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Years Lost and Medical Care Expenditures Associated with Diabetes

Diabetes can have an impact on life expectancy and health expenditures…

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Numerous studies and data collection have shown that the prevalence of diabetes has caused a substantial health and economic burden to patients and society. It is a public health concern that the prevalence of diabetes remains high and continues to grow not only in the U.S. but in other countries as well. In 2011, it was estimated that there were a total of 366 million people who are living with diabetes in the world, and this number is only expected to increase with time.

The objective of this study is to analyze the lifetime health care expenditures and life years lost that are associated with diabetes in the United States.

The data was extracted from the Sample Adult Data Files from the National Health Interview Survey (NHIS), a national probability sample of U.S., civilian non-institutionalized adults aged 18 years and older, the NHIS Linked Mortality Public use Files, which provide mortality follow-up data for the NHIS sample up to 31 December 2006 and the Household Component of the Medical Expenditure Panel Survey (MEPS-HC). MEPS-HC is a survey conducted by the Agency for Healthcare Research and Quality that provides detailed individual medical expenditure data. The NHIS sample contained 110,844 individuals, representing a population of 168,741,800 U.S. adults. The NHIS is an ongoing, continuous, nationwide, cross-sectional survey of the U.S. population conducted by the National Center for Health Statistics and the Bureau of Census. Data from the NHIS, the Medical Expenditure Panel Survey from 1997 to 2000, and the NHIS Linked Mortality Public-use Files with a mortality follow-up to 2006 were used to estimate age, race, sex, and BMI-specific risk of diabetes, mortality, and annual healthcare expenditures for both patients with diabetes and those without diabetes.

A three-state (no diabetes, diabetes, and death) Markov model was built, which was populated by the risk and cost estimates was used to compute life years and total lifetime health care expenditures. This was done by age, race, sex, and BMI classifications for patients with diabetes and without diabetes.

Results showed that the predicted life expectancy for patients with diabetes and without diabetes demonstrated an inverted U shape across most of the BMI classifications, with highest life years lost being for the overweight. BMI was categorized based on the standards established by the World Health Organization: normal weight (18.5≤ BMI <25 kg/m2); overweight (25≤ BMI <30 kg/m2); and class I (30≤ BMI <35 kg/m2), class II (35≤ BMI 40 kg/m2) had 17.9 remaining life years and lifetime health expenditures of $185,609 compared to diabetic white females with normal weight who had 22.2 remaining life years and lifetime health expenditures of $183,704.

In conclusion, the results showed that diabetes is associated with a large decrease in life expectancy and large increases in lifetime health care expenditures. In addition to a decreasing life expectancy by 3.3 to 18.7 years, diabetes was also shown to increase lifetime health care expenditures by $8,946 to $159,380 depending the age, race, sex, and BMI classification groups.

Practice Pearls:

  • Diabetic patients with a BMI >40 kg/m2 had lower remaining life years and increased lifetime health care expenditures.
  • Lifetime health care expenditure differentials were higher for whites than blacks and for females than males.
  • For a given age, race, and sex, overweight individuals with diabetes had, on average, lost the most life years, and the class II obese individuals (35≤ BMI <40 kg/m2) had the largest increase in lifetime health care expenditures.

Man-Yee Mallory Leung, Lisa M. Pollack, Graham, A.Colditz. et al. "Life Years Lost and Lifetime Health Care Expenditures Associated With Diabetes in the U.S., National Health Interview Survey, 1997–2000". Diabetes Care. March 2015;38:460–468