Lifestyle-related risk factors and trajectories of work disability over 5 years in employees with diabetes: Findings from two prospective cohort studies

Abstract

Aims: To examine work disability trajectories among employees with and without diabetes and identify lifestyle-related factors associated with these trajectories. Methods: We assessed work disability using records of sickness absence and disability pension among participants with diabetes and age-sex-, socio-economic status-and marital status-matched controls in the Finnish Public Sector Study (1102 cases; 2204 controls) and the French GAZEL study (500 cases; 1000 controls), followed up for 5 years. Obesity, physical activity, smoking and alcohol consumption were assessed at baseline and the data analysed using group-based trajectory modelling. Results: Five trajectories described work disability: 'no/very low disability' (41.1% among cases and 48.0% among controls); 'low-steady' (35.4 and 34.7%, respectively); 'high-steady' (13.6 and 12.1%, respectively); and two 'high-increasing' trajectories (10.0 and 5.2%, respectively). Diabetes was associated with a 'high-increasing' trajectory only (odds ratio 1.90, 95% CI 1.47-2.46). Obesity and low physical activity were similarly associated with high work disability in people with and without diabetes. Smoking was associated with 'high-increasing' trajectory in employees with diabetes (odds ratio 1.88, 95% CI 1.21-2.93) but not in those without diabetes (odds ratio 1.32, 95% CI 0.87-2.00). Diabetes was associated with having multiple (≥ 2) risk factors (21.1 vs. 11.4%) but the association between multiple risk factors and the 'high-increasing' trajectory was similar in both groups. Conclusions: The majority of employees with diabetes have low disability rates, although 10% are on a high and increasing disability trajectory. Lifestyle-related risk factors have similar associations with disability among employees with and without diabetes, except smoking which was only associated with poorer prognosis in diabetes. What's new?: We examined trajectories of work disability among people with and without diabetes. Five trajectories describing disability level at the beginning of follow-up and its development over 5 years were identified: 'no/very low disability', 'low-steady', 'high-steady' and two 'high-increasing' trajectories. The majority of employees with and without diabetes had low-disability trajectories. Diabetes was associated with 'high-increasing' disability trajectories, although this affected only 10% of the population with diabetes. Obesity and physical inactivity, irrespective of diabetes, and smoking among employees with diabetes were associated with adverse disability trajectories.