Diabetes Delivers Economic 'Health Shock'

RWJF Scholar finds that young adults with diabetes have higher high school dropout rates and lower lifetime earnings than peers without the disease.

    • February 6, 2012

Diabetes takes an enormous toll on health and health care. But it also has an enormous economic impact, according to a new study by Jason Fletcher, PhD, an associate professor in the School of Public Health at Yale University and a Robert Wood Johnson Foundation (RWJF) Health & Society Scholar (2010).

Diabetes delivers what Fletcher calls a “health shock” to schooling and earnings. In his study, people with diabetes were 6 percent more likely than their peers to drop out of high school—a disparity larger than differences attributed to race and gender, according to Fletcher and his co-author, Michael Richards, MD, MPH, a graduate student in health economics at Yale University. Young adults with diabetes can also expect to lose at least $160,000 over their working lives compared to peers without the disease and, by age 30, are 10 percent less likely to be employed.

“The disease sets individuals on lower trajectories that accumulate as they age,” Fletcher said.

The effects of the disease don’t stop there. People with diabetes appear to pass the negative non-medical effects of the disease on to their children, according to the study. Children with a diabetic parent are 4 to 6 percent less likely to attend college—regardless of whether they themselves have the disease or not. And young adults with diabetic fathers were 7 percent less likely to be employed by age 30, they found.

“Diabetes doesn’t affect just you,” Fletcher said. “It may also affect your kids.”

Diabetes Linked to Obesity

The findings shed new light on the national epidemic of obesity, which is linked to increasing rates of diabetes. About 8 percent of the population—or some 23 million people—currently have diabetes, and the numbers are rising.

For the study, Fletcher and Richards analyzed a national study of adolescent health that tracked the same group of 15,000 adolescents from 1994 to 2008. It was published in the January issue of Health Affairs, a leading health policy journal.

The study builds on earlier research Fletcher conducted that examines the non-medical effects of other chronic childhood illnesses such as asthma and attention deficit hyperactivity disorder (ADHD). Children with asthma, for example, went on to earn less than their peers without asthma, and children with ADHD were more likely to repeat grades, drop out of high school, skip college and engage in criminal activity, he found.

To help prevent diabetes-related “health shock,” Fletcher and Richards recommend measures such as in-school screening to determine whether the disease is having an impact on individual learning and performance. The key to success, they note, may be early intervention. “Waiting until the onset of clinical symptoms may be too late if we hope to mitigate or reverse the negative impacts of the disease on human capital and workplace success,” they write.

They also call for more attention to the short-term consequences of the disease. “Our work suggests that the urgency should be brought forward earlier,” Richards said in a recent post on the RWJF New Public Health blog. “We need to be looking at long- and short-term consequences, including educational attainment and income levels.”