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Tables for:
Economic Costs of Diabetes in the U.S. in 2002

[Diabetes Care 26(3):917-932, 2003. © 2003 American Diabetes Association, Inc.]


Table 1. Projections of the U.S. population diagnosed with diabetes (in millions)


 200220102020% Increase from 2002 to 2020
Total population28830733517
Diagnosed with diabetes12.114.517.444
Overall diabetes prevalence rate4.2%4.7%5.2%24
Race/ethnicity
Hispanic1.42.02.9107
Non-Hispanic white8.19.110.327
Non-Hispanic black2.02.53.050
Non-Hispanic other0.60.91.2100
Sex
M5.87.18.648
F6.37.48.840
Age (years)
<452.12.02.10
45-645.27.07.748
>/=654.85.57.556

Census Bureau[1] population projections adjusted using calibration factors that align Census Bureau projections for the year 2000 with actual Census 2000 counts.

Table 2. Source of health resource use and price estimates


Cost componentSource of use dataSource of price dataUnit price (2002 dollars)
Institutional care
Hospital day1999 NIS1998 MEPS2,385
Nursing home day1999 NNHSKiplinger[5]169
Outpatient care
Office-based physician encounter1998-2000 NAMCS1998 MEPS160
   Emergency department visit1998-2000 NHAMCS1998 MEPS452
Ambulance service1998-2000 NHAMCSAAA247*
Hospital outpatient and free-standing ambulatory surgical center visit1998-2000 NHAMCS1998 MEPS561
Outpatient medication1998-2000 NAMCS, 1998-2000 NHAMCS1998 MEPS47
Home health visit1998, 2000 NHHCS, 1998-2000 NHIS1998 MEPS89
Hospice care day1998, 2000 NHHCSHospice Association of America[6]107
Indirect costs
Lost workday1998-2000 NHISBLS168
Restricted activity day1998-2000 NHISBLS67
Premature mortality (lost lifetime earnings)Social Security Administration[7]BLS116,928
Permanent disability (lost annual earnings)2002 Social Security Administration Data[8]BLS42,462
Supplies
Insulin use (supplies include glucose monitoring supplies, insulin delivery supplies, and insulin) and average annual cost of use1998-2000 NHIS, 2002 The Source Prescription Audit, LifeClinic[9,10], Fertig et al.[11], Frost and Sullivan[12]2002 Red Book[13], 2002 The Source Prescription Audit, Scott-Levin, 2002 AllegroMedical et al.[14], 2002 MiniMed[15]1,778
Use of oral agents and average annual cost of use1998-2000 NHIS, Luna and Feinglos[16], 2002 The Source Prescription Audit, CDC[17], NIDDK[18]2002 Red Book[13]666

*American Ambulance Association (AAA) estimate of the national average cost for a basic life support transport, adjusted to 2002 dollars.
Actual estimate varies by age-group and sex.
Estimated annual cost per user.
CDC, Centers for Disease Control and Prevention; NAMCS, National Ambulatory Medical Care Survey; NHAMCS, National Hospital Ambulatory Medical Care Survey; NHHCS, National Home and Hospital Care Survey; NIS, National Inpatient Sample; NIDDK, National Institute of Diabetes and Digestive and Kidney Diseases; NNHS, National Nursing Home Survey.

Table 3. Health care use attributable to diabetes in the U.S., by age and type of service, 2002 (in thousands)


Type of serviceAge (years)Total
<4545-64>/=65
Institutional care
Hospital inpatient days2,1835,8028,92716,912
Nursing home days15,14132,80534,40682,352
Outpatient care
Office-based physician encounters11,55516,71834,36562,638
Emergency department encounters3349713,4784,782
Hospital outpatient and free-standing ambulatory surgical center encounters462,3993,4675,912
Home health visits1,4935,89936,82044,212
Hospice care days484304,6165,094

Table 4. U.S. health care use attributable to diabetes by medical condition (in thousands)


ServiceDiabetesChronic complicationsGeneral medical conditionsTotal
NeurologicalPeripheral vascularCardiovascularRenalMetabolicOphthalmicOther
Institutional care
Inpatient days8564603134,0844101658910,68016,912
Nursing home days25,2967,94894112,6282,600107916132,66382,352
Outpatient care
Physician office visits9,93065233613,0649801,1711,50217534,82662,638
Emergency visits3096531690166419413,4564,782
Hospital outpatient visits1,35747491,36711193109162,7635,912
Home health visits16,9241,0771,0006,973803337710317,22144,212
Hospice care days121399698521004,1755,094

Table 5. Share of total U.S. health care use attributable to diabetes by medical condition


ServiceDiabetesChronic complicationsGeneral medical conditionsTotal
NeurologicalPeripheral vascularCardiovascularRenalMetabolicOphthalmicOther
Institutional care
Inpatient days53224200163100
Nursing home days3110115300040100
Outpatient care
Physician office visits161121222056100
Emergency visits61114300172100
Hospital outpatient visits231123222047100
Home health visits382216200039100
Hospice care days21014100082100

Data are %.

Table 6. Proportion of total U.S. health care use attributable to diabetes for various conditions


Service*DiabetesChronic complicationsGeneral medical conditionsTotal
NeurologicalPeripheral vascularCardiovascularRenalMetabolicOphthalmicOther
Institutional care
Inpatient days100781910138389
Nursing home days100151219201304915
Outpatient care
Physician office visits10086208146257
Emergency visits100772071317144
Hospital outpatient visits100982281412147
Home health visits1007919127931118
Hospice care days10059191011001314

Data are %.
*Differences across service types in the proportion of total health care use attributable to diabetes occur because the etiological fraction for a particular medical condition differs by demographic group, and the demographic characteristics of patients receiving services differ by type of service.

