Economic Costs of Diabetes in the U.S. in 2007
Article Figures & Tables
Figures
- Figure 1—
Rate of health resource use by men with diabetes relative to men without diabetes for visits/days where heart failure is the primary diagnosis.
- Figure 2—
Percent of category expenditures associated with diabetes. See appendix for diagnosis codes for each category of complications.
- Figure 3—
Average hospital length of stay (ALOS) when diabetes is a secondary diagnosis.
- Figure 4—
Age distribution of deaths associated with diabetes.
- Figure 5—
Net present value of future lost earnings from premature death.
- Figure 6—
Rate ratios for inpatient care where the primary diagnosis code is a general medical condition: males. A ratio of 1.0 means that per capita hospital admissions (or days) for people with diagnosed diabetes is the same as the per capita admissions (or days) for people without diabetes.
Tables
- Table 1—
U.S. population (in thousands) and percent of U.S. population with diabetes, 2007
Total U.S. population With diagnosed diabetes With undiagnosed diabetes Total with diabetes* Total population* 301,736 17,486 5.8% 6,640 2.2% 24,126 8.0% Race/ethnicity Non-Hispanic white 199,091 11,403 5.7% 4,520 2.3% 15,923 8.0% Non-Hispanic black 37,002 2,775 7.5% 699 1.9% 3,474 9.4% Non-Hispanic other 20,101 1,076 5.4% 317 1.6% 1,393 6.9% Hispanic 45,541 2,231 4.9% 1,104 2.4% 3,335 7.3% Sex Male 148,744 8,543 5.7% 3,113 2.1% 11,656 7.8% Female 152,992 8,943 5.8% 3,528 2.3% 12,471 8.2% Age (years) <18 73,878 157 0.2% 35 0.1% 192 0.3% 18–34 70,373 964 1.4% 669 1.0% 1,633 2.3% 35–44 43,356 1,686 3.9% 1,174 2.7% 2,860 6.6% 45–54 43,838 3,443 7.9% 1,327 3.0% 4,770 10.9% 55–59 18,235 2,307 12.7% 756 4.1% 3,063 16.8% 60–64 14,323 2,261 15.8% 775 5.4% 3,036 21.2% 65–69 10,690 1,879 17.6% 850 8.0% 2,729 25.5% ≥70 27,042 4,788 17.7% 1,055 3.9% 5,843 21.6% Insurance Private 169,886 7,057 4.2% 3,018 1.8% 10,075 5.9% Government 91,794 8,997 9.8% 2,891 3.1% 11,888 13.0% Uninsured 40,055 1,432 3.6% 731 1.8% 2,163 5.4% -
Source: Combined information from the 2004–2006 NHIS, 2004 NNHS, 1999–2004 NHANES, and the U.S. Census Bureau population estimates for 2007.
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↵* Numbers do not necessarily sum to totals because of rounding.
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- Table 2—
Average cost ($) per medical event, by complication, 2007
Medical event Diabetes Chronic complications General medical Neurological Peripheral vascular Cardiovascular Renal Metabolic Ophthalmic Other Hospital inpatient day*† 1,853 2,363 2,226 3,225 1,872 2,156 2,408 1,718 2,188 Outpatient visit† 331 487 714 577 592 295 753 403 745 Emergency visit† 696 798 811 680 576 594 1,613 636 701 Physician office visit† 132 160 199 151 169 118 182 162 162 - Table 3—
Average cost per medical event, 2007
Medical event Unit cost ($) Prescription (excluding insulin and oral agents)* 72 Oral agents (per user per year)* 697 Insulin (per insulin user per year)* 751 Diabetic supplies (per person with diabetes per year)*, a 102 Home health visits (cost per person per day of use)*, a 204 Hospice care day† 147 Nursing facility day‡ (excluding food and rent) b 131 (120) Other medical supplies (excess cost per person with diabetes per year)*, a Glasses/contacts 5.57 Ambulance services 5.92 Orthopedic items 5.52 Hearing devices 9.02 Prosthesis 4.09 Bathroom aids 1.52 Medical equipment 7.09 Disposable supplies 10.85 Alterations/modifications 7.10 Other 0.14 -
Source:
- *
↵* 2003–2005 MEPS;
- †
↵† Hospice Association of America 2006.
- ‡
↵‡ Average of cost for semi-private room and private room per the Genworth Financial 2007 Cost of Care Survey (http://longtermcare.genworth.com/comweb/consumer/pdfs/long_term_care/Cost_Of_Care_Survey.pdf). Note:
- a
↵a Cost estimate varies by age and sex.
