Long-Term Health Improvements and Economic Performance Among Individuals With Diabetes.

Importance: Advances in diabetes detection and treatment have mitigated the risks of serious complications and death, but little is known about whether economic outcomes for people with diabetes have similarly improved.

Objective: To assess whether associations between diagnosed diabetes and labor market outcomes have changed over time.

Design, setting, and participants: This cross-sectional study analyzed data from the National Health Interview Survey from 1998 to 2018. The sample was nationally representative of the US population aged 40 to 64 years. Average marginal effects, the regression-adjusted difference in probability of outcomes between people with and without diabetes, pooled by 3-year periods (1998-2000 to 2016-2018), were estimated with controls for demographics, education, and comorbid health risks. Behavioral Risk Factor Surveillance (BRFSS) data from 1993 to 2023 were included in robustness analyses. Data were analyzed from September 2023 to November 2024.

Exposure: Diagnosed diabetes, defined based on respondents' self-report that they have ever been diagnosed by a medical professional.

Main outcomes and measures: The main outcomes were labor force participation and any Supplemental Security Income or Social Security Disability Insurance income receipt. Secondary outcomes included reporting health limitations for any activities, health limitations for work, any nights in hospital, and receiving health care 10 or more times in the past year.

Results: The study included 249 712 individuals, 25 177 with diabetes. The weighted population was 50% female, 12% Hispanic, 11% non-Hispanic Black, 72% non-Hispanic White, and 5% multiracial or other race (Alaska Native or American Indian, Asian, or nonspecified). In the weighted population from 1998 to 2000, 46% of people with diabetes were 55 years and older, while 27% of people without diabetes were 55 years and older. In the weighted population from 2016 to 2018, 56% of people with diabetes were 55 years and older, while 38% of people without diabetes were 55 years and older. The average marginal effect of diabetes on probability of labor force participation was -10.9 percentage points (95% CI, -13.0 to -8.9) from 1998 to 2000 and -11.0 percentage points (95% CI, -13.0 to -9.1) from 2016 to 2018; for people who received Supplemental Security Income or Social Security Disability Insurance income, it was 4.4 percentage points (95% CI, 3.3-5.5) and 4.9 percentage points (95% CI, 3.7-6.0) from 1998 to 2000 and 2016 to 2018, respectively. During the same period, average marginal effects for all examined health outcomes significantly improved. Similar patterns were observed using BRFSS data, but with a slight improvement in labor force participation between 2017 to 2019 and 2021 to 2023.

Conclusions and relevance: This cross-sectional study demonstrated that while people with diabetes experienced meaningful health improvements, they saw little progress in economic performance. Changing patient selection appears to play a role. Future research is needed to disentangle the paradox.