Wang Yu, Shao Hui, Bigman Elizabeth, Holliday Christopher, Zhang Ping
Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, Atlanta, GA 30341 (
Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
Prev Chronic Dis. 2025 Aug 7;22:E50. doi: 10.5888/pcd22.250153.
Significant differences exist in the risk of diabetes and diabetes-related complications by income level in the United States. We assessed 1) to what extent medical expenditures in total and by health service type differ by income levels, and 2) how demographic and socioeconomic factors and health status are associated with these differences.
Data from the 2017 through 2021 Medical Expenditure Panel Survey were analyzed to estimate annual per-person medical expenditures for adults with diabetes. These expenditures were categorized by service type (inpatient, outpatient, prescription, home health care services, emergency department, or other) and compared across income groups based on the federal poverty level (FPL): poor (<125% FPL), low (125% to <200% FPL), middle (200% to <400% FPL), and high (≥400% FPL). One-way analysis of variance was used to test group differences, and a regression-based decomposition identified factors driving expenditure disparities. All expenditures were adjusted to 2021 US dollars.
Mean total medical expenditures were significantly higher for the poor-income group compared with the low-income, middle-income, and high-income groups, though no significant differences were observed among the latter 3 groups. Prescription drugs and home health care services in the poor-income group accounted for most of this difference. Key factors associated with the higher expenditures in this group included elevated disability rates, poorer physical health status, and dual Medicaid-Medicare coverage.
Adults with diabetes from the poorest households incurred the highest medical expenditures, largely driven by poor physical health and higher rates of disability. Reducing disability and improving health outcomes for this group may help lower their medical expenses.
在美国，糖尿病风险及糖尿病相关并发症风险因收入水平存在显著差异。我们评估了：1）总体医疗支出及按医疗服务类型划分的医疗支出在不同收入水平之间的差异程度；2）人口统计学、社会经济因素及健康状况与这些差异之间的关联。
分析2017年至2021年医疗支出面板调查的数据，以估算成年糖尿病患者的人均年度医疗支出。这些支出按服务类型（住院、门诊、处方药、家庭保健服务、急诊科或其他）分类，并根据联邦贫困水平（FPL）在不同收入组之间进行比较：贫困（<125%FPL）、低收入（125%至<200%FPL）、中等收入（200%至<400%FPL）和高收入（≥400%FPL）。采用单因素方差分析来检验组间差异，并通过基于回归的分解确定导致支出差异的因素。所有支出均调整为2021年美元。
与低收入、中等收入和高收入组相比，贫困收入组的平均总医疗支出显著更高，不过后三组之间未观察到显著差异。贫困收入组的处方药和家庭保健服务占了这一差异的大部分。与该组较高支出相关的关键因素包括残疾率升高、身体健康状况较差以及医疗补助和医疗保险双重覆盖。
来自最贫困家庭的成年糖尿病患者医疗支出最高，主要原因是身体健康状况差和残疾率较高。降低该群体的残疾率并改善健康状况可能有助于降低他们的医疗费用。
