title: Racial/ethnic and gender differences in severity of diabetes-related complications, health care resource use, and costs in a Medicare population.
abstract: This retrospective cohort study evaluated associations of race/ethnicity and gender with outcomes of diabetes complications severity, health care resource utilization (HRU), and costs among Medicare Advantage health plan members with type 2 diabetes (T2DM). Medical and pharmacy claims were evaluated for 333,576 members continuously enrolled from January 1, 2010, to December 31, 2011, aged 18-89 years, with ≥1 primary diagnosis medical claim, or ≥2 claims with a secondary diagnosis of T2DM (International Classification of Diseases, Ninth Revision, Clinical Modification code 250.x0 or 250.x2). Complications severity assessment by Diabetes Complications Severity Index ranged from 0 (no complications) to 5+. Mean (SD) all-cause medical, pharmacy, and total costs were reported alongside all-cause HRU by place of service (outpatient, inpatient, emergency room [ER]) and number of visits. Multivariate regression showed being Hispanic, black, or male was associated with higher prevalence of more severe complications. This racial/ethnic disparity was more pronounced among females, among whom odds of having more severe complications were higher for Hispanic and black as compared to white females [(Hispanic vs. white odds ratio [OR], 1.40; 95% confidence interval [CI], 1.32-1.48), and (black vs. white OR, 1.22; 95% CI, 1.19-1.25)]. Regardless of gender, blacks had more ER visits than whites. White females incurred the highest total health care costs (mean annual costs: $13,086; 95% CI, $12,935-$13,240, vs. Hispanic females: $10,732; 95% CI, $10,406-$11,067). These effects held regardless of other demographic and clinical attributes. These findings suggest racial/ethnic and gender differences exist in certain T2DM clinical and economic outcomes.
authors.affiliation: 1 Comprehensive Health Insights , Louisville, Kentucky.
authors.forename: Leslie
authors.initials: L
authors.lastname: Hazel-Fernandez
authors.forename: Yong
authors.initials: Y
authors.lastname: Li
authors.forename: Damion
authors.initials: D
authors.lastname: Nero
authors.forename: Chad
authors.initials: C
authors.lastname: Moretz
authors.forename: Lane
authors.initials: L
authors.lastname: Slabaugh
authors.forename: Yunus
authors.initials: Y
authors.lastname: Meah
authors.forename: Jean
authors.initials: J
authors.lastname: Baltz
authors.forename: Mary
authors.initials: M
authors.lastname: Costantino
authors.forename: Nick C
authors.initials: NC
authors.lastname: Patel
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bouchard
mesh_terms: D000368:Aged; D048909:Diabetes Complications / Q000191:economics / Q000208:ethnology*; D005006:Ethnicity; D005260:Female; D006801:Humans; D007345:Insurance Claim Review / Q000191:economics*; D008297:Male; D006278:Medicare / Q000191:economics*; D009017:Morbidity / Q000639:trends; D044469:Racial Groups; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology