Racial Disparities in Cost of Diabetes for U.S. Medicare Beneficiaries

Diabetes disproportionately impacts U.S. minority populations, with Hispanics almost twice as likely as non-Hispanic whites (nHW) to be diagnosed. We analyzed data from the Medicare 5% sample file by race/ethnicity for both type 1 (T1D) and type 2 diabetes (T2D). We identified 1,397,933 enrollees in fee-for-service without Medicare Advantage coverage during 2012-13.

Although nHW accounted for the majority of this population (81.3%), the prevalence of T1D and T2D was higher for Hispanics than nHW (3.4% vs. 1.8%, p=.0006 for T1D and 33.4% vs. 21.9%, p<.0001 for T2D). Hispanics also had more acute hospital admissions (p=.0235 for T1D and p=.0009 for T2D) and longer length of stay (7.5 vs. 6.9 days for T1D, p=.0105 and 6.7 vs. 6.2 for T2D, p<.0001). Allowed and paid costs per member per month adjusted for confounding were higher for nHW compared to Hispanics with T1D (both p<.0001), and higher for Hispanics compared to nHW for T2D (both p<.0001).

The burden of chronic disease was significantly higher in Hispanics than nHW (both T1D and T2D, p<.0001). Hispanics with T1D were also more likely to have A1c and lipid tests (p=.0014 and p=.0011 respectively), although retinopathy and nephropathy screening rates were similar. For T2D, Hispanics were more likely to have A1c and lipid testing as well as retinopathy and nephropathy screening (all p<.0001).

This highlights important racial disparities in the burden and cost of diabetes for Medicare recipients in the U.S.