Productivity loss associated with type 2 diabetes in China: the trend and projection from 1990 to 2050

Background: Type 2 diabetes (T2D) has become increasingly prevalent among young adults in their prime working years. This study aimed to estimate the productivity-adjusted life years (PALYs) loss associated with T2D among working-age Chinese adults from 1990 to 2021, with projections to 2050. Methods: Leveraging data from the Global Burden of Disease (GBD) 2021 database, the United Nations, and the China Chronic Disease and Risk Factors Surveillance study, we quantified individual- and population-level PALYs loss associated with T2D between 1990 and 2021 and projected trends through 2050 using a projection model. Loss of PALYs was calculated by combining productivity losses from excess mortality (years of life lost, YLL) with reductions in labour force participation, presenteeism, and absenteeism (years of productivity lost, YPL). Gross domestic product (GDP) loss was estimated by valuing each lost PALY using China's annual GDP per worker. Results: In 2021, 39.8 million working-age Chinese men and 23.3 million women had T2D. Over their working lifetime, T2D was associated with 53.42 (95% uncertainty interval (UI) = 51.25-55.59) million PALYs loss in men and 33.56 (95% UI = 31.59-35.52) million in women, equivalent to 1.34 (95% UI = 1.29-1.40) and 1.44 (95% UI = 1.36-1.53) PALYs loss per man and woman, respectively. Loss of GDP reached USD 1035.31 billion for men and USD 650.38 billion for women. Total PALYs loss is projected to increase from 1990 to 2050, although per-person losses decline in both sexes. Women with T2D experience greater per-person PALYs loss than men in 2030 and 2050. Conclusions: T2D among working-age population is associated with substantial PALY and economic losses, underscoring urgent need for targeted interventions.