Racial/Ethnic Disparity in Individual Economic Burden of Diabetes in the USA

Racial/ethnic disparities in the burden and treatment of diabetes are not unknown in the US. This study aimed to examine individual economic burden and its impact on use of preventive care among people with diabetes in the US. This cross-sectional study analyzed the 2012 household component of the Medical Expenditure Panel Survey (MEPS). Individual economic burden was defined as out-of-pocket (OOP) expense relative to the total health care expenditure (THE). OOP shares in medical care and prescriptions were calculated as the percentage of annual self-paid cost out of total expenditure in respective category. OOP shares were reported and compared between three populations: Hispanics, non-Hispanic whites, non-Hispanic blacks. Estimates were weighted to the total American non-institutionalized population (WTP). Logistic regression models were employed to assess the association of OOP share and receipt of eye exam that is recommended by guidelines. 1,379 (WTP: 11,789,395) individuals with diabetes were identified in 2102. Hispanics and non-Hispanic blacks spent less on medical care than non-Hispanic whites (OOP expenses: $8,144±788, $9,272±671 and $10,896±657), however they bore a higher burden in terms of both medical care and prescription expenditures (OOP shares: 36.52%, 26.70% and 25.78% in medical care; 49.70%, 44.30% and 37.61% in prescription). Eye exam rates differed across different racial/ethnic groups: 55.42% in Hispanics, 59.84% in non-Hispanic blacks and 62.35% in non-Hispanic whites, with a statistically significant difference found between Hispanics and non-Hispanic whites (p<0.001). A lower OOP share in medical care was found a significant predictor of receiving eye exam in the general population and racial/ethnic groups. Being socio-economic disadvantaged, minority groups may not afford medical care, yet be more likely to face catastrophic health expenditure. Diminishing disparities in health care is not only a right thing to do, but also improves efficiencies of resources allocation on health care.