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

MedStar author(s):
Citation: Circulation. Cardiovascular Quality & Outcomes. 13(2):e006139, 2020 02.PMID: 32069093Institution: MedStar Union Memorial HospitalDepartment: MedicineForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *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 AdultYear: 2020ISSN:
  • 1941-7713
Name of journal: Circulation. Cardiovascular quality and outcomesAbstract: 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]).All authors: Caraballo C, Grandhi GR, Khera R, Krumholz HM, Mahajan S, Mszar R, Nasir K, Valero-Elizondo J, Virani SSOriginally published: Circulation. Cardiovascular Quality & Outcomes. 13(2):e006139, 2020 Feb.Fiscal year: FY2020Digital Object Identifier: Date added to catalog: 2020-02-26
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Journal Article MedStar Authors Catalog Article 32069093 Available 32069093

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]).

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