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The Easy/Medium/Hard setting only changes what you start up with. It doesn't change anything about how much workers produce, how much they eat or their luck when it comes to accidents. It only really matters for the start of the game. If you manage to get through the early years and start trading and get farming stuff, you won't see a difference after that.
The "real" difficulty comes from picking a terrible climate and a mountain map without a lof of nice flat space to expand easily. And variety comes from adding mods with more start conditions, climates, maps and a bit of extra complexity. There again, it doesn't exactly add real difficulty as AI behavior can't be tweaked.