Health Affairs

Adolescents and Young Adults with Diabetes Are More Likely to Drop Out of High School and Face Worse Job Prospects and Lower Wages Than Their Peers without Diabetes, Says Yale Study

People with diabetes can expect to lose more than $160,000 in wages over their working life

Bethesda, MD -- Having diabetes can carry many health consequences, but a new study in the January issue of Health Affairs shows that it also highly influences a young person's ability to complete high school, be employed, and earn a living wage. High school dropout rates among young people with diabetes are six percentage points higher than for young people without the disease. What's more, young adults with diabetes can expect to earn $160,000 less in wages over their working lives compared to peers without diabetes.

"Diabetes has a marked effect on schooling and earnings early in life, yet these are relatively unexamined implications of this disease," says the study's lead author, Jason M. Fletcher, an associate professor of public health at Yale University. (Fletcher conducted the study as a Robert Wood Johnson Foundation Health and Society Scholar at Columbia University.) He and coauthor Michael R. Richards, a physician researcher also at Yale, based their findings on the National Longitudinal Study of Adolescent Health, a national school-based study of teen health behaviors and their effects into young adulthood. Because the survey followed 15,000 teenagers well into their adulthood, it offers a unique window into the potential economic burden of disease over time.

The study shows that the nonmedical consequences of diabetes can manifest themselves early in life, with societal and economic implications as follows:

• The high school dropout rate among people with diabetes is 6 percentage points higher than the rate among people without the disease.
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• This disparity is larger than the black-white and male-female differences in the general population and is similar in magnitude to the effects of attention deficit hyperactivity disorder among children.
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• By age thirty, a person with diabetes can expect to have a ten-percentage-point reduction in the likelihood of being employed, in part because of reduced education, and to earn $6,000 less each year--or $160,000 over a lifetime--than peers without diabetes.

Fletcher and Richards offer several reasons for these outcomes. Having diabetes could alter a person's desire for and success in investing in a career or could dilute an employer's willingness to invest in an employee because of concerns about work absences or low productivity. In addition, people with diabetes may be affected by "job lock," which leads them to stay in lower-paying jobs for fear of losing health insurance or becoming subject to preexisting condition restrictions if they transition to other jobs.

In a surprising link, the researchers found that having a parent with diabetes also influences education and earnings. For example, having a parent with diabetes reduces the chance that a young adult with diabetes will attend college by four to six percentage points.

The findings highlight the urgency of combating diabetes, a disease that now afflicts nearly twenty-five million people in the United States and costs as much as $200 billion a year. The authors warn that the early effects of diabetes on high school dropout rates among young people, including on their employment and wage prospects, could cost society as much as $10 billion over the lifetime of the group studied for this paper.

The authors recommend that

• Policymakers place greater emphasis on diabetes prevention at younger ages, given how soon the disease's effects emerge and how profound the impact is later in life.
  
  
• Researchers identify and study children of parents with diabetes with an eye to isolating potential economic and educational spillover effects on the next generation. "Given the unyielding rise of diabetes and obesity among the population as a whole, the potential of diabetes to strike in one generation and then have negative effects on the next is a cause for alarm," the authors say.
  
  
• Health advocates promote in-school screening of diabetes at younger ages because there may be a large number of undiagnosed cases. Waiting until the onset of clinical symptoms may be too late if the goal is to mitigate or reverse the negative impacts of diabetes on education and workplace success, the authors conclude.

The January issue of Health Affairs was produced with support from UnitedHealth Foundation, Novo Nordisk, and the New York State Health Foundation.

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at www.healthaffairs.org. Read daily perspectives on Health Affairs Blog. Download weekly Narrative Matters podcasts on iTunes.