title: Trends in health care expenditure in U.S. adults with diabetes: 2002-2011.
abstract: OBJECTIVE
  Direct medical cost of diabetes in the U.S. has been estimated to be 2.3 times higher relative to individuals without diabetes. This study examines trends in health care expenditures by expenditure category in U.S. adults with diabetes between 2002 and 2011.
  
  
  METHODS
  We analyzed 10 years of data representing a weighted population of 189,013,514 U.S. adults aged ≥18 years from the Medical Expenditure Panel Survey. We used a novel two-part model to estimate adjusted mean and incremental medical expenditures by diabetes status, while adjusting for demographics, comorbidities, and time.
  
  
  RESULTS
  Relative to individuals without diabetes ($5,058 [95% CI 4,949-5,166]), individuals with diabetes ($12,180 [11,775-12,586]) had more than double the unadjusted mean direct expenditures over the 10-year period. After adjustment for confounders, individuals with diabetes had $2,558 (2,266-2,849) significantly higher direct incremental expenditures compared with those without diabetes. For individuals with diabetes, inpatient expenditures rose initially from $4,014 in 2002/2003 to $4,183 in 2004/2005 and then decreased continuously to $3,443 in 2010/2011, while rising steadily for individuals without diabetes. The estimated unadjusted total direct expenditures for individuals with diabetes were $218.6 billion/year and adjusted total incremental expenditures were approximately $46 billion/year.
  
  
  CONCLUSIONS
  Our findings show that compared with individuals without diabetes, individuals with diabetes had significantly higher health expenditures from 2002 to 2011 and the bulk of the expenditures came from hospital inpatient and prescription expenditures.
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC.
authors.forename: Mukoso N
authors.initials: MN
authors.lastname: Ozieh
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC.
authors.forename: Kinfe G
authors.initials: KG
authors.lastname: Bishu
authors.affiliation: Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, Charleston, SC.
authors.forename: Clara E
authors.initials: CE
authors.lastname: Dismuke
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, SC Center for Health Disparities Research, Medical University of South Carolina, Charleston, SC Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Medical Center, Charleston, SC egedel@musc.edu.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000191:economics; D003920:Diabetes Mellitus / Q000191:economics* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data / Q000639:trends*; D006801:Humans; D007348:Insurance, Health / Q000191:economics; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult