# Medical Expenditure Differences Between Income Levels Among US Adults With Diabetes

## TL;DR

People with diabetes in the US who are in the poorest income group spend more on healthcare, mainly due to higher costs for prescriptions and home care.

## Contribution

This study quantifies income-based medical expenditure disparities for diabetes patients and identifies contributing factors like disability and health status.

## Key findings

- Poor-income adults with diabetes had significantly higher total medical expenditures compared to low-, middle-, and high-income groups.
- Prescription drugs and home health care services were the main drivers of higher expenditures in the poor-income group.
- Elevated disability rates and poorer physical health were key factors associated with increased medical costs in the poorest group.

## Abstract

Significant differences exist in the risk of diabetes and diabetes-related complications by income level in the United States. We assessed 1) to what extent medical expenditures in total and by health service type differ by income levels, and 2) how demographic and socioeconomic factors and health status are associated with these differences.

Data from the 2017 through 2021 Medical Expenditure Panel Survey were analyzed to estimate annual per-person medical expenditures for adults with diabetes. These expenditures were categorized by service type (inpatient, outpatient, prescription, home health care services, emergency department, or other) and compared across income groups based on the federal poverty level (FPL): poor (<125% FPL), low (125% to <200% FPL), middle (200% to <400% FPL), and high (≥400% FPL). One-way analysis of variance was used to test group differences, and a regression-based decomposition identified factors driving expenditure disparities. All expenditures were adjusted to 2021 US dollars.

Mean total medical expenditures were significantly higher for the poor-income group compared with the low-income, middle-income, and high-income groups, though no significant differences were observed among the latter 3 groups. Prescription drugs and home health care services in the poor-income group accounted for most of this difference. Key factors associated with the higher expenditures in this group included elevated disability rates, poorer physical health status, and dual Medicaid–Medicare coverage.

Adults with diabetes from the poorest households incurred the highest medical expenditures, largely driven by poor physical health and higher rates of disability. Reducing disability and improving health outcomes for this group may help lower their medical expenses.