Survival rates and worker compensation expenses in a national cohort of Mexican workers with permanent occupational disability caused by diabetes

Abstract

BackgroundPermanent occupational disability is one of the most severe consequences of diabetes that impedes the performance of usual working activities among economically active individuals. Survival rates and worker compensation expenses have not previously been examined among Mexican workers. We aimed to describe the worker compensation expenses derived from pension payments and also to examine the survival rates and characteristics associated with all-cause mortality, in a cohort of 34,014 Mexican workers with permanent occupational disability caused by diabetes during the years 2000–2013 at the Mexican Institute of Social Security.MethodsA cross-sectional analysis study was conducted using national administrative records data from the entire country, regarding permanent occupational disability medical certification, pension payment and vital status. Survival rates were estimated using the Kaplan–Meier method. Multivariate Cox proportional hazard model was used to estimate adjusted hazard ratios (HR) and 95 % confidence intervals (95 % CI) in order to assess the cohort characteristics and all-cause mortality risk. Total expenses derived from pension payments for the period were accounted for in U.S. dollars (USD, 2013).ResultsThere were 12,917 deaths in 142,725.1 person-years. Median survival time was 7.26 years. After multivariate adjusted analysis, males (HR, 1.39; 95 % CI, 1.29–1.50), agricultural, forestry, and fishery workers (HR, 1.41; 95 % CI, 1.15–1.73) and renal complications (HR, 3.49; 95 % CI, 3.18–3.83) had the highest association with all-cause mortality. The all-period expenses derived from pension payments amounted to $777.78 million USD (2013), and showed a sustained increment: from $58.28 million USD in 2000 to $111.62 million USD in 2013 (percentage increase of 91.5 %).ConclusionsMexican workers with permanent occupational disability caused by diabetes had a median survival of 7.26 years, and those with renal complications showed the lowest survival in the cohort. Expenses derived from pension payments amounted to $ 777 million USD and showed an important increase from 2000 to 2013.

Cost-effectiveness of the use of the continuous subcutaneous insulin infusion pump versus daily multiple injections in type 1 diabetes adult patients at the Mexican Institute of Social Security

“…These results do not consider pension payments for early retirement due to diabetes that would result in a further reduction of the estimated ICER. An analysis of a retrospective cohort of 34,014 Mexican workers with permanent occupational disability caused by T1D and T2D during the years 2000–2013 at IMSS found that the mean age for permanent occupational disability was 51.6 years, and that the expenditure on diabetes-related pensions almost doubled (USD$58.28 to USD$111.62 million) [35]. As such, the results of this analysis may be considered a conservative estimate.…”

Socio-demographic and clinical characteristics of type 1 diabetes patients associated with emergency room visits and hospitalizations in Mexico

“…The second challenge is the economic burden from indirect costs, since IMSS affiliates are entitled to receive temporary and permanent disability leave and pensions. Between 2000 and 2013, diabetes-related pensions almost doubled, from USD$58.28 million to USD$111.62 million [ 28 ]. From an economic and social perspective, the poor health of T1D patients −particularly chronic complications− have critical consequences such as increased work absence, reduced work productivity, permanent occupational disability, early retirement, shortened life-expectancy and low quality-of-life [ 29 , 30 ].…”

“…The analysis of a retrospective cohort of 34,014 Mexican workers with permanent occupational disability caused by T1D and T2D during the years 2000–2013 at IMSS found that the mean age for permanent occupational disability was 51.6 years. Life expectancy was 7.26 years less, and 55.5 ± 8.0 years (mean, SD) of age at death [ 28 ]. Renal complications are the principal characteristic associated with a significantly elevated all-cause mortality (Hazard Ratio 3.49; 95% CI 3.18–3.83) [ 28 ].…”

“…Life expectancy was 7.26 years less, and 55.5 ± 8.0 years (mean, SD) of age at death [ 28 ]. Renal complications are the principal characteristic associated with a significantly elevated all-cause mortality (Hazard Ratio 3.49; 95% CI 3.18–3.83) [ 28 ]. Assessing the risks for ER visits and hospital admission of T1D patients is justifiable since there is a lack of evidence in developing countries such as Mexico that can guide interventions to achieve glycemic control, reduce acute complications and delay chronic complications.…”

Prevalence of diabetes complications and associated comorbidities in the Family Medicine setting at the Mexican Institute of Social Security

“…Such difference might be explained by the fact that we analyzed the complications that occurred in this entire population, whereas that study evaluated the percentage of complications that were observed among patients applying for a disability pension. 16 However, as pointed out by Arredondo et al, chronic kidney disease, retinopathy, cardiovascular disease, diabetic neuropathy and peripheral vascular disease have a rather high impact on the cost of medical care in Mexico. 17 Microvascular complications were the most frequently recorded (25.4 %), perhaps because they are diagnosed and treated by the family doctor.…”