Smoking-attributable health care expenditures among persons with diabetes mellitus

Objective: To estimate and compare the health care expenditures attributable to smoking by the diabetes status.

Method: We used the 2000 to 2003 Medical Expenditure Panel Surveys (MEPS) data and 1998 to 2002 National Health Interview Survey (NHIS) data to estimate smoking-attributable medical expenditures by diabetes status. The sample includes 38,299 adults. All costs data are inflated to 2005 dollars. Separate two-part econometric models are used to estimate annual smoking-attributable expenditures by diabetes status and service type

Results:

Comparing the sample with diabetes (N=3,424) to the sample without diabetes (N=34,875), medical expenditures on inpatient, outpatient and prescription drugs are significantly higher for those with diabetes. People with diabetes are older; are more likely to be non-white, have lower income level, are covered by public insurance, are obese and are less likely to be married. Comparing the sample of ever smokers to never-smokers, on average, ever smokers have significantly higher health care expenditures among people without diabetes. Expenditures on prescription drugs are significantly higher for smokers among people with diabetes. Smoking-attributable fractions (SAF) for those without diabetes are larger than for those with diabetes. Smoking-attributable expenditures (SAE) are larger for all three categories but statistically non-significant (except for prescription drugs) for those with diabetes.

Conclusion:

Persons with diabetes had much higher total healthcare expenditures than those without diabetes. Among persons with diabetes, smokers had higher prescription drug expenditures which may be related to smoking influence on glycemic control.