Abstract
BackgroundThere is scarcity of data concerning retirement and workforce loss exclusively in patients with type 1 diabetes. The aim of this study was to evaluate the prevalence, causes, and predictors of retirement in patients with type 1 diabetes in Brazil.MethodsThis was a multicenter cross-sectional study conducted between December 2008 and December 2010 in 28 public clinics in 20 Brazilian cities. Data were obtained from 3,180 patients aged 22 ± 11.7 years; 56.3% of the participants were female, and 57.4% were Caucasians. The mean time since diabetes diagnosis was 10.3 ± 8.1 years. Patients’ information (clinical factors and retirement data) was obtained through a questionnaire and a chart review. Patients were retired by diabetes according to the Brazilian Institute of Social Security’s criteria that takes in account the presence of diabetes-related chronic complications certified by a doctor, excluding any personal reason or another health condition besides diabetes. Both quantitative and qualitative tests were employed, and a multivariate logistic regression model was performed to identify the factors associated with retirement due to disabilities in patients with type 1 diabetes.ResultsThe overall frequency of retirement was 4.2%, with no difference between genders. The mean age of retirement was 35.5 ± 9.3 years, resulting in 17.5 ± 9.1 years of workforce losses. These patients had a significantly higher prevalence of severe hypoglycemia, proliferative and non-proliferative retinopathy, foot disorders, chronic or end-stage renal disease requiring dialysis or transplantation, cataracts, glaucoma, psychological disorders, hypertension, and overweight/obesity than did the employed patients. Multivariate logistic regression analysis with retirement as the dependent variable showed adjusted odds ratios (ORs) of 4.87 (2.66-8.78) for the presence of microvascular complications and 3.7 (2.04-6.70) for macrovascular complications.ConclusionsRetirement due to disabilities occurred in 4.2% of Brazilian patients with type 1 diabetes at an early age and is strongly associated with diabetes-related chronic complications. Health care workers should thus reevaluate the quality of care given to these patients.
Highlights
There is scarcity of data concerning retirement and workforce loss exclusively in patients with type 1 diabetes
The indirect costs of diabetes are primarily related to productivity losses due to disability, early retirement, unemployment, and absenteeism caused by acute and chronic complications [4,8,9]
Another study conducted in the US evaluating the sociodemographic characteristics of persons with diabetes has found that patients with type 1 diabetes (T1D) have a lower probability of employment and higher rates of absenteeism and early retirement [12]
Summary
There is scarcity of data concerning retirement and workforce loss exclusively in patients with type 1 diabetes. The indirect costs of diabetes are primarily related to productivity losses due to disability, early retirement, unemployment, and absenteeism caused by acute and chronic complications [4,8,9]. Patients with diabetes generally participate less in the workforce than subjects without diabetes of the same age and gender, as indicated by the indirect costs of diabetes reported by the Health and Retirement Study (HRS) conducted in the US [10]. This study as well as the GAZEL study conducted in France [11] have linked diabetes with greater risks of disability, retirement, and early death. These studies were conducted in predominantly middle-aged patients with type 2 diabetes. It is important to emphasize that so far there are few data in the international literature including Brazil on this topic, which is a very important issue because of its long-lasting consequences for patients and society
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