- b
↵b An estimated 38% of the cost per day in a nursing home is for food and rent. For long-term residents, we exclude from the cost estimates expenses for room and board that would still have been incurred if the person were living at home. Estimates are adjusted to 2007 dollars.
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- Table 4—
Health resource use (in millions of units) in the U.S., by diabetes attribution and cost component, 2007
Health resource Population with diabetes Incurred by population without diabetes U.S. total* Attributed to diabetes Incurred by people with diabetes Units % of U.S. total Units % of U.S. total Institutional care Hospital inpatient days 24.3 13 40.7 22 145.7 186.4 Nursing/residential facility days 56.1 10 140.6 25 433.3 573.9 Outpatient care Physician's office visits 64.7 7 137.6 14 822.1 959.7 Emergency visits 5.6 5 11.5 10 104.4 115.9 Hospital outpatient and freestanding ambulatory surgical center visits 5.7 6 10.9 12 81.7 92.7 Home health visits 27.4 13.8 46.0 23.2 152.7 198.8 Hospice care days 0.2 <1 9.6 11 81.5 91.1 Retail prescriptions 175.3 8 359.6 17 1,762.0 2,121.6 - *
↵* Numbers do not necessarily sum to totals because of rounding.
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- Table 5—
Health resource use attributed to diabetes in the U.S., by age and type of service, 2007 (in thousands)
Health resource Age (years) Total* < 45 45–64 ≥ 65 Institutional care Hospital inpatient days 2,115 7,586 14,562 24,262 Nursing/residential facility days 1,269 11,103 43,687 56,059 Outpatient care Office-based physician visits 7,353 26,552 30,808 64,713 Emergency visits 1,499 1,984 2,084 5,567 Hospital outpatient and freestanding ambulatory surgical center visits 1,307 2,535 1,888 5,730 Home health visits 0 8,939 18,449 27,388 Hospice care days 4 22 165 192 Retail prescriptions 15,181 71,295 88,841 175,317 - *
↵* Numbers do not necessarily sum to totals because of rounding.
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- Table 6—
Health resource use attributed to diabetes in the U.S., by medical condition (in thousands)
Health resource Diabetes Chronic complications General medical conditions Total* Neuro-logical Peripheral vascular Cardio-vascular Renal Metabolic Ophthalmic Other Hospital inpatient days 828 1,318 1,221 6,446 1,755 82 15 1,871 10,726 24,262 Office-based physician visits 21,931 2,386 1,405 6,635 1,905 403 4,934 1,443 23,672 64,713 Emergency visits 336 173 53 592 229 22 7 280 3,874 5,567 Hospital outpatient and freestanding ambulatory surgical center visits 2,544 154 189 549 147 27 173 173 1,773 5,730 - *
↵* Numbers do not necessarily sum to totals because of rounding.
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- Table 7—
Share of total attributed health resource use, by medical condition
Health resource Diabetes Chronic complications General medical conditions Total* Neuro-logical Peripheral vascular Cardio-vascular Renal Metabolic Ophthalmic Other Hospital inpatient days 3 5 5 27 7 0 0 8 44 100 Office-based physician visits 34 4 2 10 3 1 8 2 37 100 Emergency visits 6 3 1 11 4 0 0 5 70 100 Hospital outpatient and freestanding ambulatory surgical center visits 44 3 3 10 3 0 3 3 31 100 - *
↵* Numbers do not necessarily sum to totals because of rounding.
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- Table 8—
Proportion of total health resource use attributed to diabetes in the U.S. by medical condition
Health resource Diabetes Chronic complications General medical conditions Total Neurological Peripheral vascular Cardio-vascular Renal Metabolic Ophthalmic Other Hospital inpatient days 100 26 36 34 35 51 27 44 7 13 Office-based physician visits 100 26 18 11 15 4 19 13 3 7 Emergency visits 100 22 12 19 9 41 9 7 4 5 Hospital outpatient and freestanding ambulatory surgical center visits 100 27 24 10 11 4 18 14 2 6 - Table 9—
Health care expenditures in the U.S., by diabetes status and type of service, 2007 (in millions of dollars and % of U.S. total)
Cost component Population with diabetes Population without diabetes U.S. total* Attributed to diabetes Total incurred by people with diabetes Dollars % of U.S. total Dollars % of U.S. total Institutional care Hospital inpatient 58,344 14 96,974 23 332,902 429,875 Nursing/residential facility 7,486 10 18,525 25 56,692 75,217 Outpatient care 21,739 Physician's office 9,897 6 8,065 14 132,984 154,723 Emergency department 3,870 5 7,879 10 73,381 81,446 Ambulance services 103 5 370 18 1,726 2,096 Hospital outpatient 2,985 4 6,770 10 60,054 66,824 Home health 5,586 14 9,391 23 31,149 40,546 Hospice 28 <1 1,411 11 10,622 12,033 Podiatry 273 19 408 28 1,028 1,437 Outpatient medications and supplies Insulin 3,733 100 3,733 100 NA 3,733 Diabetic supplies 1,783 100 1,783 100 NA 1,783 Oral agents 8,586 100 8,586 100 NA 8,586 Retail prescriptions 12,692 8 26,035 17 127,562 153,597 Other equipment and supplies 890 5 2,714 14 16,901 19,615 Total* 116,257 11 205,092 20 834,379 1,051,505 - *
↵* Numbers do not necessarily sum to totals because of rounding.
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- Table 10—
Health care expenditures attributed to diabetes in the U.S., by age group and type of service, 2007 (in millions of dollars)
Cost component Age (years) Total* <45 45–64 ≥65 Institutional care Hospital inpatient 4,551 18,447 35,346 58,344 Nursing/residential facility 166 1,527 5,793 7,486 Outpatient care Physician's office 1,113 3,982 4,802 9,897 Emergency department 1,047 1,384 1,438 3,870 Ambulance services 4 79 21 103 Hospital outpatient 645 1,312 1,028 2,985 Home health 0 1,823 3,763 5,586 Hospice 1 3 24 28 Podiatry 14 58 202 273 Outpatient medications and supplies Insulin 788 1,564 1,381 3,733 Diabetic supplies 217 859 707 1,783 Oral agents 967 4,163 3,456 8,586 Retail prescriptions 1,099 5,161 6,432 12,692 Other equipment and supplies 77 448 365 890 Total* 10,689 40,810 64,758 116,257 - *
↵* Numbers do not necessarily sum to totals because of rounding.
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- Table 11—
Annual per capita health care expenditures attributed to diabetes by age group 2007
Cost component Age (years) Total* <45 45–64 ≥65 Institutional care Hospital inpatient 1,621 2,303 5,302 3,337 Nursing/residential facility 59 191 869 428 Outpatient care Physician's office 397 497 720 566 Emergency department 373 173 216 221 Ambulance services 1 10 3 6 Hospital outpatient 230 164 154 171 Home health 0 228 564 319 Hospice 0 0 4 2 Podiatry 5 7 30 16 Outpatient medications and supplies Insulin 281 195 207 214 Diabetic supplies 77 107 106 102 Oral agents 344 520 518 491 Retail prescriptions 392 644 965 726 Other equipment and supplies 27 56 55 51 Total* 3,808 5,094 9,713 6,649 - *
↵* Numbers do not necessarily sum to totals because of rounding.
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- Table 12—
Health care expenditures attributed to diabetes in the U.S., by medical condition for select settings, 2007 (in millions of dollars)
Setting Diabetes Chronic complications General medical conditions Total* Neuro-logical Peripheral vascular Cardio-vascular Renal Metabolic Ophthalmic Other Hospital inpatient 1,535 3,115 2,719 20,790 3,285 176 36 3,215 23,473 58,344 Physician's office 2,899 382 279 1,004 323 48 899 233 3,830 9,897 Emergency department 234 138 43 403 132 13 11 178 2,717 3,870 Hospital outpatient 842 75 135 317 87 8 130 70 1,321 2,985 - *
↵* Numbers do not necessarily sum to totals because of rounding.
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- Table 13—
Annual per capita health care expenditures by diabetes status, 2007
Cost component With diabetes Unadjusted Age-sex adjusted Attributed to diabetes Without diabetes Ratio with to without diabetes Without diabetes Ratio with to without diabetes Institutional care Hospital inpatient 5,546 1,171 4.7 2,209 2.5 3,337 Nursing/residential facility 1,059 199 5.3 631 1.7 428 Outpatient care Physician's office 1,243 468 2.7 677 1.8 566 Emergency department 461 258 1.8 240 1.9 221 Ambulance services 21 6 3.5 15 1.4 6 Hospital outpatient and freestanding ambulatory surgical center 387 211 1.8 216 1.8 171 Home care 551 110 5.0 232 2.4 319 Hospice care NA NA NA NA NA 2 Podiatry 23 4 6.5 8 3.0 16 Outpatient medications and supplies Insulin 214 NA NA NA NA 214 Diabetic supplies 102 NA NA NA NA 102 Oral agents 491 NA NA NA NA 491 Retail prescriptions 1,489 449 3.3 763 2.0 726 Other equipment and supplies 155 59 2.6 104 1.5 51 Total* $11,744 $2,935 4.0 $5,095 2.3 $6,649 - *
↵* Numbers do not precisely sum to totals because of rounding.
