Burden and Consequences of Financial Hardship From Medical Bills Among Nonelderly Adults With Diabetes Mellitus in the United States. 

 -  2020 
<br/><br/> 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]). 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>1941-7713 
<br/><br/><label>Standard No.: </label>10.1161/CIRCOUTCOMES.119.006139 [doi] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Cost of Illness<br/>*Diabetes Mellitus/ec [Economics]<br/>*Diabetes Mellitus/th [Therapy]<br/>*Financing, Personal/ec [Economics]<br/>*Health Care Costs<br/>*Health Expenditures<br/>*Health Services Accessibility/ec [Economics]<br/>Adolescent<br/>Adult<br/>African Americans<br/>Age Factors<br/>Comorbidity<br/>Cross-Sectional Studies<br/>Diabetes Mellitus/di [Diagnosis]<br/>Diabetes Mellitus/eh [Ethnology]<br/>Female<br/>Food Supply/ec [Economics]<br/>Health Care Surveys<br/>Humans<br/>Income<br/>Male<br/>Medically Uninsured<br/>Middle Aged<br/>Patient Compliance<br/>Risk Assessment<br/>Risk Factors<br/>United States/ep [Epidemiology]<br/>Young Adult
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Union Memorial Hospital
<br/><br/><label>Index Terms--Occupation: </label><br/>Medicine
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article