Statewide Estimates of Medical Expenditures for Diabetes Care

Diabetes is the sixth leading cause of death and is associated with several serious and costly health complications including diabetic neuropathy, diabetic retinopathy, and kidney failure, and is the most common cause of non-traumatic amputation of a lower limb. This epidemic affects at least seven percent of the United States population and has been increasing since 1994 (US 4.2%). It is no surprise, then, that the cost of treatment for diabetes has also increased. Several analyses have intended to put a price tag on the total costs for treating diabetes-related problems. Our question of interest is how do medical expenditures for diabetes vary across the United States. We provide state-specific estimates for the cost of medical care expenditures based on two nationwide surveys administered in 2005: the Behavioral Risk Surveillance System Survey (BRFSS) and the Medical Expenditure Panel Survey (MEPS).

The BRFSS is a state-based system of health surveys. In 2005 the BRFSS was administered over the phone to 356,112 adults of the US population across 50 states and the District of Columbia. Synthetic estimates for the prevalence of diabetes were estimated for gender, race/ethnicity and age categories at the zip-code level. Expenditure data were provided using MEPS, a set of large-scale surveys administered to 32,320 individuals in 2005 within selected communities across the US. MEPS services included in the estimate: Outpatient and Office-Based Medical Provider Visits, Hospital Inpatient Stays, Emergency Room Visits, and Home Health and Costs of Prescribed Medicine. Because MEPS provides regional data, the mean cost of medical care and services for each of four US regions by gender, race/ethnicity and age categories were calculated. Using the synthetic estimates for the prevalence of diabetes for each zip code and the mean cost for each region, statewide estimates of total expenditures for diabetes were obtained.

Based on 2005 BRFSS self-reported data, the overall prevalence of diabetes in the US was 7.4% (2005), ranging from 4.4% (Alaska) to 10.4% (West Virginia). The total cost in the US of diabetes obtained using MEPS was $32,293,942,179, ranging from $5,099,069,789 to $14,831,376,894 in the four regions. We utilized GIS software to produce maps to examine the geographic patterns of diabetes expenditures across the US continent and the District of Columbia for levels of age, race/ethnicity and gender. Results suggest that the total cost of diabetes varies not only across states, but also across demographic categories.