Disparities in Healthcare Expenditures Associated with Diabetes: Focus on the Effects of Nativity, Length of Residence in the U.S. and Age

Increasing medical expenses are reported among people with diabetes. To understand whether the financial costs of diabetes are evenly distributed across individuals by their age, foreign-born status, and length of residence in the U.S., this study compares 1) the prevalence of diabetes, and 2) the total healthcare expenditures associated with diabetes between the recent immigrant, the longer-term immigrant, and the U.S.-born groups. In addition, this study examined whether the above mentioned relationships are different by age group (moderator; 18-64 vs. 65+).

The 2003-2007 Medical Expenditure Panel Survey linked to the National Health Interview Survey was analyzed (N=147,545). Bivariate statistics and logistic regression models were conducted by age group to compare the prevalence of diabetes by immigration status (U.S.-born; foreign-born with 0-10 years in the U.S.; foreign-born with 11+ years in the U.S.). The prevalence of diabetes was calculated based on the question asking whether an individual was told by a doctor or other health care professionals he/she had diabetes. Separate OLS regression models by age group were tested for the total medical expenditures (log-transformed) among those with diabetes. The STATA survey procedures were used to account for the complex sampling design.

Study findings supported a healthy immigrant effect in relation to diabetes only among younger adults (ages 18-64). While 2.3% of recent immigrants with less than 10 years in the U.S. suffered from diabetes, 6.8% of longer-term immigrants and 5.8% of U.S.-born individuals did. In the older adult group, recent immigrants had the highest prevalence of diabetes (29.4%) when compared to longer-term immigrants (18.6%) and the U.S.-born (18.5%). However, these bivariate differences disappeared in the older adult group after controlling for SES and demographic factors. In terms of the total annual healthcare expenditures, results from the bivariate tests indicate that among those who were diagnosed with diabetes, the U.S.-born had higher healthcare expenditures ($9,603) than their recent immigrant counterparts ($3,762) only in the younger age group (p<.001). After controlling for SES/demographic characteristics, health, and health insurance status, however, the differences disappeared.

Treatment of diabetes requires ongoing communication between an individual and a healthcare professional. This study suggests disparities in healthcare for diabetes among recent immigrants in the U.S. ages between 18-64. This supports targeted interventions by age, nativity, and length of residence in the U.S. of an individual.