Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis.
Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles.
JAMA Intern Med. 2023 Oct 1;183(10):1071-1079. doi: 10.1001/jamainternmed.2023.3283.
An intensive lifestyle intervention (ILI) has been shown to improve diabetes management and physical function. These benefits could lead to better labor market outcomes, but this has not been previously studied.
To estimate the association of an ILI for weight loss in type 2 diabetes with employment, earnings, and disability benefit receipt during and after the intervention.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study included participants with type 2 diabetes and overweight or obesity and compared an ILI with a control condition of diabetes support and education. Data for the original trial were accrued from August 22, 2001, to September 14, 2012. Trial data were linked with Social Security Administration records to investigate whether, relative to the control group, the ILI was associated with improvements in labor market outcomes during and after the intervention period. Difference-in-differences models estimating relative changes in employment, earnings, and disability benefit receipt between the ILI and control groups were used, accounting for prerandomization differences in outcomes for linked participants. Outcome data were analyzed from July 13, 2020, to May 17, 2023.
The ILI consisted of sessions with lifestyle counselors, dieticians, exercise specialists, and behavioral therapists on a weekly basis in the first 6 months, decreasing to a monthly basis by the fourth year, designed to achieve and maintain at least 7% weight loss. The control group received group-based diabetes education sessions 3 times annually during the first 4 years, with 1 annual session thereafter.
Employment and receipt of federal disability benefits (Supplemental Security Income and Social Security Disability Insurance), earnings, and disability benefit payments from 1994 through 2018.
A total of 3091 trial participants were linked with Social Security Administration data (60.1% of 5145 participants initially randomized and 97.0% of 3188 of participants consenting to linkage). Among the 3091 with fully linked data, 1836 (59.4%) were women, and mean (SD) age was 58.4 (6.5) years. Baseline clinical and demographic characteristics were similar between linked participants in the ILI and control groups. Employment increased by 2.9 (95% CI, 0.3-5.5) percentage points for the ILI group relative to controls (P = .03) with no significant relative change in disability benefit receipt (-0.9 [95% CI, -2.1 to 0.3] percentage points; P = .13).
The findings of this cohort study suggest that an ILI to prevent the progression and complications of type 2 diabetes was associated with higher levels of employment. Labor market productivity should be considered when evaluating interventions to manage chronic diseases.
强化生活方式干预（ILI）已被证明可改善糖尿病管理和身体功能。这些益处可能会带来更好的劳动力市场结果，但这尚未得到研究证实。
评估 2 型糖尿病患者的 ILI 减肥干预对就业、收入和残疾福利领取的影响，包括干预期间和之后的情况。
设计、地点和参与者：这项队列研究纳入了 2 型糖尿病且超重或肥胖的患者，并将 ILI 与糖尿病支持和教育的对照组进行了比较。原始试验的数据收集时间为 2001 年 8 月 22 日至 2012 年 9 月 14 日。试验数据与社会保障管理局记录相关联，以调查与对照组相比，ILI 是否与干预期间和之后劳动力市场结果的改善相关。使用差异中的差异模型估计 ILI 组和对照组之间就业、收入和残疾福利领取的相对变化，同时考虑到链接参与者的预先随机化结果差异。对 2020 年 7 月 13 日至 2023 年 5 月 17 日的结果数据进行了分析。
ILI 包括在最初的 6 个月内每周与生活方式顾问、营养师、运动专家和行为治疗师进行一次会议，在第 4 年减少到每月一次，旨在实现并维持至少 7%的体重减轻。对照组在最初的 4 年内每 3 次接受年度团体式糖尿病教育课程，之后每年接受 1 次。
1994 年至 2018 年的就业和联邦残疾福利（补充保障收入和社会保障残疾保险）领取、收入和残疾福利支出。
共有 3091 名试验参与者与社会保障管理局数据相关联（最初随机分配的 5145 名参与者中有 60.1%，同意链接的 3188 名参与者中有 97.0%）。在具有完全关联数据的 3091 名参与者中，1836 名（59.4%）为女性，平均（SD）年龄为 58.4（6.5）岁。ILI 和对照组的链接参与者之间的基线临床和人口统计学特征相似。ILI 组的就业比例比对照组增加了 2.9（95%CI，0.3-5.5）个百分点（P=0.03），残疾福利领取的相对变化无统计学意义（-0.9 [95%CI，-2.1 至 0.3] 个百分点；P=0.13）。
这项队列研究的结果表明，预防 2 型糖尿病进展和并发症的 ILI 与更高的就业水平相关。在评估管理慢性病的干预措施时，应考虑劳动力市场的生产力。
