# Impact of Non-Payment of Salaries on Treatment Interruption among Patients with Diabetes

## TL;DR

This study shows that not receiving salaries during the pandemic increased the risk of diabetes treatment interruptions in Japan.

## Contribution

It identifies a direct link between recent non-payment of salaries and higher treatment interruption rates in diabetic patients.

## Key findings

- Recent non-payment of salaries was associated with a 4.58 times higher risk of treatment interruption.
- Past non-payment was linked to a 2.00 times higher risk of treatment interruption.
- Male participants showed similar patterns, with recent non-payment increasing risk by 3.67 times.

## Abstract

Financial stability during the coronavirus disease 2019 (COVID-19) pandemic was crucial for accessing health care services, including treatment for conditions such as diabetes mellitus. Understanding the relationship between non-payment of salaries and treatment interruption is vital.

This cohort study investigated the association between non-payment of salaries and treatment interruption in Japanese patients with diabetes. Data from web-based nationwide surveys conducted between July and October 2020 and from January to March 2021 were used.

This study followed up 655 patients with diabetes over time. Of these participants, 15 (2.3%) had recently experienced non-payment for their treatment, whereas 36 (5.5%) had experienced non-payment in the past. Compared with those who received payment for their treatment, the risk ratios (RRs) of treatment interruption were 4.58 (95% confidence interval [CI] 2.34-8.97) for those with recent non-payment and 2.00 (95% CI 0.92-4.36) for those with past non-payment. The RRs for the 548 male participants were 3.67 (95% CI 1.58-8.51) and 2.06 (95% CI 0.88-4.86) for recent and past non-payment, respectively.

In this longitudinal study of Japanese patients with diabetes, we identified an association between non-payment of salary and treatment interruption. Patients who experienced recent non-payment were more likely to experience interruptions in their scheduled care during the COVID-19 pandemic than those who experienced non-payment in the past.