Table 7. Health care expenditures attributable to diabetes in the U.S., by age and type of service, 2002 (in millions of dollars)


Type of serviceAge (years)Total
<4545-64>/=65
Institutional care
Hospital inpatient days5,20713,83821,29340,337
Nursing home days2,5525,5285,79813,878
Outpatient care
Office-based physician encounters1,8512,6785,50510,033
Emergency department encounters1514391,5722,162
Hospital outpatient and free-standing ambulatory surgical center encounters261,3451,9443,315
Home health visits1335243,2733,930
Hospice care days546492543
Other expenditures
Ambulance services284077146
Outpatient medication7561,9912,7695,516
Oral agents5332,3182,1575,009
Insulin and delivery supplies1,3552,8912,7456,991
Total12,59631,64047,62691,861

Table 8. Health care expenditures attributable to diabetes, by medical condition and type of service, 2002 (in millions of dollars)


Medical conditionInpatient daysOffice visitsOutpatient visitsEmergency visitsNursing home daysHome health visitsHospice care daysOtherTotal
Diabetes2,0431,5917611404,2631,5041312,91623,231
Neurological symptoms1,09610426291,339964522,748
Peripheral vascular disease746542714159891311,121
Cardiovascular disease9,7402,0937673122,128620741,89217,626
Renal complications9771576275438716921,879
Endocrine/metabolic complications381885221830126426
Ophthalmic complications1124161927092422
Other complications21228919279014318
General medical conditions25,4735,5781,5491,5625,5041,5314452,44744,091
Total40,33710,0333,3152,16213,8783,93054317,66291,861

Includes ambulance services, outpatient medications, oral agents, insulin, and supplies.

Table 9. Total health care expenditures by diabetes status, 2002 (in millions of dollars and % of U.S. total)


Cost componentPopulation with diabetesPopulation without diabetesU.S. total
Attributable to diabetesIncurred by people with diabetes
Millions of dollars% of U.S. totalMillions of dollars% of U.S. total
Hospital inpatient40,337976,24518354,970 (millions of dollars)431,216 (millions of dollars)
Nursing home13,8781525,8602867,91593,775
Physician's office10,033718,43313118,484136,917
Hospital outpatient3,31575,9111242,33048,240
Emergency2,16244,424944,95249,375
Outpatient medication5,51699,6361555,07464,710
Home health3,930186,2302815,87322,103
Hospice care543141,020262,9603,981
Ambulance services1465281102,4332,714
Insulin and delivery supplies6,9911006,991100NA6,991
Oral agents5,0091005,009100NA5,009
Total health care costs91,86111160,04119704,991865,032

Table 10. Annual per capita health care expenditures by diabetes status, 2002


Cost componentWith diabetesUnadjustedAdjusted*
Without diabetesRatio with to without diabetesWithout diabetesRatio with to without diabetes
Hospital inpatient$6,309$1,2894.9$2,9712.1
Nursing home2,1402478.79912.2
Physician's office1,5254303.56952.2
Hospital outpatient4891543.22152.3
Emergency3661632.21872.0
Home health516588.91902.7
Hospice84117.9392.1
Ambulance services2392.6112.1
Outpatient medication7972023.93412.3
Insulin & delivery supplies579NANANANA
Oral agents414NANANANA
Total health care costs$13,243$2,5605.2$5,6422.4

*Adjusted to reflect demographic composition of the population with diabetes.

Table 11. Morbidity costs attributable to diabetes, 2002


Cause of permanent disabilityAttributed disability cases% of total attributed casesValue of lost productivity (billions of dollars)
Diabetes121,893695.2
Cardiovascular disease12,11070.5
Renal disease3,88720.2
Other diagnoses38,584221.6
Total176,4751007.5

Table 12. Mortality costs attributable to diabetes, 2002


Primary cause of deathDeaths attributed to diabetes (thousands)% of total U.S. deathsTotal lost years (thousands)Value of lost productivity (millions of dollars)
Diabetes721001,08010,622
Renal disease2631273
Cerebrovascular disease41254305
Cardiovascular disease108191,35710,358
Grand total186NA*2,522

*Grand total comprises mortality for reasons other than diabetes, renal disease, cerebrovascular disease, and cardiovascular disease.

Table 13. Total cost of diabetes, 2002


Cost componentTotal cost attributable to diabetes (millions of dollars)Components' proportion of total cost (%)*
Health care expenditures91,86170
Institutional care54,21541
   Hospital inpatient care40,33731
   Nursing home care13,87811
Outpatient care20,13015
   Physician office-based care10,0338
   Emergency care2,1622
   Ambulance services1460
   Hospital outpatient care3,3153
   Home healthcare3,9303
   Hospice care5430
Outpatient medication and supplies17,51613
   Outpatient medication5,5164
   Insulin and delivery supplies6,9915
   Oral agents5,0094
Indirect costs due to lost productivity39,81030
Lost work days4,5033
Restricted activity days6,2565
Mortality21,55816
Permanent disability7,4946
Total cost131,672100

*Cost component percentages do not necessarily sum to category totals because of rounding.