Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA.
Diabetes Care. 2021 Aug;44(8):1797-1804. doi: 10.2337/dc20-2708. Epub 2021 Jun 28.
We examined the magnitude of and trends in the burden of out-of-pocket (OOP) costs among Medicare beneficiaries age 65 years or older with diabetes overall, by income level, by race/ethnicity, and compared with beneficiaries without diabetes.
Using data from the 1999-2017 Medicare Current Beneficiary Survey, we estimated average annual per capita OOP costs and percentage of beneficiaries experiencing high OOP burden, defined as OOP costs >10% or >20% of household income. We used joinpoint regression to examine the trends and generalized linear model and logistic regression for comparisons between beneficiaries with and without diabetes. Cost and income estimates were adjusted to 2017 USD.
Total OOP costs were $3,609-$5,283, with significant increases until 2005 followed by a leveling off. The prevalence of high OOP burden was 57%-72% at the 10% income threshold and 29%-41% at the 20% threshold, with significant increasing trends until 2003 followed by decreases. Total OOP costs were the highest in the ≥75% income quartile, whereas prevalence of high OOP burden was highest in the <25% and 25-50% income quartiles. Non-Hispanic Whites had the highest OOP costs and prevalence of high OOP burden. Beneficiaries with diabetes had significantly higher OOP costs ($498, < 0.01) and were more likely to have high OOP burden than those without diabetes (odds ratios 1.32 and 1.25 at >10% and >20% thresholds, respectively, < 0.01).
Over the past two decades, Medicare beneficiaries age 65 years or older with diabetes have faced substantial OOP burden, with large income-related disparities.
我们考察了医疗保险受益人群中，65 岁及以上患有糖尿病的患者自付费用（OOP）负担的严重程度和变化趋势，按收入水平、种族/民族进行了划分，并与没有糖尿病的患者进行了比较。
利用 1999-2017 年医疗保险当前受益人调查数据，我们估算了平均每年每位患者的 OOP 费用以及 OOP 负担过重（定义为 OOP 费用>10%或>20%家庭收入）的患者比例。我们使用 Joinpoint 回归分析了趋势，并使用广义线性模型和逻辑回归分析了患有和不患有糖尿病的患者之间的差异。成本和收入估计值调整为 2017 年美元。
OOP 总成本为 3609-5283 美元，在 2005 年之前呈显著上升趋势，之后趋于平稳。在 10%收入阈值下，高 OOP 负担的患病率为 57%-72%，在 20%收入阈值下，患病率为 29%-41%，在 2003 年之前呈显著上升趋势，之后呈下降趋势。OOP 总成本在收入≥75%的四分位数中最高，而高 OOP 负担的患病率在收入<25%和 25-50%的四分位数中最高。非西班牙裔白人的 OOP 费用和高 OOP 负担的患病率最高。患有糖尿病的患者 OOP 费用显著更高（498 美元，<0.01），且 OOP 负担过重的可能性高于未患有糖尿病的患者（>10%和>20%阈值的比值比分别为 1.32 和 1.25，均<0.01）。
在过去的二十年中，65 岁及以上患有糖尿病的医疗保险受益人面临着巨大的 OOP 负担，且存在较大的收入相关差异。
