Katerina Gousia, Olena Nizalova, Gintare Malisauskaite, Hansel Teo, Julien Forder
Diabetes is one of the most common long-term conditions in the UK and worldwide. In addition to affecting health, diabetes impacts on social care needs. People with diabetes are more likely to suffer limitations with their mobility, activities of daily living and instrumental activities of daily living, have lower quality of life and struggle with their psychological wellbeing. As a result, diabetes can affect formal and informal care demand and costs. However, we do not yet have a good understanding of how large this effect is likely to be. This paper tries to fill this evidence gap. The objective of this study is to estimate the effect of diabetes on the utilization of formal care services and informal care in the UK.
We use data from the English Longitudinal Study of Ageing (ELSA) (1998-2017), a longitudinal survey that contains information on diabetes prevalence and utilization of formal care services and informal care, together with other individual level characteristics. To address endogeneity concerns, generated by unobserved comorbidities and environmental factors, we use recently released polygenic score data on diabetes and a Mendelian Randomization approach, whereby diabetes is instrumented by individuals’ genetic predisposition to develop the condition.
We find that diabetes has a positive and statistically significant effect on the probability of using formal and informal care. Having diabetes predicts a 10 percent higher probability of using formal care and a 34 percent probability of using informal care in the baseline estimates. Controlling for demographics, household income and other comorbidities that may confound the relationship between diabetes and the use of long-term care, we continue to find that diabetes increases the probability of using formal care by 9 percent and the probability of using informal care by 27 percent.
Diabetes has been long acknowledged as a pressing healthcare need. Our results indicate that diabetes is likely to put significant pressures on social care too. The findings highlight the importance of considering both health and social care services when assessing the implications of diabetes and provide estimates to inform projections about social care costs and evaluations of interventions associated with diabetes.
