Trends in diabetes-related sickness absence and social insurance costs in Poland: a national registry-based study, 2020–2024

IntroductionDiabetes mellitus is recognized as a major contributor to productivity losses, yet nationwide evidence on diabetes-related sickness absence in Central and Eastern Europe has been limited. This study was designed to characterize trends in sickness absence and rehabilitation benefits due to type 1 and type 2 diabetes in Poland between 2020 and 2024 using national social insurance registry data.MethodsAll sickness absence and rehabilitation benefit certificates issued in 2020–2024 for adults covered by the Polish Social Insurance Institution (ZUS) were analyzed, with diabetes identified by ICD-10 codes E10 (type 1) and E11 (type 2). Annual numbers of certificates, total days of absence, crude rates per 100,000 population, and social insurance expenditures in PLN and EUR were calculated and stratified by sex, age group and region.ResultsAmong 16.6 million insured adults, days of sickness absence due to type 1 diabetes were reduced from 300,387 in 2020 to 232,976 in 2024 (−22.4%), while those due to type 2 diabetes were reduced from 520,090 to 488,531 (−6.1%). Between 2020 and 2024, the reduction in type 2 diabetes—related absence was driven mainly by women (−20.2%), whereas only a marginal decline was observed among men (−1.5%). Despite these declines in days of absence, yearly social insurance expenditures were increased by 16.1% for type 1 diabetes and by 39.8% for type 2 diabetes, reaching approximately 6.44 and 15.03 million EUR in 2024, respectively, with up to four-fifths of total costs being attributed to men. Marked regional variation was observed, with voivodeship-level rates differing by more than twofold and rising diabetes-related absence being recorded in some regions despite national declines.ConclusionsIn Poland, diabetes-related sickness absence declined between 2020 and 2024, while social insurance expenditures increased substantially, particularly for type 2 diabetes and among men. These findings highlight the need for targeted workplace and clinical interventions.