Burden and consequences of financial hardship from medical bills among nonelderly adults with diabetes mellitus in the United States.
Abstract
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.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Between Black and White individuals, age-adjusted death rates narrowed from 1993 to 2015, but the gap began widening after 2016.
“Age-adjusted death rates by race and ethnicity between Black individuals and White individuals narrowed from 1993 to 2015, but since 2016 the gap began widening.”
From Trends in Differences in Health Status and Health Care Access and Affordability by Race and Ethnicity in the United States, 1999–2018 (2021) · cites this paper as [6]
Cites
Economic Costs of Diabetes in the U.S. in 2017
American Diabetes Association (2018) · Diabetes Care · doi:10.2337/dci18-0007 · Cited by 2,528 · see citing works
Food Insecurity Is Associated with Chronic Disease among Low-Income NHANES Participants
Seligman, H. K., Laraia, B. A., & Kushel, M. (2009) · Journal of Nutrition · doi:10.3945/jn.109.112573 · Cited by 1,648 · see citing works
Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2006
Pleis, J. R., & Lethbridge‐Çejku, M. (2007) · PsycEXTRA Dataset · doi:10.1037/e403882008-001 · Cited by 1,432 · see citing works
Kent, E. E., Forsythe, L. P., Yabroff, K. R., Weaver, K. E., de Moor, J. S., Rodriguez, J. L., & Rowland, J. H. (2013) · Cancer · doi:10.1002/cncr.28262 · Cited by 413 · see citing works
Insulin Access and Affordability Working Group: Conclusions and Recommendations
Cefalu, W. T., Dawes, D. E., Gavlak, G., Goldman, D., Herman, W. H., Van Nuys, K., Powers, A. C., Taylor, S. I., Yatvin, A. L., & on behalf of the Insulin Access and Affordability Working Group (2018) · Diabetes Care · doi:10.2337/dci18-0019 · Cited by 256 · see citing works
Weaver, K. E., Rowland, J. H., Bellizzi, K. M., & Aziz, N. M. (2010) · Cancer · doi:10.1002/cncr.25209 · Cited by 254 · see citing works
The Lifetime Cost of Diabetes and Its Implications for Diabetes Prevention
Zhuo, X., Zhang, P., Barker, L. E., Albright, A. L., Thompson, T. J., & Gregg, E. W. (2014) · Diabetes Care · doi:10.2337/dc13-2484 · Cited by 201 · see citing works
The cost of diabetes care-an elephant in the room
Riddle, M. C., & Herman, W. H. (2018) · Diabetes Care · doi:10.2337/dci18-0012 · Cited by 191 · see citing works
Patel, M. R., Piette, J. D., Resnicow, K., Kowalski-Dobson, T., & Heisler, M. (2016) · Medical Care · doi:10.1097/mlr.0000000000000565 · Cited by 143 · see citing works
Cost of medication adherence and persistence in type 2 diabetes mellitus: a literature review
Kennedy‐Martin, T., Boye, K. S., & Peng, X. (2017) · Patient Preference and Adherence · doi:10.2147/ppa.s136639 · Cited by 109 · see citing works
Ong, S. E., Koh, J. J. K., Toh, S.-A. E. S., Chia, K. S., Balabanova, D., McKee, M., Perel, P., & Legido‐Quigley, H. (2018) · PLoS ONE · doi:10.1371/journal.pone.0195086 · Cited by 101 · see citing works
Hong, J. S., & Kang, H. C. (2011) · Medical Care · doi:10.1097/mlr.0b013e31820292d1 · Cited by 95 · see citing works
Ngo‐Metzger, Q., Sorkin, D. H., Billimek, J., Greenfield, S., & Kaplan, S. H. (2011) · Journal of General Internal Medicine · doi:10.1007/s11606-011-1910-7 · Cited by 95 · see citing works
Kim, Y.-Y., Lee, J.-S., Kang, H.-J., & Park, S. M. (2018) · Scientific Reports · doi:10.1038/s41598-018-30740-y · Cited by 92 · see citing works
Elizondo, J. V., Khera, R., Saxena, A., Grandhi, G. R., Virani, S. S., Butler, J., Samad, Z. Z., Desai, N. R., Krumholz, H. M., & Nasir, K. (2019) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2018.12.004 · Cited by 84 · see citing works
Self-citationKarter, A. J., Parker, M. M., Solomon, M. D., Lyles, C. R., Adams, A. S., Moffet, H. H., & Reed, M. (2017) · Health Services Research · doi:10.1111/1475-6773.12700 · Cited by 80 · see citing works
Use and Out-of-Pocket Costs of Insulin for Type 2 Diabetes Mellitus From 2000 Through 2010
Lipska, K. J., Ross, J. S., Houten, H. K. V., Beran, D., Yudkin, J. S., & Shah, N. D. (2014) · JAMA · doi:10.1001/jama.2014.6316 · Cited by 79 · see citing works
Chen, J. E., LOU, V. W. Q., Jian, H., Zhou, Z., Yan, M., Zhu, J., Li, G., & He, Y. (2017) · Supportive Care in Cancer · doi:10.1007/s00520-017-3949-4 · Cited by 74 · see citing works
Why Are We Failing to Address the Issue of Access to Insulin? A National and Global Perspective
Beran, D., Hirsch, I. B., & Yudkin, J. S. (2018) · Diabetes Care · doi:10.2337/dc17-2123 · Cited by 65 · see citing works
Boye, K., Curtis, S. E., Lage, M., & García-Pérez, L. (2016) · Patient Preference and Adherence · doi:10.2147/ppa.s107543 · Cited by 60 · see citing works
Wharam, J. F., Zhang, F., Eggleston, E., Lu, C. Y., Soumerai, S. B., & Ross‐Degnan, D. (2018) · Diabetes Care · doi:10.2337/dc17-1183 · Cited by 54 · see citing works
Annual Total Medical Expenditures Associated with Hypertension by Diabetes Status in U.S. Adults
Wang, G., Zhou, X., Zhuo, X., & Zhang, P. (2017) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2017.07.018 · Cited by 52 · see citing works
Casagrande, S. S., McEwen, L. N., & Herman, W. H. (2018) · Diabetes Care · doi:10.2337/dc17-2524 · Cited by 52 · see citing works
Changes Over Time in High Out-of-Pocket Health Care Burden in U.S. Adults With Diabetes, 2001–2011
Li, R., Barker, L. E., Shrestha, S. S., Zhang, P., Duru, O., Pearson-Clarke, T., & Gregg, E. W. (2014) · Diabetes Care · doi:10.2337/dc13-1997 · Cited by 46 · see citing works
Bibeau, W. S., Fu, H., Taylor, A. D., & Kwan, A. Y. M. (2016) · Journal of Managed Care & Specialty Pharmacy · doi:10.18553/jmcp.2016.22.11.1338 · Cited by 45 · see citing works
Medication adherence and improved outcomes among patients with type 2 diabetes.
Curtis, S. E., Boye, K. S., Lage, M. J., & García‐Pérez, L. (2017) · PubMed · Cited by 41 · see citing works
Health Care Spending on Diabetes in the U.S., 1996–2013
Squires, E., Duber, H. C., Campbell, M., Cao, J., Chapin, A., Horst, C., Li, Z., Matyasz, T., Reynolds, A., Hirsch, I. B., et al. (2018) · Diabetes Care · doi:10.2337/dc17-1376 · Cited by 40 · see citing works
Perez‐Nieves, M., Boye, K. S., Kiljanski, J. I., Cao, D., & Lage, M. J. (2018) · Diabetes Therapy · doi:10.1007/s13300-018-0421-5 · Cited by 30 · see citing works
Mayberry, L. S., Mulvaney, S. A., Johnson, K. B., & Osborn, C. Y. (2016) · Journal of Diabetes Science and Technology · doi:10.1177/1932296816668374 · Cited by 29 · see citing works
Choi, S. (2018) · Health Education & Behavior · doi:10.1177/1090198117739671 · Cited by 25 · see citing works
Choi, Y. J., & Smaldone, A. M. (2017) · The Science of Diabetes Self-Management and Care · doi:10.1177/0145721717747880 · Cited by 24 · see citing works
Trends in the financial burden of medical care for nonelderly adults with diabetes, 2001 to 2009.
Cunningham, P. J., & Carrier, E. R. (2014) · PubMed · Cited by 19 · see citing works
Barriers to Health Care for Adults With Multiple Chronic Conditions: United States, 2012-2015.
Ward, B. W. (2017) · PubMed · Cited by 17 · see citing works
Wang, Z., Dong, B., Hu, J., Adegbija, O., & Arnold, L. W. (2016) · Diabetic Medicine · doi:10.1111/dme.13111 · Cited by 15 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Heart Disease and Stroke Statistics—2023 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Beaton, A. Z., Boehme, A. K., Buxton, A. E., et al. (2023) · Circulation · doi:10.1161/cir.0000000000001123 · Cited by 8,300 · see citing works
Self-citationHeart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association
Tsao, C. W., Aday, A. W., Almarzooq, Z. I., Alonso, A., Beaton, A. Z., Bittencourt, M. S., Boehme, A. K., Buxton, A. E., Carson, A. P., Commodore-Mensah, Y., et al. (2022) · Circulation · doi:10.1161/cir.0000000000001052 · Cited by 5,987 · see citing works
Self-citationHeart Disease and Stroke Statistics—2021 Update: A Report From the American Heart Association
Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Cheng, S., Delling, F. N., et al. (2021) · Circulation · doi:10.1161/cir.0000000000000950 · Cited by 5,784 · see citing works
Self-citationMartin, S. S., Aday, A. W., Almarzooq, Z. I., Anderson, C. A. M., Arora, P., Avery, C. L., Baker-Smith, C. M., Barone Gibbs, B., Beaton, A. Z., Boehme, A. K., et al. (2024) · Circulation · doi:10.1161/cir.0000000000001209 · Cited by 2,800 · see citing works
Martin, S. S., Aday, A. W., Allen, N. B., Almarzooq, Z., Anderson, C. A. M., Arora, P. K., Avery, C. L., Baker-Smith, C. M., Bansal, N., Beaton, A., et al. (2025) · Circulation · doi:10.1161/cir.0000000000001303 · Cited by 1,206 · see citing works
The Relationship Between Financial Worries and Psychological Distress Among U.S. Adults
Ryu, S., & Fan, L. (2022) · Journal of Family and Economic Issues · doi:10.1007/s10834-022-09820-9 · Cited by 441 · see citing works
Mahajan, S., Caraballo, C., Lu, Y., Valero-Elizondo, J., Massey, D., Annapureddy, A. R., Roy, B., Riley, C., Murugiah, K., Onuma, O., et al. (2021) · JAMA · doi:10.1001/jama.2021.9907 · Cited by 368 · see citing works
Self-citationPalaniappan, L. P., Allen, N. B., Almarzooq, Z., Anderson, C. A. M., Arora, P. K., Avery, C. L., Baker-Smith, C. M., Bansal, N., Currie, M. E., Earlie, R. S., et al. (2026) · Circulation · doi:10.1161/cir.0000000000001412 · Cited by 312 · see citing works
Caraballo, C., Ndumele, C. D., Roy, B., Lu, Y., Riley, C. L., Herrin, J. S., & Krumholz, H. M. (2022) · JAMA Health Forum · doi:10.1001/jamahealthforum.2022.3856 · Cited by 203 · see citing works
Self-citationKhera, R., Elizondo, J. V., & Nasir, K. (2020) · Journal of the American Heart Association · doi:10.1161/jaha.120.017793 · Cited by 148 · see citing works
Self-citationCaraballo, C., Mahajan, S., Elizondo, J. V., Massey, D. S., Lu, Y., Roy, B., Riley, C. L., Annapureddy, A., Murugiah, K., Elumn, J. E., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.6385 · Cited by 106 · see citing works
Self-citationCaraballo, C., Herrin, J. S., Mahajan, S., Massey, D. S., Lu, Y., Ndumele, C. D., Drye, E. E., & Krumholz, H. M. (2022) · The American Journal of Medicine · doi:10.1016/j.amjmed.2022.04.010 · Cited by 101 · see citing works
Self-citationAdvances in the management of type 2 diabetes in adults
Galindo, R. J., Trujillo, J. M., Wang, C. C. L., & McCoy, R. G. (2023) · BMJ Medicine · doi:10.1136/bmjmed-2022-000372 · Cited by 80 · see citing works
Nguyen, N. H., Khera, R., Lucila Ohno-machado, A., Sandborn, W. J., & Singh, S. (2020) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2020.05.056 · Cited by 69 · see citing works
Self-citationPatel, M. R., Zhang, G., Heisler, M., Song, P. X. ‐., Piette, J. D., Shi, X., Choe, H. M., Smith, A. L., & Resnicow, K. (2022) · Diabetes Care · doi:10.2337/dc22-0494 · Cited by 66 · see citing works
Ng, M. S. N., Chan, D. N. S., Cheng, Q., Miaskowski, C. A., & So, W. K. W. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18189541 · Cited by 51 · see citing works
Income variability and incident cardiovascular disease in diabetes: a population-based cohort study
Park, Y., Baek, J. H., Lee, H. S., Elfassy, T., Brown, C. C., Schootman, M., Narcisse, M., Ko, S., McElfish, P. A., Thomsen, M. R., et al. (2024) · European Heart Journal · doi:10.1093/eurheartj/ehae132 · Cited by 39 · see citing works
Nguyen, N. H., Khera, R., Dulai, P. S., Boland, B. S., Lucila Ohno-machado, A., Sandborn, W. J., & Singh, S. (2020) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izaa266 · Cited by 38 · see citing works
Self-citationHigh Out-of-pocket Health Care Cost Burden Among Medicare Beneficiaries With Diabetes, 1999–2017
Park, J., Zhang, P., Wang, Y., Zhou, X., Look, K. A., & Bigman, E. T. (2021) · Diabetes Care · doi:10.2337/dc20-2708 · Cited by 31 · see citing works
Mszar, R., Grandhi, G. R., Valero-Elizondo, J., Caraballo, C., Khera, R., Desai, N., Virani, S., Blankstein, R., Blaha, M., & Nasir, K. (2020) · Journal of the American Heart Association : Cardiovascular and Cerebrovascular Disease · doi:10.1161/jaha.119.015523 · Cited by 27 · see citing works
Self-citationAgrawal, T., Acquah, I., Dey, A. K., Glassner, K. L., Abraham, B. P., Blankstein, R., Virani, S. S., Blaha, M. J., Elizondo, J. V., Mehta, N. N., et al. (2021) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2021.100171 · Cited by 29 · see citing works
Self-citationLivingston, K. A., Freeman, K. J., Friedman, S. M., Stout, R., Lianov, L. S., Drozek, D. S., Shallow, J., Shurney, D. W., Patel, P. M., Campbell, T. M., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182111364 · Cited by 28 · see citing works
Lago‐Hernandez, C., Nguyen, N. H., Khera, R., Loomba, R. S., Asrani, S. K., & Singh, S. (2021) · Hepatology · doi:10.1002/hep.31835 · Cited by 27 · see citing works
Self-citationNasir, K., Acquah, I., Dey, A. K., Agrawal, T., Hassan, S. Z., Glassner, K. L., Abraham, B. P., Quigley, E. M. M., Blankstein, R., Virani, S. S., et al. (2022) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2022.100316 · Cited by 27 · see citing works
Self-citationSeyoum, S., Regenstein, M., Benoit, M., Dieni, O., Willis, A., Reno, K., & Clemm, C. (2023) · Journal of Cystic Fibrosis · doi:10.1016/j.jcf.2023.01.002 · Cited by 27 · see citing works
Patel, M. R., Tolentino, D. A., Smith, A. L., & Heisler, M. (2023) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2023.102246 · Cited by 26 · see citing works
Like a Grinding Stone: How Crowdfunding Platforms Create, Perpetuate, and Value Health Inequities
Kenworthy, N. (2021) · Medical Anthropology Quarterly · doi:10.1111/maq.12639 · Cited by 23 · see citing works
A Scoping Review of Behavioral Interventions Addressing Medical Financial Hardship
Patel, M. R., Jagsi, R., Resnicow, K., Smith, S. N., Hamel, L. M., Su, C. T., Griggs, J. J., Buchanan, D., Isaacson, N. F., & Torby, M. (2021) · Population Health Management · doi:10.1089/pop.2021.0043 · Cited by 27 · see citing works
Nasir, A., Javed, U., Hagan, K., Chang, R. P., Kundi, H., Amin, Z., Butt, S., Al-Kindi, S. G., & Javed, Z. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1485513 · Cited by 23 · see citing works
Elizondo, J. V., Javed, Z., Khera, R., Tano, M., Dudum, R., Acquah, I., Hyder, A. A., Andrieni, J., Sharma, G. V., Blaha, M. J., et al. (2022) · Archives of Public Health · doi:10.1186/s13690-022-00987-z · Cited by 22 · see citing works
Self-citationCost and utilization of healthcare services for persons with diabetes
Reynolds, E. L., Mizokami‐Stout, K., Putnam, N. M., Banerjee, M., Albright, D. K., Ang, L. P., Lee, J. M., Pop‐Busui, R., Feldman, E. L., & Callaghan, B. C. (2023) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2023.110983 · Cited by 20 · see citing works
Caballero, J., Jacobs, R. J., & Ownby, R. L. (2022) · PLoS ONE · doi:10.1371/journal.pone.0263264 · Cited by 18 · see citing works
Ayyala-Somayajula, D., Dodge, J. L., Farias, A. J., Terrault, N. A., & Lee, B. P. (2023) · Journal of Hepatology · doi:10.1016/j.jhep.2023.03.020 · Cited by 18 · see citing works
Financial Hardship Among Nonelderly Adults With CKD in the United States
Acquah, I., Elizondo, J. V., Javed, Z., Ibrahim, H. N., Patel, K. V., Ali, H.-J. R., Menser, T. L., Khera, R., Cainzos‐Achirica, M., & Nasir, K. (2021) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2021.04.011 · Cited by 16 · see citing works
Self-citationWang, S. Y., Elizondo, J. V., Cainzos‐Achirica, M., Desai, N. R., Nasir, K., & Khera, R. (2022) · JAMA Health Forum · doi:10.1001/jamahealthforum.2022.1962 · Cited by 16 · see citing works
Self-citationAlawode, O. A., Humble, S., & Herrick, C. (2023) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2022-003205 · Cited by 18 · see citing works
Chang, R. P., Philip, J. S., Javed, U., Titus, A., Gardezi, S. K., Kundi, H., Yousefzai, R., Hyder, A. A., Mossialos, E. A., Nasir, K., et al. (2024) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2023-003710 · Cited by 16 · see citing works
Self-citationMein, S. A., Marinacci, L., Zheng, Z., Ahmad, I., & Wadhera, R. K. (2024) · JAMA Health Forum · doi:10.1001/jamahealthforum.2024.1939 · Cited by 15 · see citing works
Association between household debt and depressive mood among Chinese residents
Liu, P., Zhou, L., Tian, Y., & Nie, W. (2021) · Public Health · doi:10.1016/j.puhe.2021.03.015 · Cited by 15 · see citing works
Disease and debt: Findings from the 2019 Panel Study of Income Dynamics in the United States
Grafova, I. B., Clifford, P. R., Hudson, S. V., Steinberg, M. B., O’Malley, D. M., Elliott, J., Llanos, A. A. M., Saraiya, B., & Duberstein, P. R. (2022) · Preventive Medicine · doi:10.1016/j.ypmed.2022.107248 · Cited by 13 · see citing works
Diabetes in childhood cancer survivors: emerging concepts in pathophysiology and future directions
Bhandari, R., Armenian, S. H., McCormack, S. E., Natarajan, R. D., & Mostoufi‐Moab, S. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1206071 · Cited by 11 · see citing works
Grandhi, G. R., Elizondo, J. V., Mszar, R., Brandt, E. J., Annapureddy, A., Khera, R., Saxena, A., Virani, S. S., Blankstein, R., Desai, N. R., et al. (2020) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2020.100034 · Cited by 11 · see citing works
Self-citationFinancial toxicity in people with chronic kidney disease undergoing hemodialysis treatment
Silva, E. C. D. S., Mantovani, M. D. F., Nogueira, L. D. A., Küchler, M. L., Cassi, C. C. A. V., & Kalinke, L. P. (2023) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2022-0671 · Cited by 10 · see citing works
Benning, T. J., Heien, H. C., & McCoy, R. G. (2022) · Diabetes Care · doi:10.2337/dc21-2623 · Cited by 10 · see citing works
Inequities in atherosclerotic cardiovascular disease prevention
Gomez, S. E., Dudum, R., & Rodríguez, F. (2024) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2024.05.002 · Cited by 9 · see citing works
Chronic Illness in Children and Foregone Care Among Household Adults in the United States
Narm, K. E., Wen, J., Sung, L., Dar, S., Kim, P., Olson, B., Schrager, A., Tsay, A. J., Himmelstein, D. U., Woolhandler, S. J., et al. (2022) · Medical Care · doi:10.1097/mlr.0000000000001791 · Cited by 9 · see citing works
Springer, M. V., Skolarus, L., & Patel, M. (2023) · Journal of health care for the poor and underserved · doi:10.1353/hpu.2023.0054 · Cited by 10 · see citing works
The Burden of Food Insecurity on Quality of Life in Adults with Diabetes
Walker, R. J., Egede, J. K., Thorgerson, A. A., Mosley-Johnson, E., Campbell, J. A., & Egede, L. E. (2024) · Nutrients · doi:10.3390/nu16213602 · Cited by 9 · see citing works
Morris, J. L., Belcher, S. M., Jeon, B., Godzik, C. M., Imes, C. C., Luyster, F. S., Sereika, S. M., Scott, P. W., & Chasens, E. R. (2021) · Chronic Illness · doi:10.1177/17423953211065002 · Cited by 8 · see citing works
Deprescribing medications: Do out‐of‐pocket costs have a role?
Hung, A., Sloan, C. E., Boyd, C. M., Bayliss, E. A., Hastings, S. N., & Maciejewski, M. L. (2022) · Journal of the American Geriatrics Society · doi:10.1111/jgs.17974 · Cited by 8 · see citing works
Akyirem, S., Ekpor, E., & Kwanin, C. B. (2025) · BMC Health Services Research · doi:10.1186/s12913-024-12052-2 · Cited by 8 · see citing works
Shrestha, R., Shakya, A., & Sapkota, V. P. (2024) · Advances in Public Health · doi:10.1155/2024/5571393 · Cited by 8 · see citing works
The forgotten - overcoming challenges in diabetes care for marginalized populations
Martinez-Cruz, M., Namasingh, N., Alexopoulos, A., Batch, B. C., Crowley, M. J., & Bosworth, H. B. (2025) · Expert Review of Endocrinology & Metabolism · doi:10.1080/17446651.2025.2526200 · Cited by 8 · see citing works
Oseran, A. S., Sun, T., Aggarwal, R., Kyalwazi, A. N., Yeh, R. W., & Wadhera, R. K. (2022) · Circulation Cardiovascular Quality and Outcomes · doi:10.1161/circoutcomes.121.008762 · Cited by 7 · see citing works
Ilyan, A., Abuhalima, D., Al‐Jabi, S. W., & Zyoud, S. H. (2025) · BMC Public Health · doi:10.1186/s12889-025-23566-7 · Cited by 9 · see citing works
Food insecurity and diabetes management among adults of African descent: A systematic review
Magny‐Normilus, C., Luppino, F., Lyons, K. S., Luu, J., & Taylor, J. Y. (2024) · Diabetic Medicine · doi:10.1111/dme.15398 · Cited by 6 · see citing works
Lum, Z. K., Tan, J. Y., Wong, C. S. M., Kok, Z. Y., Kwek, S. C., Tsou, K. Y. K., Gallagher, P., & Lee, J. Y.-C. (2024) · BMC Health Services Research · doi:10.1186/s12913-024-11199-2 · Cited by 6 · see citing works
Online Crowdfunding Campaigns for Diabetes-Related Expenses
Sloan, C. E., Campagna, A., Tu, K., Doerstling, S. S., Davis, J. K., & Ubel, P. A. (2023) · Annals of Internal Medicine · doi:10.7326/m23-0540 · Cited by 5 · see citing works
Du, Q. H., Yang, J., Zhang, Z. C., Li, S. B., Liu, Y. Q., Li, Y., Yang, Y., & Jia, H. H. (2024) · BMJ Open · doi:10.1136/bmjopen-2024-087126 · Cited by 4 · see citing works
Wu, Z., Qian, F., Zou, S., Zou, X., Zhang, R., Guo, X., & Li, H. (2025) · BMC Medicine · doi:10.1186/s12916-025-04315-4 · Cited by 4 · see citing works
Type 2 Diabetes and Financial Outcomes
Pesavento, M. T., Loibl, C., Moulton, S., Haurin, D. R., Hyer, M., Dalmacy, D. M., & Joseph, J. J. (2025) · JAMA Network Open · doi:10.1001/jamanetworkopen.2025.23453 · Cited by 3 · see citing works
Diabetes and Financial Well-Being: Differential Hardship Among Vulnerable Populations
Evans, E., & Jacobs, M. (2024) · The Science of Diabetes Self-Management and Care · doi:10.1177/26350106241256324 · Cited by 3 · see citing works
Frankiewicz, P., Sawe, Y., Sakita, F. M., Mmbaga, B. T., Staton, C. A., Joiner, A., & Smith, E. R. (2024) · PLoS ONE · doi:10.1371/journal.pone.0308539 · Cited by 4 · see citing works
Out-of-Pocket Costs Burden in Marketplace Plans for People With Diabetes
Ruscitti, B., Kern, C., & H, D. B. M. P. (2024) · Health Services Insights · doi:10.1177/11786329241304618 · Cited by 3 · see citing works
Giombi, K., D’Angelo, S. R., Kirsch, S., & Shenkar, E. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-095832 · Cited by 3 · see citing works
Ng, B. P., Stewart, M. P., Kwon, S., Hawkins, G. T., & Park, C. (2023) · The Science of Diabetes Self-Management and Care · doi:10.1177/26350106231163516 · Cited by 3 · see citing works
Mesgie, K., Atnafu, A., Tafere, T. Z., Worku, N., Addis, B., & Hagos, A. (2025) · BMC Health Services Research · doi:10.1186/s12913-025-12952-x · Cited by 3 · see citing works
