The Burden of Obesity on Diabetes in the United States: Medical Expenditure Panel Survey, 2008 to 2012

Abstract

Background: Diabetes is one of the most prevalent and costly chronic diseases in the United States.

Objectives: To analyze the risk of developing diabetes and the annual cost of diabetes for a US general population.

Methods: Data from the Medical Expenditure Panel Survey, 2008 to 2012, were used to analyze 1) probabilities of developing diabetes and 2) annual total health care expenditures for diabetics. The age-, sex-, race-, and body mass index (BMI)-specific risks of developing diabetes were estimated by fitting an exponential survival function to age at first diabetes diagnosis. Annual health care expenditures were estimated using a generalized linear model with log-link and gamma variance function. Complex sampling designs in the Medical Expenditure Panel Survey were adjusted for. All dollar values are presented in 2012 US dollars.

Results: We observed a more than 6 times increase in diabetes risks for class III obese (BMI ≥ 40 kg/m²) individuals compared with normal-weight individuals. Using age 50 years as an example, we found a more than 3 times increase in annual health care expenditures for those with diabetes ($13,581) compared with those without diabetes ($3,954). Compared with normal-weight (18.5 ≤ BMI < 25 kg/m²) individuals, class II obese (35 ≤ BMI < 40 kg/m²) and class III obese (BMI ≥ 40 kg/m²) individuals incurred an annual marginal cost of $628 and $756, respectively. The annual health care expenditure differentials between those with and without diabetes of age 50 years were the highest for individuals with class II ($12,907) and class III ($9,703) obesity.

Conclusions: This article highlights the importance of obesity on diabetes burden. Our results suggested that obesity, in particular, class II and class III (i.e., BMI ≥ 35 kg/m²) obesity, is associated with a substantial increase in the risk of developing diabetes and imposes a large economic burden.

Keywords: diabetes; economic burden; health care expenditures; obesity.

Figure 1

Data attrition diagram

Figure 2

Mean predicted probabilities of developing diabetes by age, gender, race, and BMI category based on predicted BMI at diagnosis for individuals with diabetes and BMI at survey for individuals without diabetes Percentages (%) presented in the above figure [Table: see text]

Figure 3

Mean predicted annual total healthcare* expenditures (2012$) for diabetics and non-diabetics age 50** *All of the graphs were generated from the result of the multivariable analysis, using the GLM model controlling for age, age square, race (white, black, Hispanic, Asian, other), education level (less than high school, high school diploma, college degree, graduate degree, other degree), household income level as a percentage of Federal Poverty Level (<100%, 100–199%, 200–399%, 400%), census region (northeast, Midwest, south, west), primary source of health insurance (Medicaid, Medicare, private insurance, other public insurance, other public insurance), diabetes-related comorbidities (heart disease, stroke, congestive heart failure, hypertension, high cholesterol, renal failure), year dummies (2009, 2010, 2011, 2012), and current smoker or not. **Results for mean predicted annual total healthcare expenditures (2012$) for diabetics and non-diabetics age 40, 50, and 60 are presented in Appendix Table 3.

Figure 3

Mean predicted annual total healthcare* expenditures (2012$) for diabetics and non-diabetics age 50** *All of the graphs were generated from the result of the multivariable analysis, using the GLM model controlling for age, age square, race (white, black, Hispanic, Asian, other), education level (less than high school, high school diploma, college degree, graduate degree, other degree), household income level as a percentage of Federal Poverty Level (<100%, 100–199%, 200–399%, 400%), census region (northeast, Midwest, south, west), primary source of health insurance (Medicaid, Medicare, private insurance, other public insurance, other public insurance), diabetes-related comorbidities (heart disease, stroke, congestive heart failure, hypertension, high cholesterol, renal failure), year dummies (2009, 2010, 2011, 2012), and current smoker or not. **Results for mean predicted annual total healthcare expenditures (2012$) for diabetics and non-diabetics age 40, 50, and 60 are presented in Appendix Table 3.