Whenever I hear statistics that diabetes costs the U.S. $245 billion a year — and billions more globally — these numbers feel too big to get my head around.
So a new analysis — which attempts to break down the cost-per-person toll of diabetes in countries around the globe — caught my attention.
One finding: In the U.S., women with diabetes have total lifetime health care costs of $283,000. Equally striking is that the condition is linked to a significant decline in earning power.
The analysis looks at the costs from the rise in diabetes, which now affects 382 million people worldwide. The number is expected to surge to 592 million by 2035.
Two out of every three new cases occur in countries with low and medium incomes, such as China, India, Mexico and Egypt. Study author Till Seuring of Norwich Medical School, University of East Anglia in the UK, blames "rapid urbanization, changing eating habits and increasingly sedentary lifestyles."
The direct costs for treating the disease vary widely in different countries. For instance, they range from "$242 [per person, per year] for a study on out-of-pocket expenditures in Mexico to $11,917 [per person, per year] for a study on the cost of diabetes in the USA," according to the paper. Mexicans with diabetes pay, on average, about 50 percent of the costs of treating the disease.
The blue circle is the symbol of diabetes — carried here by students marching in a World Diabetes Day rally in Kolkata, India.
In India, where type 2 diabetes is on the rise, the median direct costs are estimated at about $1,500 per person, per year. But there's much more spending in urban areas, researchers say, compared to rural areas in part due to the availability of care in cities.
In Pakistan, the researchers found that people with diabetes spend about 18 percent of their income to treat the disease.
The study, which is published in Pharmaco Economics, finds that costs of treating diabetes are closely linked to a country's GDP (gross domestic product), partly because wealthier countries spend more on healthcare.
The study also shows the extent to which diabetes is associated with a significant erosion in earning power and opportunities for people living with the condition.
In China, the researchers found that men with diabetes earn 22 percent less than men without the diagnosis and their health care costs are three times higher.
The economic fall-out of the disease is not limited to the developing world.
In the U.S., the analysis finds that employment opportunities for women with diabetes are reduced by about 50 percent, and that women with diabetes lose about $21,000 in earnings per year.
In Canada, a study has found that women are 17 percent less likely to be employed (19 percent for men).
"Our findings underline the fact that diabetes not only has strong adverse effects on people's health but also presents a large — and at least partly avoidable — economic burden," Seuring says.
Interestingly, in Taiwan, women with diabetes did not lose earnings, but researchers have documented a 19 percent reduction in employment opportunities for men.
It's not clear why, but "the labor markets are different," says study author Seuring. Men may have more physically demanding jobs so the lost wages could reflect diminished physical capabilities among men with diabetes.
But there are several caveats to interpreting the studies on diabetes costs. "It's tricky," says Seuring.
For starters, this new analysis is based on dozens of studies — all based on different methodologies. So it's not apples to apples.
This may help explain some of the big divergences — such as the paper's finding that indirect diabetes costs (which include wages lost due to the disease) ranged from $45 in Pakistan per person, per year to $16,000 per person, per year in the Bahamas.
These figures were derived, in part, from surveys that asked people in to estimate lost work due to diabetes. But the techniques and databases that researchers used to calculate losses in Pakistan may be quite different than those used in the Bahamas.
Another caveat: There's no clear distinction between type 1 diabetes and type 2, though the authors point out that the vast majority of global diabetes is type 2.
Since type 2 diabetes can be managed successfully — and in some cases reversed by lifestyle changes and medicines — its toll on wages and job opportunities is most illuminating. And, humph, depressing.