Young-onset diabetes (YOD) costs Hong Kong more than USD 400 million annually in productivity, researchers from the Chinese University of Hong Kong (CUHK) have reported.
In this first study to quantify productivity costs of YOD among Chinese patients, researchers from CUHK recruited patients with YOD aged 18–50 years who participated in the PRISM (Precision Medicine to Redefine Insulin Secretion and Monogenic Diabetes) trial in Hong Kong. During PRISM’s year 3 follow-up visit (between June 2023 and April 2024), 639 patients were invited to participate in the EIDC (Economic Impact of Diabetes and Related Complications) substudy. A total of 589 patients completed the EIDC questionnaire. [Diabetes Obes Metab 2026;28:1730-1740]
The final analysis of EIDC included 444 patients with young-onset type 2 diabetes who were actively employed (female, 40.1 percent; aged 40–50 years, 80.4 percent). Most of the participants were full-time employees (82.4 percent) with regular working hours (81.8 percent). The highest proportion (38.5 percent) had an annual salary of USD ≥29,000–<45,000.
A majority of the participants had had diabetes for ≥5 years (85.1 percent) and were either overweight (42.3 percent) or obese (30.2 percent). Less than half (46.8 percent) had HbA1c ≥7 percent, and 24.8 percent had LDL-cholesterol ≥2.6 mmol/L. One in ten (10.6 percent) had albuminuria, and 26.1 percent had reduced kidney function. Chronic kidney disease (6.1 percent) was the most common complication/comorbidity, followed by coronary heart disease (4.8 percent) and any-site cancer (3.4 percent). A majority of the participants were on oral glucose-lowering drugs (96.4 percent), lipid-lowering drugs (82.0 percent), and blood pressure–lowering drugs (78.6 percent).
Substantial productivity costs
Productivity losses were driven mainly by presenteeism. Nearly all (93.9 percent) participants reported presenteeism during the past 4 weeks, rating their overall job performance at 7.34 out of 10 on the WHO Health and Performance Questionnaire.
Annually, estimated mean productivity loss was 26.6 percent for presenteeism. This translated to an estimated on-the-job productivity loss of USD 10,834 per person per year when applied to self-reported salary.
Total mean sick leave taken was 0.48 days over the past 4 weeks. Nearly one-quarter (22.1 percent) of participants had taken at least half a day of sick leave during the same period. The mean annual number of sick leave days was 6.3 per person, which translated to an estimated cost of USD 647 per person per year for absenteeism.
When projected based on the number of patients with YOD (n=38,700) in Hong Kong’s electronic medical records, the territory-wide annual total productivity loss reached USD 444 million, of which USD 419 million was attributed to presenteeism and USD 25 million was attributed to absenteeism. [Int J Epidemiol 2022;51:e9-e17]
Factors associated with productivity
“Demographics, family background, work nature, and health status were independently associated with productivity in YOD,” the researchers noted.
Factors associated with increased productivity were female, childcare, flexible work schedule, and higher salary. On the other hand, several indicators of suboptimal health – including albuminuria, use of lipid-lowering drugs, and a higher number of sick leave days – were associated with reduced productivity.
Implications
“This study is the first to quantify productivity costs in Chinese patients with YOD, highlighting the need for workplace policies, intensive treatment and management strategies to enhance support for individuals with YOD,” the researchers concluded.