Type 1 diabetes is a lifelong, chronic disease, that generally has a sudden onset early in life, which changes the conditions for the affected child and the child’s family. The overall purpose of this thesis was to explore the socioeconomic consequences of childhood onset type 1 diabetes and through this investigate how an early life health shock can affect adult socioeconomic status. The four included papers aim to capture the overall effect of type 1 diabetes on socioeconomic outcomes, such as education, employment and earnings, during different stages in life, including adolescence, young adulthood, and midlife. The thesis also explores potential pathways through which type 1 diabetes may ultimately lead to detrimental labor market outcomes.
The analyses were performed using data from the Swedish Childhood Diabetes Register, a Swedish national research register for childhood incidence of type 1 diabetes, that has been linked to other national health data registers and socio-economic databases. Using a control group of four unique population controls, matched by year of birth and municipality of residence at the time of the diagnosis, the effect of type 1 diabetes was studied in birth cohorts born between 1962 and 1993, analyzing outcomes in ages 16 to 50 years.
The results show that the onset of type 1 diabetes, before the age of 15, negatively affects educational achievements, in both compulsory schooling and upper secondary school, as well as the final level of education. Despite developments in treatment and educational changes over time, the data indicate a persistent negative effect of type 1 diabetes on school performance also in later birth cohorts. In a longer perspective, the results show that childhood onset type 1 diabetes negatively affects employment and earnings for both women and men. The magnitude of the effect, however, depends on individual characteristics, such as gender, age at diagnosis, and disease duration. The results suggest that adult health contributes to a large proportion of the total labor market effect of type 1 diabetes, but other important factors, related to occupation, education, and family formation, also explain part of the impact on employment and earnings.
In conclusion, the findings of this thesis show that childhood onset type 1 diabetes negatively impacts socioeconomic outcomes, both early in life and in adulthood, and represents a burden that is borne both by the individual and the society. In a broader perspective, the results provide insights to how a distinct and definable shift in childhood health may translate into working life consequences.
Thesis 2017. Lund: Lund University, the Faculty of Medicine, Sweden.