enable people with chronic disabilities to manage their condition at work. A barrier to successful implementation of such accommodations can be lack of co-workers' willingness to support people with T2D. This study aimed to examine the willingness to pay (WTP) of people with and without T2D for five workplace initiatives that help individuals with type 2 diabetes manage their diabetes at work. METHODS: Three samples with employed Danish participants were drawn from existing online panels: a general population sample (n = 600), a T2D sample (n = 693), and a matched sample of people without diabetes (n = 539). Participants completed discrete choice experiments eliciting their WTP (reduction in monthly salary, €/month) for five hypothetical workplace initiatives: part-time job, customized work, extra breaks with pay, and time off for medical consultations with and without pay. WTP was estimated by conditional logits models. Bootstrapping was used to estimate confidence intervals for WTP. RESULTS: There was an overall WTP for all initiatives. Average WTP for all attributes was 34 €/month (95% confidence interval [CI]: 27-43] in the general population sample, 32 €/month (95% CI: 26-38) in the T2D sample, and 55 €/month (95% CI: 43-71) in the matched sample. WTP for additional breaks with pay was considerably lower than for the other initiatives in all samples. People with T2D had significantly lower WTP than people without diabetes for part-time work, customized work, and time off without pay, but not for extra breaks or time off with pay. CONCLUSIONS: For people with and without T2D, WTP was present for initiatives that could improve management of diabetes at the workplace. WTP was lowest among people with T2D. Implementation of these initiatives seems feasible and may help unnecessary exclusion of people with T2D from work.

Increased risk of long-term sickness absence, lower rate of return to work, and higher risk of unemployment and disability pensioning for thyroid patients: a Danish register-based cohort study.

CONTEXT: Little is known about how thyroid diseases affect work ability. OBJECTIVE: The objective of this study was to evaluate the risk of work disability for patients with thyroid disease compared with the general population. DESIGN, SETTING, AND PARTICIPANTS: In a longitudinal register study, outpatients (n = 862) with nontoxic goiter, hyperthyroidism, Graves' orbitopathy (GO), autoimmune hypothyroidism, or other thyroid diseases and their matched controls (n = 7043) were observed in the years 1994-2011 in Danish national registers of social benefits, health, and work characteristics. Cox regression analyses estimated adjusted hazard ratios (HRs) for the first year after diagnosis and subsequent years. MAIN OUTCOME MEASURES: Transitions between work, long-term sickness absence, unemployment, and disability pension were measured. RESULTS: Patients differed significantly from the general population with regard to sickness absence, disability pension, return from sickness absence, and unemployment. In the first year after diagnosis, higher risks of sickness absence was seen for GO (HR 6.94) and other hyperthyroid patients (HR 2.08), who also had lower probability of returning from sickness absence (HR 0.62) and higher risk of disability pension (HR 4.15). Patients with autoimmune hypothyroidism showed a lower probability of returning from sickness absence (HR 0.62). In subsequent years, GO patients had significantly higher risk of sickness absence (HR 2.08), lower probability of return from sickness absence (HR 0.51), and unemployment (HR 0.52) and a higher risk of disability pension (HR 4.40). Hyperthyroid patients also had difficulties returning from sickness absence (HR 0.71). CONCLUSIONS: Thyroid patients' risk of work disability is most pronounced in the first year after diagnosis and attenuates in subsequent years. GO patients have the highest risk of work disability.