Burden and Consequences of Financial Hardship From Medical Bills Among Nonelderly Adults With Diabetes Mellitus in the United States

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.

Racial and Ethnic Disparities in Access to Health Care Among Adults in the United States: A 20-Year National Health Interview Survey Analysis, 1999–2018

“…Individuals were classified as “uninsured” if at the time of interview they reported not having any private health insurance, Medicare, Medicaid, military plan, government- or state-sponsored health plan, or if they had only Indian Health Service coverage. 17 Consistent with Data Briefs from the National Center for Health Statistics 18 and prior NHIS studies, 19-23 we used survey responses that indicated foregone or delayed medical care due to cost and not having a usual source of care as additional indicators of barriers to health care access. Foregone or delayed medical care was defined as answering “Yes” to any of the following three questions: (during the past 12 months) “Has medical care been delayed for you because of worry about the cost?”; “Was there any time when you needed medical care, but did not get it because you couldn’t afford it?”; or “Was there any time when you needed prescription medicines but didn’t get it because you couldn’t afford it?.” Not having a usual source of care was defined as answering “No” to the question “Is there a place that you usually go to when you are sick or need advice about your health?” For each of these 3 outcomes and each study year, we calculated racial/ethnic “disparities” as the absolute prevalence gap between non-Hispanic White and the other race/ethnicity subgroups defined below.…”

“…We also included annual family income based on percent of family income relative to the respective year’s federal poverty limit from the US Census Bureau 24 using categories consistent with prior NHIS studies: middle/high income (≥200% federal poverty limit) or low income (<200% federal poverty limit). 19,25…”

Association of cardiovascular risk factor profile and financial hardship from medical bills among non-elderly adults in the United States

“…These expenses can represent major financial challenges to patients, regardless of their insurance status, and can lead to a reduction in overall quality of health and psychological well-being along with other cost-related consequences and tradeoffs such as high financial distress, medication non-adherence, and foregone/delayed medical care [ 14 , 15 ]. The burden of financial hardship among individuals with ASCVD is worsened in the presence of other comorbid conditions such as diabetes mellitus [16] , [29] .…”

Like a Grinding Stone: How Crowdfunding Platforms Create, Perpetuate, and Value Health Inequities

“…But while Chris's campaign undoubtedly helped him get through a rough patch, he and his family were still struggling to get by when we spoke a year later. Research shows that considerable financial toxicity accompanies diabetes diagnoses in the United States: More than 40% of people with diabetes report difficulty paying their medical bills (Caraballo et al 2020). Chris's diagnosis came at an especially vulnerable period in his life.…”