Chao, G. F., Yang, J., Thumma, J. R., Chhabra, K. R., Arterburn, D. E., Ryan, A. M., Telem, D. A., & Dimick, J. B. (2023) · PubMed · doi:10.1097/sla.0000000000005291 · Cited by 2 · see citing works
The Ongoing Need to Address Cost-Related Nonadherence to Diabetes Medications
Hung, A., & Sloan, C. E. (2025) · Diabetes Care · doi:10.2337/dci25-0030 · Cited by 2 · see citing works
Dhingra, L. S., Pedroso, A. F., Aminorroaya, A., RAJPURA, J. R., MEHANNA, S. J., Tonnu-Mihara, I. Q., & Khera, R. (2026) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2026.101425 · Cited by 2 · see citing works
Self-citation舟越, 光., Nishioka, D., Haruguchi, S., Yonemura, S., Takebe, T., Nonaka, M., & Iwashita, S. (2024) · BMJ Public Health · doi:10.1136/bmjph-2023-000686 · Cited by 3 · see citing works
Dong, L., & Dong, Z. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1601112 · Cited by 2 · see citing works
Amen, T. B., Dee, E. C., Jain, B., Batter, S., Jain, U., Bajaj, S. S., Varady, N. H., Amen, L. J., & Goodman, S. M. (2024) · JCR Journal of Clinical Rheumatology · doi:10.1097/rhu.0000000000002110 · Cited by 1 · see citing works
A Patient-Informed Framework of Financial Strain Among Adults with Multimorbidity
Sloan, C. E., Lourie, M. A., Bowling, C. B., Pignone, M. P., Houtven, C. H. V., & McDermott, C. L. (2025) · Journal of General Internal Medicine · doi:10.1007/s11606-025-09911-x · Cited by 1 · see citing works
Financial Outcomes Among Medicaid Expansion Enrollees
Becker, N. V., Levy, H. G., Hirth, R. A., Clark, S. J., Tipirneni, R., & Ayanian, J. Z. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.9328 · Cited by 1 · see citing works
Khera, R., Kondamudi, N., Liu, M., Ayers, C. R., Spatz, E. S., Rao, S. G., Essien, U. R., Powell‐Wiley, T. M., Nasir, K., Das, S. R., et al. (2023) · American Journal of Preventive Cardiology · doi:10.1016/j.ajpc.2023.100493 · Cited by 1 · see citing works
Self-citationA toxicidade financeira em pessoas com doença renal crônica em tratamento hemodialítico
Silva, E. C. D. S., Mantovani, M. D. F., Nogueira, L. D. A., Küchler, M. L., Cassi, C. C. A. V., & Kalinke, L. P. (2023) · Revista Brasileira de Enfermagem · doi:10.1590/0034-7167-2022-0671pt · Cited by 1 · see citing works
Pharmacy and neighborhood-level variation in cash price of diabetes medications in the United States
Warraich, H. J., Siddiqi, H. K., Li, D. G., van Meijgaard, J., & Vaduganathan, M. (2023) · PLoS ONE · doi:10.1371/journal.pone.0294164 · Cited by 1 · see citing works
Kang, M. W., Oh, J., Lee, J., Kim, M. H., Koh, J. H., Cho, J. M., Kim, S. G., Cho, S., Lee, S., Kim, Y., et al. (2025) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2025.02.609 · Cited by 1 · see citing works
Kane, R. L., Billig, J. I., Ouyang, Z., Wang, L., Wang, L., & Chung, K. C. (2025) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000011702 · Cited by 1 · see citing works
Kim, D., Danpanichkul, P., Wijarnpreecha, K., & Ahmed, A. (2025) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2025.112340 · Cited by 1 · see citing works
Deborah, S. D. E. (2022) · Journal of Biology Agriculture and Healthcare · doi:10.7176/jbah/12-16-02
Deborah, S. D. E. (2022) · Public Policy and Administration Research · doi:10.7176/ppar/12-6-06
Hospital Encounters Within 1 Year Postpartum Across Insurance Types, Oregon 2012–2017
Kaufman, M. R., McConnell, K. J., Rodriguez, M. I., Stratton, K., Richardson, D. M., & Snowden, J. M. (2023) · Medical Care · doi:10.1097/mlr.0000000000001958
Argetsinger, S., LeCates, R. F., Zhang, F., Ross‐Degnan, D., Wharam, J. F., Arterburn, D. E., Fernandez, A., & Lewis, K. H. (2024) · Obesity · doi:10.1002/oby.23997
Hysterectomy and medical financial hardship among U.S. women.
