The Diabetes Paradox: Health Gains Not Translating into Better Workforce Participation

Advancements in medical technology over the past three decades have significantly improved the health outcomes for individuals with diabetes, making it easier to diagnose and manage the condition. Despite these health improvements, recent research from the USC Schaeffer Center reveals that workforce participation among people with diabetes has not increased accordingly. The study, published in JAMA Health Forum, analyzed data spanning 20 years from nearly 250,000 Americans aged 40–64—the age group most affected by diabetes and peak earning years. Findings show that individuals with diabetes are still substantially less likely to be employed and more likely to depend on disability benefits than their peers without the condition, with gaps of 21–24 percentage points in employment and 12–13 points in disability claims, even after demographic adjustments.

The phenomenon, termed the "diabetes paradox," suggests that health improvements alone may not be enough to enhance economic participation. Factors such as disparities in healthcare access, shifting diagnosis patterns, and changes in the nature of work may contribute. For instance, increased diagnoses following Medicaid expansion and greater access to healthcare could have identified more vulnerable populations with poorer economic prospects. Additionally, the types of jobs available to those with lower education levels—often physically demanding and increasingly so—pose barriers for those managing diabetes.

Interestingly, there was a slight increase in employment among diabetics during the COVID-19 pandemic, possibly due to remote work policies that made employment more accessible. Researchers propose that addressing the economic barriers faced by people with diabetes, perhaps through expanded access to preventive medications and targeted workplace policies, could improve workforce participation. Moving forward, clinical trials focusing on both health and economic outcomes are recommended to better understand how to support employment among individuals living with diabetes.

This research highlights the complex relationship between health improvements and economic outcomes, emphasizing the need for multi-faceted strategies to support people with diabetes in remaining engaged in the workforce.