Burden and Consequences of Financial Hardship From Medical Bills Among Nonelderly Adults With Diabetes Mellitus in the United States.
Burden and Consequences of Financial Hardship From Medical Bills Among Nonelderly Adults With Diabetes Mellitus in the United States.
- 2020
BACKGROUND: The trend of increasing total and out-of-pocket expenditure among patients with diabetes mellitus represents a risk of financial hardship for Americans and a threat to medical and nonmedical needs. We aimed to describe the national scope and associated tradeoffs of financial hardship from medical bills among nonelderly individuals with diabetes mellitus. CONCLUSIONS: Nonelderly patients with diabetes mellitus have a high prevalence of financial hardship from medical bills, with deleterious consequences. METHODS AND RESULTS: We used the National Health Interview Survey data from 2013 to 2017, including adults <=64 years old with a self-reported diagnosis of diabetes mellitus. Among 164 696 surveyed individuals, 8967 adults <=64 years old reported having diabetes mellitus, representing 13.1 million individuals annually across the United States. The mean age was 51.6 years (SD 10.3), and 49.1% were female. A total of 41.1% were part of families that reported having financial hardship from medical bills, with 15.6% reporting an inability to pay medical bills at all. In multivariate analyses, individuals who lacked insurance, were non-Hispanic black, had low income, or had high-comorbidity burden were at higher odds of being in families with financial hardship from medical bills. When comparing the graded categories of financial hardship, there was a stepwise increase in the prevalence of high financial distress, food insecurity, cost-related nonadherence, and foregone/delayed medical care, reaching 70.5%, 49.4%, 49.5%, and 74% among those unable to pay bills, respectively. Compared with those without diabetes mellitus, individuals with diabetes mellitus had higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 1.27 [95% CI, 1.18-1.36]) or any of its consequences, including high financial distress (aOR, 1.14 [95% CI, 1.05-1.24]), food insecurity (aOR, 1.27 [95% CI, 1.16-1.40]), cost-related medication nonadherence (aOR, 1.43 [95% CI, 1.30-1.57]), and foregone/delayed medical care (aOR, 1.30 [95% CI, 1.20-1.40]).
English
1941-7713
10.1161/CIRCOUTCOMES.119.006139 [doi]
*Cost of Illness
*Diabetes Mellitus/ec [Economics]
*Diabetes Mellitus/th [Therapy]
*Financing, Personal/ec [Economics]
*Health Care Costs
*Health Expenditures
*Health Services Accessibility/ec [Economics]
Adolescent
Adult
African Americans
Age Factors
Comorbidity
Cross-Sectional Studies
Diabetes Mellitus/di [Diagnosis]
Diabetes Mellitus/eh [Ethnology]
Female
Food Supply/ec [Economics]
Health Care Surveys
Humans
Income
Male
Medically Uninsured
Middle Aged
Patient Compliance
Risk Assessment
Risk Factors
United States/ep [Epidemiology]
Young Adult
MedStar Union Memorial Hospital
Medicine
Journal Article
BACKGROUND: The trend of increasing total and out-of-pocket expenditure among patients with diabetes mellitus represents a risk of financial hardship for Americans and a threat to medical and nonmedical needs. We aimed to describe the national scope and associated tradeoffs of financial hardship from medical bills among nonelderly individuals with diabetes mellitus. CONCLUSIONS: Nonelderly patients with diabetes mellitus have a high prevalence of financial hardship from medical bills, with deleterious consequences. METHODS AND RESULTS: We used the National Health Interview Survey data from 2013 to 2017, including adults <=64 years old with a self-reported diagnosis of diabetes mellitus. Among 164 696 surveyed individuals, 8967 adults <=64 years old reported having diabetes mellitus, representing 13.1 million individuals annually across the United States. The mean age was 51.6 years (SD 10.3), and 49.1% were female. A total of 41.1% were part of families that reported having financial hardship from medical bills, with 15.6% reporting an inability to pay medical bills at all. In multivariate analyses, individuals who lacked insurance, were non-Hispanic black, had low income, or had high-comorbidity burden were at higher odds of being in families with financial hardship from medical bills. When comparing the graded categories of financial hardship, there was a stepwise increase in the prevalence of high financial distress, food insecurity, cost-related nonadherence, and foregone/delayed medical care, reaching 70.5%, 49.4%, 49.5%, and 74% among those unable to pay bills, respectively. Compared with those without diabetes mellitus, individuals with diabetes mellitus had higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 1.27 [95% CI, 1.18-1.36]) or any of its consequences, including high financial distress (aOR, 1.14 [95% CI, 1.05-1.24]), food insecurity (aOR, 1.27 [95% CI, 1.16-1.40]), cost-related medication nonadherence (aOR, 1.43 [95% CI, 1.30-1.57]), and foregone/delayed medical care (aOR, 1.30 [95% CI, 1.20-1.40]).
English
1941-7713
10.1161/CIRCOUTCOMES.119.006139 [doi]
*Cost of Illness
*Diabetes Mellitus/ec [Economics]
*Diabetes Mellitus/th [Therapy]
*Financing, Personal/ec [Economics]
*Health Care Costs
*Health Expenditures
*Health Services Accessibility/ec [Economics]
Adolescent
Adult
African Americans
Age Factors
Comorbidity
Cross-Sectional Studies
Diabetes Mellitus/di [Diagnosis]
Diabetes Mellitus/eh [Ethnology]
Female
Food Supply/ec [Economics]
Health Care Surveys
Humans
Income
Male
Medically Uninsured
Middle Aged
Patient Compliance
Risk Assessment
Risk Factors
United States/ep [Epidemiology]
Young Adult
MedStar Union Memorial Hospital
Medicine
Journal Article