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- Table 14—
Indirect costs attributed to diabetes, 2007
Cost component Productivity loss Total cost attributable to diabetes ($ billions) Proportion of indirect costs (%) Work days absent 15 million days 2.6 4 Reduced performance at work 120 million days 20.0 34 Reduced productivity days for those not in labor force 6 million days 0.8 1 Permanent disability 445,000 people, 107 million days 7.9 14 Mortality 284,000 deaths 26.9 46 Total 58.2 100 - Table 15—
Annual productivity loss per person with diabetes by cause, 2007
Sex Age Absenteeism Presenteeism Reduced productivity for those not in labor force Unemployment from disability Premature mortality Male <18 — — — — 4,306 18–34 22 1,458 17 936 3,366 35–44 99 2,883 10 728 4,476 45–54 493 2,688 72 652 4,468 55–59 360 2,196 109 315 3,081 60–64 181 1,517 131 806 1,822 65–69 86 721 — 274 569 70+ 45 378 — 146 284 Female <18 — — — — 2,070 18–34 50 844 21 743 1,095 35–44 47 1,378 14 1,216 1,456 45–54 240 1,310 70 449 1,388 55–59 179 1,093 90 491 994 60–64 72 604 80 492 642 65–69 27 228 — 448 140 70+ 17 140 — 74 116 - Table 16—
Mortality costs attributed to diabetes, 2007
Primary cause of death Total U.S. deaths (thousands) Deaths attributed to diabetes Deaths (thousands) % of total U.S. deaths Value of lost productivity (millions of dollars) Diabetes 77 77 100.0 9,520 Renal disease 43 25 57.4 2,116 Cerebrovascular disease 155 59 37.6 3,849 Cardiovascular disease 739 123 16.5 11,417 Grand total NA* 284 NA* 26,902 - *
↵* Grand total comprises mortality for reasons other than diabetes, renal disease, cerebrovascular disease, and cardiovascular disease.
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- Table A1—
Summary of data sources
Data source and description Used to estimate/analysis Strengths and limitations National Health Interview Survey (NHIS): combined 2004–2006 surveys to increase sample size. Diabetes diagnosed prevalence by age, sex, and race/ethnicity Prevalence of insulin and oral agents use Impact of diabetes on employment/hours worked Activity limitation and restriction +Large sample size +Contains employment-related information −Diabetes status self-reported of whether ever been told by physician you have diabetes −Excludes institutionalized population where diabetes is overrepresented National Health and Nutrition Examination Survey (NHANES): combined the three biannual surveys (1999–2000, 2001–2002, and 2003–2004) to increase sample size. Verify diagnosed prevalence Estimate undiagnosed prevalence +Contain both self-reported and lab test–identified diabetic persons −Excludes institutionalized population where diabetes is overrepresented Medical Expenditure Panel Survey (MEPS): combined 2003–2005 surveys to increase sample size. Average cost per physician office, outpatient, and emergency visit and outpatient prescription Average annual expenditures for podiatry, home health, insulin, oral agents, diabetes-related supplies use and cost, other medical equipment and supplies +Rich source of health resource use and cost information −Relatively small sample size per year −Contains only three-digit diagnosis codes; many chronic conditions of diabetes require four-digit codes to identify −Excludes institutionalized population where diabetes is overrepresented National Ambulatory Medical Care Survey (NAMCS): combined 2003–2005 surveys to increase sample size. National number of physician office visits by medical condition(using primary diagnosis code) Average number of scripts written per visit +Larger sample size than MEPS +Contains five-digit diagnosis codes to identify chronic conditions of diabetes −Visits are the unit of observations, with incomplete information on patients (including whether they have diabetes) National Hospital Ambulatory Medical Care Survey (NHAMCS): combined 2003–2005 surveys to increase sample size. National number of hospital outpatient and emergency visits by medical condition (using primary diagnosis code) +Same as for NAMCS −Same as for NAMCS Average number of scripts written per visit Nationwide Inpatient Sample (NIS): used 2004–2005 surveys. National number of hospital inpatient days for diabetes and comorbidities of diabetes (using primary diagnosis) +Same as for NAMCS −Same as for NAMCS Cost per inpatient day calculated using hospital-specific cost-to-charge ratios National Home and Hospice Care Survey (NHHCS): used 2000 data. Hospice care use (also validate home health) +Same as for NAMCS −Same as for NAMCS National Nursing Home Survey (NNHS): used 2004 data. Nursing facility use +Same as for NAMCS −Same as for NAMCS Ingenix MCURE database Calculate age-sex specific relative rate ratios for each medical condition for hospital inpatient days, emergency visits, and ambulatory visits (physician office and hospital outpatient combined) +Large sample size −All medical records can be linked for the year to identify people with diabetes based on whether they have any diabetes diagnosis code during the year −Lacks detailed data on health behavior found in MEPS - Table A2—
Chronic complications of diabetes
Chronic complications of diabetes ICD-9 codes Neurological symptoms Myasthetic syndromes in diseases classified elsewhere (amyotrophy) 358.1 Other specified idiopathic peripheral neuropathy 356.8 Mononeuritis of upper and lower limbs 354, 355 Arthropathy associated w/neurological disorders (Charcot's arthropathy) 713.5 Peripheral autonomic neuropathy 337.1 Polyneuropathy in diabetes 357.2 Neuralgia, neuritis, and radiculitis, unspecified 729.2 Diabetes with neurological complications 250.6 Occlusion of cerebral arteries 434 Hemorrhagic stroke 430–432 Late effects of cerebrovascular disease 438 Occlusion of stenosis of pre-cerebral arteries 433 Other and ill-defined cerebrovascular disease 437 Acute, but ill-defined, cerebrovascular disease 436 TIAs 435 Peripheral vascular disease Atherosclerosis 440 Embolism and thrombosis, structure of artery 444, 447.1 Other peripheral vascular disease 443 Other disorders of circulatory system 459 Phlebitis and thrombophlebitis, portal vein throbosis and thrombolism and venous thrombolism 451,452 Other venous embolism and thrombolism 453 Varicose veins of lower extremities 454 Gangrene and amputations 785.4, 885–887, 895–897 Chronic ulcer of skin 707 Cardiovascular disease Aortic and other aneurysms 441, 442 Hypotension 458 Angina 413 Conduction disorders and cardiac dysrhythmias 426–427 ASCVD 429.2 Cardiomegaly 429.3 Cardiomyopathy 425 Other acute and subacute forms of ischemic heart disease 411 Heart failure 428 Diabetes w/peripheral circulatory disorders 250.7 Myocardial degeneration 429.1 Myocardial infarction 410, 412 Other chronic ischemic heart disease 414 Hypertension 401–405 Renal Complications Infections of kidney 590 Other disorders of bladder 596 Cystitis 595 Renal sclerosis, unspecified 587 Glomerulonephritis, nephrotic syndrome, nephritis, and nephropathy 580–583 Proteinuria 791.0 Renal failure and its sequelae 584, 586, 588 Other disorders of kidney and ureter 593 Urinary tract infection 599.0 Diabetes and renal complications 250.4 Chronic renal failure (ESRD) 585 Endocrine/metabolic complications Dwarfism-obesity syndrome 259.4 Glycogenosis and galactosemia 271.0, 271.1 Disorders of iron metabolism 275.0 Hypercholesterolemia 272.0 Hyperchylomicronemia 272.3 Hyperkalemia 276.7 Hypertriglyceridemia 272.1 Macroglobulinemia 273.3 Lancereaux's disease 261 Lipidoses 272.7 Other specified endocrine disorders 259.8 Other and unspecified hyperlipidemia 272.4 Mixed hyperlipidemia 272.2 Renal glycosuria 271.4 Ophthalmic complications Other retinal disorders 362 Vascular disorders of the iris and ciliary body 364.0, 364.4 Disorders of the optic nerve and visual pathways 377 Diabetes with ophthalmic complications 250.5 Cataract 366 Glaucoma 365 Visual disturbance, low vision, blindness 368–369 Other complications Bacteremia, bacterial infection, Coxsackie virus 079.2, 790.7 Candidiasis of skin and nails 112.3 Chronic osteomyelitis of the foot 730.17 Other and unspecified noninfectious gastroenteritis and colitis 558.9 Impotence of organic origin 607.84 Infective otitis externa 380.1 Degenerative skin disorders 709.3 Candidiasis of vulva and vagina 112.1 Cellulitis 681, 682 Diabetes with other specified manifestations 250.8 Diabetes with unspecified complication 250.9 Other bone involvement in disease classified elsewhere 731.8
In this Issue
March 2008, 31(3)
