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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.
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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]
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Metadata
- 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
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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
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