Work Disability among Employees with Diabetes: Latent Class Analysis of Risk Factors in Three Prospective Cohort Studies.

Marianna Virtanen,Jenny Head,Marcel Goldberg,Jussi Vahtera,Mika Kivimäki,Marie Zins,Markus Jokela,Annaleena Okuloff,Adam G Tabak,Jenni Ervasti,Jaana Pentti,Archana Singh-Manoux,Rosemary Dray-Spira

doi:10.1371/journal.pone.0143184

Abstract

BackgroundStudies of work disability in diabetes have examined diabetes as a homogeneous disease. We sought to identify subgroups among persons with diabetes based on potential risk factors for work disability.MethodsParticipants were 2,445 employees with diabetes from three prospective cohorts (the Finnish Public Sector study, the GAZEL study, and the Whitehall II study). Work disability was ascertained via linkage to registers of sickness absence and disability pensions during a follow-up of 4 years. Study-specific latent class analysis was used to identify subgroups according to prevalent comorbid disease and health-risk behaviours. Study-specific associations with work disability at follow-up were pooled using fixed-effects meta-analysis.ResultsSeparate latent class analyses for men and women in each cohort supported a two-class solution with one subgroup (total n = 1,086; 44.4%) having high prevalence of chronic somatic diseases, psychological symptoms, obesity, physical inactivity and abstinence from alcohol and the other subgroup (total n = 1,359; 55.6%) low prevalence of these factors. In the adjusted meta-analyses, participants in the ‘high-risk’ group had more work disability days (pooled rate ratio = 1.66, 95% CI 1.38–1.99) and more work disability episodes (pooled rate ratio = 1.33, 95% CI 1.21–1.46). These associations were similar in men and women, younger and older participants, and across occupational groups.ConclusionsDiabetes is not a homogeneous disease in terms of work disability risk. Approximately half of people with diabetes are assigned to a subgroup characterised by clustering of comorbid health conditions, obesity, physical inactivity, abstinence of alcohol, and associated high risk of work disability; the other half to a subgroup characterised by a more favourable risk profile.

Highlights

Worldwide, more than 340 million people have diabetes [1] and years lived with disability due to diabetes has almost doubled between 1990 and 2010 [2]
The funders had no role in the study design; in the collection, analysis and interpretation of data; in writing of the report; or in the decision to submit the paper for publication
Half of people with diabetes are assigned to a subgroup characterised by clustering of comorbid health conditions, obesity, physical inactivity, abstinence of alcohol, and associated high risk of work disability; the other half to a subgroup characterised by a more favourable risk profile

Summary

Introduction

More than 340 million people have diabetes [1] and years lived with disability due to diabetes has almost doubled between 1990 and 2010 [2]. As diabetes is associated with reduced productivity, working capacity, and increased disability [3,4,5] it is important to identify factors that might help reduce disease complications, such as work disability, among individuals with diabetes. The majority of studies reported higher sickness absenteeism among people with diabetes compared to those without diabetes. Major risk factors of work disability—comorbid chronic diseases, obesity, physical inactivity, smoking, and high alcohol use [7,8,9,10,11,12,13]–may cause significant heterogeneity in the risk of work disability among people with diabetes. Studies of work disability in diabetes have examined diabetes as a homogeneous disease. We sought to identify subgroups among persons with diabetes based on potential risk factors for work disability

Methods

Results

Conclusion