Direct and Indirect Costs of Diabetes in the United States
(From American Diabetes Association)
The total annual economic cost of diabetes in 2002 was estimated to be $132 billion.
Direct medical expenditures totaled $92 billion and comprised $23.2 billion for diabetes care, $24.6 billion for chronic diabetes-related complications, and $44.1 billion for excess prevalence of general medical conditions. Indirect costs resulting from lost workdays, restricted activity days, mortality, and permanent disability due to diabetes totaled $40.8 billion.
The per capita annual costs of health care for people with diabetes rose from $10,071 in 1997 to $13,243 in 2002, an increase of more than 30%. In contrast, health care costs for people without diabetes amounted to $2,560 in 2002.
One out of every 10 health care dollars spent in the United States is spent on diabetes and its complications.
Direct Costs of Diabetes
· Estimated at $92 billion in 2002, compared to $44 billion in 1997.
· Diabetes alone represents 11% of the US health care expenditure. People with diabetes have medical expenditures 2.4 times higher than they would if they did not have diabetes.
· $40.3 billion was spent for inpatient hospital care and $13.8 billion for nursing home care for people with diabetes.
· Diabetes-related hospitalizations totaled 16.9 million days in 2002. Rates of outpatient care were highest for physician office visits, which included 62.6 million visits to treat persons with diabetes.
· Cardiovascular disease is the most costly complication of diabetes, accounting for more than $17.6 billion of the $91.8 billion annual direct medical costs for diabetes in 2002.
Indirect Costs of Diabetes
· Estimated to be $40 billion in 2002.
· In 2002, diabetes accounted for a loss of nearly 88 million disability days.
· 176,000 cases of permanent disability were caused by diabetes, at a cost of $7.5 billion.
Complications of diabetes in the United States
Heart disease and stroke
Heart disease and stroke account for about 65% of deaths in people with diabetes.
Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes.
The risk for stroke is 2 to 4 times higher among people with diabetes.
High blood pressure
About 73% of adults with diabetes have blood pressure greater than or equal to 130/80 millimeters of mercury (mm Hg) or use prescription medications for hypertension.
Blindness
Diabetes is the leading cause of new cases of blindness among adults aged 20 74 years.
Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year.
Kidney disease
Diabetes is the leading cause of kidney failure, accounting for 44% of new cases in 2002.
In 2002, 44,400 people with diabetes began treatment for end-stage kidney disease in the United States and Puerto Rico.
In 2002, a total of 153,730 people with end-stage kidney disease due to diabetes were living on chronic dialysis or with a kidney transplant in the United States and Puerto Rico.
Nervous system disease
About 60% to 70% of people with diabetes have mild to severe forms of nervous system damage. The results of such damage include impaired sensation or pain in the feet or hands, slowed digestion of food in the stomach, carpal tunnel syndrome, and other nerve problems.
Almost 30% of people with diabetes aged 40 years or older have impaired sensation in the feet (i.e., at least one area that lacks feeling).
Severe forms of diabetic nerve disease are a major contributing cause of lower-extremity amputations.
Amputations
More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.
In 2002, about 82,000 nontraumatic lower-limb amputations were performed in people with diabetes.
Dental disease
Periodontal (gum) disease is more common in people with diabetes. Among young adults, those with diabetes have about twice the risk of those without diabetes.
Almost one-third of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5 millimeters or more.
Complications of pregnancy
Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in 5% to 10% of pregnancies and spontaneous abortions in 15% to 20% of pregnancies.
Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, posing a risk to both mother and child.
Other complications
Uncontrolled diabetes often leads to biochemical imbalances that can cause acute life-threatening events, such as diabetic ketoacidosis and hyperosmolar (nonketotic) coma.
People with diabetes are more susceptible to many other illnesses and, once they acquire these illnesses, often have worse prognoses. For example, they are more likely to die with pneumonia or influenza than people who do not have diabetes