Datta, B., Tiwari, A., Abdelgawad, Y. H., & Wasata, R. (2024) · Sexual & Reproductive HealthCare · doi:10.1016/j.srhc.2024.101019
Adesoba, T. P., Brown, C. C., Felix, H. C., Baloh, J., Lipschitz, R., & Goudie, A. (2025) · Medical Care · doi:10.1097/mlr.0000000000002129
Gevela, G. N., & Acosta, R. A. (2025) · International Journal For Multidisciplinary Research · doi:10.36948/ijfmr.2025.v07i03.47266
Xu, J. (2025) · Advances in Economics Management and Political Sciences · doi:10.54254/2754-1169/2025.lh23807
Examining out-of-pocket health expenditures of individuals with Type 1 diabetes: The case of Türkiye
Ardıç, M., & ERİŞEN, M. A. (2025) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2025.112362
John, T., Nawshin, T., Mohanraj, S., Mehta, T. S., & Thirumalai, M. (2025) · doi:10.2196/preprints.81441
Kret, Z. S., Scarnati, K., Dakroub, A., Esser, K. L., Matus, C. D., & Paat, R. (2025) · Clinical Diabetes · doi:10.2337/cd24-0097
Lum, Z. K., Tan, J. Y., Wong, C. S. M., Kok, Z. Y., Kwek, S. C., Tsou, K. Y. K., Gallagher, P., & Lee, J. Y.-C. (2024) · Figshare · doi:10.6084/m9.figshare.26737650
Elizondo, J. V., Javed, Z., Khera, R., Tano, M., Dudum, R., Acquah, I., Hyder, A. A., Andrieni, J., Sharma, G. V., Blaha, M. J., et al. (2024) · Figshare · doi:10.6084/m9.figshare.26550979
Self-citationFinancial hardship from medical bills and depression among adults with diabetes in the United States
Alharbi, H., & Popovici, I. (2025) · Journal of Pharmaceutical Health Services Research · doi:10.1093/jphsr/rmaf016
Outpatient support needs and related potential risk factors among older adults with diabetes
Miyawaki, Y., & Shimizu, Y. (2025) · Journal of International Nursing Research · doi:10.53044/jinr.2023-0048
Health Care Financial Hardship Among Nonelderly U.S. Adults by Diabetes Status
Zhou, X., Wang, Y., Li, R., Rolka, D. B., & Zhang, P. (2026) · Diabetes Obesity and Cardiometabolic CARE · doi:10.2337/doc25-0037
Bose, A., Prochnow, T. M., Bergeron, C., Park, J.-H., Johannes, B. L., Sherman, L. D., Patterson, M. S., Merianos, A. L., & Smith, M. L. (2026) · Patient Preference and Adherence · doi:10.2147/ppa.s589075
John, T., Mohanraj, S., Nawshin, T., Mehta, T. S., & Thirumalai, M. (2026) · JMIR Diabetes · doi:10.2196/81441
Association Between Financial Strain and Hemoglobin A1c Levels in Adults with Diabetes
Patel, M. R., Leung, C. W., & Hao, W. (2026) · Journal of General Internal Medicine · doi:10.1007/s11606-026-10653-7
- Authors
- Caraballo, C., Valero-Elizondo, J., Khera, R., Mahajan, S., Grandhi, G. R., Virani, S. S., Mszar, R., Krumholz, H. M., & Nasir, K.
- Affiliations
- Yale New Haven Health System (US)
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (J.V.-E., K.N.).
- The University of Texas Southwestern Medical Center (US)
- Yale University (US)
- MedStar Union Memorial Hospital (US)
- Michael E. DeBakey VA Medical Center (US)
- Houston Methodist (US)
- Corresponding author
- Caraballo, César
- ORCID
- Venue
- Circulation: Cardiovascular Quality and Outcomes
- Published
- 2020-02
- Volume
- 13
- Issue
- 2
- Pages
- e006139-e006139
- ISSN
- 1941-7705 (ISSN-L)
- 1941-7713
- OpenAlex
- W3005022849
- Cited by
- 104
- References
- 34
- Citations by year
- 2026: 10 · 2025: 23 · 2024: 19 · 2023: 17 · 2022: 17 · 2021: 13 · 2020: 5
- FWCI
- 11.06
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Cardiovascular Quality and Outcomes (publishedVersion)
- PubMed (publishedVersion)
- eCommons - AKU (Aga Khan University) (submittedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Keywords
- diabetes mellitus, financial hardship, medical bills, out-of-pocket costs, non-elderly adults, food insecurity, cost-related medication nonadherence, delayed care, health insurance status, racial disparities, low income, comorbidity burden, financial distress, health care costs, United States, National Health Interview Survey, health equity
- MeSH terms
- Adolescent, Adult, Age Factors, Black or African American, Cross-Sectional Studies, Diabetes Mellitus, Health Expenditures, Female, Financing, Personal, Food Supply, Health Services Accessibility, Humans, Income, Male, Middle Aged, Patient Compliance, Risk Factors, United States, Comorbidity, Health Care Costs, Medically Uninsured, Cost of Illness, Risk Assessment, Health Care Surveys, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
