César Caraballo1, Javier Valero-Elizondo2,3, Rohan Khera4, Shiwani Mahajan1, Gowtham R Grandhi5, Salim S Virani6,7, Reed Mszar1,8, Harlan M Krumholz1,9,10, Khurram Nasir2,3. 1. Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.C., S.M., R.M., H.M.K.). 2. Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX (J.V.-E., K.N.). 3. Center for Outcomes Research, Houston Methodist, TX (J.V.-E., K.N.). 4. Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K.). 5. Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD (G.R.G.). 6. Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX (S.S.V.). 7. Baylor College of Medicine, Houston, TX (S.S.V.). 8. Department of Chronic Disease Epidemiology (R.M.), Yale School of Public Health, New Haven, CT. 9. Department of Health Policy and Management (H.M.K.), Yale School of Public Health, New Haven, CT. 10. Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT (H.M.K.).
Abstract
BACKGROUND: The trend of increasing total and out-of-pocket expenditure among patients with diabetes mellitus represents a risk of financial hardship for Americans and a threat to medical and nonmedical needs. We aimed to describe the national scope and associated tradeoffs of financial hardship from medical bills among nonelderly individuals with diabetes mellitus. METHODS AND RESULTS: We used the National Health Interview Survey data from 2013 to 2017, including adults ≤64 years old with a self-reported diagnosis of diabetes mellitus. Among 164 696 surveyed individuals, 8967 adults ≤64 years old reported having diabetes mellitus, representing 13.1 million individuals annually across the United States. The mean age was 51.6 years (SD 10.3), and 49.1% were female. A total of 41.1% were part of families that reported having financial hardship from medical bills, with 15.6% reporting an inability to pay medical bills at all. In multivariate analyses, individuals who lacked insurance, were non-Hispanic black, had low income, or had high-comorbidity burden were at higher odds of being in families with financial hardship from medical bills. When comparing the graded categories of financial hardship, there was a stepwise increase in the prevalence of high financial distress, food insecurity, cost-related nonadherence, and foregone/delayed medical care, reaching 70.5%, 49.4%, 49.5%, and 74% among those unable to pay bills, respectively. Compared with those without diabetes mellitus, individuals with diabetes mellitus had higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 1.27 [95% CI, 1.18-1.36]) or any of its consequences, including high financial distress (aOR, 1.14 [95% CI, 1.05-1.24]), food insecurity (aOR, 1.27 [95% CI, 1.16-1.40]), cost-related medication nonadherence (aOR, 1.43 [95% CI, 1.30-1.57]), and foregone/delayed medical care (aOR, 1.30 [95% CI, 1.20-1.40]). CONCLUSIONS: Nonelderly patients with diabetes mellitus have a high prevalence of financial hardship from medical bills, with deleterious consequences.
BACKGROUND: The trend of increasing total and out-of-pocket expenditure among patients with diabetes mellitus represents a risk of financial hardship for Americans and a threat to medical and nonmedical needs. We aimed to describe the national scope and associated tradeoffs of financial hardship from medical bills among nonelderly individuals with diabetes mellitus. METHODS AND RESULTS: We used the National Health Interview Survey data from 2013 to 2017, including adults ≤64 years old with a self-reported diagnosis of diabetes mellitus. Among 164 696 surveyed individuals, 8967 adults ≤64 years old reported having diabetes mellitus, representing 13.1 million individuals annually across the United States. The mean age was 51.6 years (SD 10.3), and 49.1% were female. A total of 41.1% were part of families that reported having financial hardship from medical bills, with 15.6% reporting an inability to pay medical bills at all. In multivariate analyses, individuals who lacked insurance, were non-Hispanic black, had low income, or had high-comorbidity burden were at higher odds of being in families with financial hardship from medical bills. When comparing the graded categories of financial hardship, there was a stepwise increase in the prevalence of high financial distress, food insecurity, cost-related nonadherence, and foregone/delayed medical care, reaching 70.5%, 49.4%, 49.5%, and 74% among those unable to pay bills, respectively. Compared with those without diabetes mellitus, individuals with diabetes mellitus had higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 1.27 [95% CI, 1.18-1.36]) or any of its consequences, including high financial distress (aOR, 1.14 [95% CI, 1.05-1.24]), food insecurity (aOR, 1.27 [95% CI, 1.16-1.40]), cost-related medication nonadherence (aOR, 1.43 [95% CI, 1.30-1.57]), and foregone/delayed medical care (aOR, 1.30 [95% CI, 1.20-1.40]). CONCLUSIONS: Nonelderly patients with diabetes mellitus have a high prevalence of financial hardship from medical bills, with deleterious consequences.
Authors: Andrew S Oseran; Tianyu Sun; Rahul Aggarwal; Ashley Kyalwazi; Robert W Yeh; Rishi K Wadhera Journal: Circ Cardiovasc Qual Outcomes Date: 2022-09-02
Authors: Grace F Chao; Jie Yang; Jyothi R Thumma; Karan R Chhabra; David E Arterburn; Andrew M Ryan; Dana A Telem; Justin B Dimick Journal: Ann Surg Date: 2021-11-11 Impact factor: 13.787
Authors: Gowtham R Grandhi; Javier Valero-Elizondo; Reed Mszar; Eric J Brandt; Amarnath Annapureddy; Rohan Khera; Anshul Saxena; Salim S Virani; Ron Blankstein; Nihar R Desai; Michael J Blaha; Faisal H Cheema; Farhaan S Vahidy; Khurram Nasir Journal: Am J Prev Cardiol Date: 2020-07-13