美国非老年糖尿病成年人医疗费用导致的经济困难负担及后果
Burden and Consequences of Financial Hardship From Medical Bills Among Nonelderly Adults With Diabetes Mellitus in the United States.
作者信息
Caraballo César, Valero-Elizondo Javier, Khera Rohan, Mahajan Shiwani, Grandhi Gowtham R, Virani Salim S, Mszar Reed, Krumholz Harlan M, Nasir Khurram
机构信息
Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.C., S.M., R.M., H.M.K.).
Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (J.V.-E., K.N.).
出版信息
Circ Cardiovasc Qual Outcomes. 2020 Feb;13(2):e006139. doi: 10.1161/CIRCOUTCOMES.119.006139. Epub 2020 Feb 6.
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.
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]).
CONCLUSIONS
Nonelderly patients with diabetes mellitus have a high prevalence of financial hardship from medical bills, with deleterious consequences.
背景
糖尿病患者的总支出和自付费用呈上升趋势，这给美国人带来了经济困难风险，并对医疗和非医疗需求构成威胁。我们旨在描述非老年糖尿病患者因医疗账单导致经济困难的全国范围及相关权衡。
方法与结果
我们使用了2013年至2017年的国家健康访谈调查数据，包括自我报告诊断为糖尿病的64岁及以下成年人。在164696名接受调查的个体中，有8967名64岁及以下成年人报告患有糖尿病，相当于美国每年有1310万人。平均年龄为51.6岁（标准差10.3），49.1%为女性。共有41.1%的人所在家庭报告因医疗账单而面临经济困难，其中15.6%的人报告完全无力支付医疗账单。在多变量分析中，缺乏保险、非西班牙裔黑人、低收入或高合并症负担的个体，其所在家庭因医疗账单而面临经济困难的几率更高。在比较经济困难的分级类别时，高经济困境、粮食不安全、与费用相关的治疗依从性差以及放弃/推迟医疗护理的患病率呈逐步上升趋势，在无力支付账单的人群中分别达到70.5%、49.4%、49.5%和74%。与非糖尿病患者相比，糖尿病患者因医疗账单而面临经济困难或其任何后果的几率更高，包括高经济困境（调整后的优势比[aOR]，1.14[95%置信区间，1.05-1.24]）、粮食不安全（aOR，1.27[95%置信区间，1.16-1.40]）、与费用相关的药物治疗依从性差（aOR，1.43[95%置信区间，1.30-1.57]）以及放弃/推迟医疗护理（aOR，1.30[95%置信区间，1.20-1.40]）。
结论
非老年糖尿病患者因医疗账单而面临经济困难的患病率很高，且会产生有害后果。
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