Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
Center for Advancing Population Science (CAPS), Medical College of Wisconsin, Milwaukee, WI.
Ethn Dis. 2020 Sep 24;30(4):621-628. doi: 10.18865/ed.30.4.621. eCollection 2020 Fall.
Diabetes results in $327 billion in medical expenditures annually, while obesity, a risk factor for type 2 diabetes, leads to more than $147 billion in expenditure annually. The aims of this study were: 1) to evaluate racial/ethnic trends in obesity and medical expenditures; and 2) to assess incremental medical expenditures among a nationally representative sample of women with diabetes.
Nine years of data (2008-2016) from the Medical Expenditure Panel Survey Full Year Consolidated File (unweighted = 11,755; weighted = 10,685,090) were used. The outcome variable was medical expenditure. The primary independent variable was race/ethnicity defined as non-Hispanic Black (NHB), Hispanic, or non-Hispanic White (NHW). Covariates included age, education, marital status, income, insurance, employment, region, comorbidity, and year. Cochran-Armitage tests determined statistical significance of trends in obesity and mean expenditure. Two-part modeling using Probit and gamma distribution was used to assess incremental medical expenditure. Data were clustered to 2008-2010, 2011-2013, 2014-2016.
Trends in medical expenditures differed significantly between NHB and NHW women between 2008-2016 (P<.001). Hispanic women paid $1,291 less compared with NHW women, after adjusting for relevant covariates. There were no significant differences in obesity trends from 2008-2016 between NHB (P=.989) or Hispanic women with diabetes (P=.938) compared with NHW women with diabetes.
These findings suggest the need to further understand the factors associated with differences in trends for medical expenditures between NHB and NHW women with diabetes and incremental medical expenditures in Hispanic women with diabetes compared with NHW women with diabetes.
糖尿病每年导致医疗支出 3270 亿美元，而肥胖是 2 型糖尿病的一个风险因素，每年导致的支出超过 1470 亿美元。本研究的目的是：1）评估肥胖和医疗支出的种族/民族趋势；2）评估具有代表性的全国糖尿病女性样本中增量医疗支出。
使用医疗支出面板调查全年综合文件 9 年的数据（2008-2016 年）（未加权=11755；加权=10685090）。因变量是医疗支出。主要自变量是种族/民族，定义为非西班牙裔黑人（NHB）、西班牙裔或非西班牙裔白人（NHW）。协变量包括年龄、教育程度、婚姻状况、收入、保险、就业、地区、合并症和年份。Cochran-Armitage 检验确定肥胖和平均支出趋势的统计学意义。使用 Probit 和伽马分布的两部分模型评估增量医疗支出。数据聚类到 2008-2010 年、2011-2013 年和 2014-2016 年。
2008-2016 年期间，NHB 和 NHW 女性的医疗支出趋势差异显著（P<.001）。在调整了相关协变量后，与 NHW 女性相比，西班牙裔女性的支出少了 1291 美元。与 NHW 女性相比，NHB（P=.989）或患有糖尿病的西班牙裔女性（P=.938）的肥胖趋势在 2008-2016 年期间没有显著差异。
这些发现表明，需要进一步了解与 NHB 和 NHW 患有糖尿病的女性之间医疗支出趋势差异以及与 NHW 患有糖尿病的女性相比，西班牙裔女性的增量医疗支出相关的因素。
