Background: Obesity results in significant morbidity, preventable mortality, and increased medical expenditures among women with diabetes. The aim of this study was to examine racial/ethnic differences in obesity trends and medical expenditures among a nationally representative sample of women with diabetes.

Methods: Nine years of data (2008-2016) from the Medical Expenditure Panel Survey (MEPS) Full Year Consolidated File were used for the analyses. Cochran-Armitage tests were used to determine statistical significance of trends in obesity and mean expenditure for women with diabetes. Two-part statistical modeling with a combination of binomial and positive distributions was used to evaluate differences in medical expenditure. Data were clustered to 3 time points: 2008-2010, 2011-2013, 2014-2016. BMI levels were classified as underweight (<18.5), normal (≥18.5 - 24.9, overweight (≥25.0 - 29.9), and obese (≥30.0 - 134.7). Analyses were weighted for the U.S. population.

Results: Cochran-Armitage tests showed trends in obesity from 2008 to 2016 differed significantly between Hispanic and Non-Hispanic white (NHW) women with diabetes (p=0.01). Among obese women, trends in mean medical expenditures differed significantly between Hispanic (p<0.001), non-Hispanic black (NHB) (p<0.001), and other (p<0.001) women with diabetes compared to NHW women with diabetes. Two-part modeling showed obese Hispanic (-0.66 (-0.87, -0.42)) and NHB (-0.33 (-059, -0.01)) women with diabetes were significantly less likely to spend on healthcare compared to NHW women with diabetes; however, among those with expenditure, Hispanic women spent 30% less ($4520.81) and NHB women spent 17% less ($2555.72) compared to NHW women with diabetes.

Conclusions: These findings suggest further understanding of the factors associated with differences in trends for obesity between Hispanic and NHW women with diabetes and medical expenditures among obese minority and NHW women with diabetes.


J.S. Williams: None. S. Nagavally: None. L.E. Egede: Consultant; Self; Novo Nordisk Inc. Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases.


National Institutes of Health

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