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Cited by 4,147Health Systems, Economic Evaluations, Quality of LifeDiabetes Management and ResearchHealthcare Policy and Management

Economic Costs of Diabetes in the U.S. in 2002

American Diabetes Association·2003·Diabetes Care
DOI 10.2337/diacare.26.3.917
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Abstract

OBJECTIVE—Diabetes is the fifth leading cause of death by disease in the U.S. Diabetes also contributes to higher rates of morbidity—people with diabetes are at higher risk for heart disease, blindness, kidney failure, extremity amputations, and other chronic conditions. The objectives of this study were 1) to estimate the direct medical and indirect productivity-related costs attributable to diabetes and 2) to calculate and compare the total and per capita medical expenditures for people with and without diabetes. RESEARCH DESIGN AND METHODS—Medical expenditures were estimated for the U.S. population with and without diabetes in 2002 by sex, age, race/ethnicity, type of medical condition, and health care setting. Health care use and total health care expenditures attributable to diabetes were estimated using etiological fractions, calculated based on national health care survey data. The value of lost productivity attributable to diabetes was also estimated based on estimates of lost workdays, restricted activity days, prevalence of permanent disability, and mortality attributable to diabetes. RESULTS—Direct medical and indirect expenditures attributable to diabetes in 2002 were estimated at $132 billion. Direct medical expenditures alone totaled $91.8 billion and comprised $23.2 billion for diabetes care, $24.6 billion for chronic complications attributable to diabetes, and $44.1 billion for excess prevalence of general medical conditions. Inpatient days (43.9%), nursing home care (15.1%), and office visits (10.9%) constituted the major expenditure groups by service settings. In addition, 51.8% of direct medical expenditures were incurred by people >65 years old. Attributable indirect expenditures resulting from lost workdays, restricted activity days, mortality, and permanent disability due to diabetes totaled $39.8 billion. U.S. health expenditures for the health care components included in the study totaled $865 billion, of which $160 billion was incurred by people with diabetes. Per capita medical expenditures totaled $13,243 for people with diabetes and $2,560 for people without diabetes. When adjusting for differences in age, sex, and race/ethnicity between the population with and without diabetes, people with diabetes had medical expenditures that were ∼2.4 times higher than expenditures that would be incurred by the same group in the absence of diabetes. CONCLUSIONS—The estimated $132 billion cost likely underestimates the true burden of diabetes because it omits intangibles, such as pain and suffering, care provided by nonpaid caregivers, and several areas of health care spending where people with diabetes probably use services at higher rates than people without diabetes (e.g., dental care, optometry care, and the use of licensed dietitians). In addition, the cost estimate excludes undiagnosed cases of diabetes. Health care spending in 2002 for people with diabetes is more than double what spending would be without diabetes. Diabetes imposes a substantial cost burden to society and, in particular, to those individuals with diabetes and their families. Eliminating or reducing the health problems caused by diabetes through factors such as better access to preventive care, more widespread diagnosis, more intensive disease management, and the advent of new medical technologies could significantly improve the quality of life for people with diabetes and their families while at the same time potentially reducing national expenditures for health care services and increasing productivity in the U.S. economy.

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Authors
American Diabetes Association
Affiliations
Lewin Group (United States) (US)
Corresponding author
American Diabetes Association
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2003-03-01
Volume
26
Issue
3
Pages
917-932
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/diacare.26.3.917
OpenAlex
W3122152400
Cited by
4,147
References
11
Citations by year
2026: 2 · 2025: 5 · 2024: 11 · 2023: 12 · 2022: 15 · 2021: 224 · 2020: 310 · 2019: 290 · 2018: 279 · 2017: 251 · 2016: 271 · 2015: 322 · 2014: 305 · 2013: 245 · 2012: 172
FWCI
365.94
Type
journal article
Language
en
Open access
closed
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • American Diabetes Association
  • National Institute of Diabetes and Digestive and Kidney Diseases
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
diabetes mellitus, economic burden of disease, health care costs, productivity loss, lost workdays, chronic complications of diabetes, etiological fraction, diabetes mortality, disability, health care utilization, nursing home care, inpatient days, age and sex differences, racial and ethnic disparities
MeSH terms
Adolescent, Adult, Aged, Black or African American, Diabetes Mellitus, Efficiency, Health Expenditures, Female, Persons with Disabilities, Disabled Persons, Health Resources, Hispanic or Latino, Humans, Male, Middle Aged, United States, Comorbidity, Prevalence, Health Care Costs, Age Distribution, Sick Leave, White People

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