title: Work disability among individuals with diabetes.
abstract: OBJECTIVE
  Diabetes is rapidly increasing in prevalence among working-age adults, but little is known about the clinical characteristics that predict work disability in this population. This study assessed clinical predictors of work disability among working-age individuals with diabetes.
  
  
  METHODS
  In a cohort of diabetic individuals (n = 1,642) enrolled in a large health maintenance organization, excluding homemakers and retirees, we assessed the relation of diabetes severity, chronic disease comorbidity, depressive illness, and behavioral risk factors with work disability. Three indicators of work disability were assessed: being unable to work or otherwise being unemployed; missing > or =5 days from work in the prior month; and having severe difficulty with work tasks.
  
  
  RESULTS
  In the study population, 19% had significant work disability: 12% were unemployed, 7% of employed subjects had missed > or =5 days from work in the prior month, and 4% of employed subjects reported having had severe difficulty with work tasks. Depressive illness, chronic disease comorbidity, and diabetes symptoms were associated with all three types of work disability. Diabetes complications predicted unemployment and overall work disability status, whereas obesity and sedentary lifestyle did not predict work disability. Among subjects experiencing both major depression and three or more diabetes complications, >50% were unemployed; of those with significant work disability, half met the criteria for major or minor depression.
  
  
  CONCLUSIONS
  Depressive illness was strongly associated with unemployment and problems with work performance. Disease severity indicators, including complications and chronic disease comorbidity, were associated with unemployment and overall work disability status. Effective management of work disability among diabetic patients may need to address both physical and psychological impairments.
authors.affiliation: Center for Health Studies, Group Health Cooperative, 1730 Minor Ave., Suite 1600, Seattle, WA 98101, USA. vonkorff.m@ghc.org
authors.forename: Michael
authors.initials: M
authors.lastname: Von Korff
authors.forename: Wayne
authors.initials: W
authors.lastname: Katon
authors.forename: Elizabeth H B
authors.initials: EH
authors.lastname: Lin
authors.forename: Gregory
authors.initials: G
authors.lastname: Simon
authors.forename: Paul
authors.initials: P
authors.lastname: Ciechanowski
authors.forename: Evette
authors.initials: E
authors.lastname: Ludman
authors.forename: Malia
authors.initials: M
authors.lastname: Oliver
authors.forename: Carolyn
authors.initials: C
authors.lastname: Rutter
authors.forename: Bessie
authors.initials: B
authors.lastname: Young
mesh_terms: D015897:Comorbidity; D003863:Depression; D003920:Diabetes Mellitus / Q000503:physiopathology* / Q000523:psychology; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004522:Educational Status; D005006:Ethnicity; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006279:Health Maintenance Organizations; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012907:Smoking; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D006442:Glycated Hemoglobin