Relatively little is known about diabetes-related medical costs across income groups, yet such information can assist efforts to reduce income-related diabetes disparities. Using data from the 2017-20 Medical Expenditure Panel Survey, we estimated medical expenditures (total and by service category [inpatient, outpatient, and drug]) in adults with diabetes, overall and by income level (<125% of federal poverty level (FPL) , ≥125% and <200% FPL, ≥200% and <400% FPL, ≥400% FPL) . We also identified factors that contribute to the differences (education, health insurance, marital status, physical and mental health) by constructing a concentration index (CI) (an inequality measure with values ranging from -1 to 1 with 0 indicating no disparity) and conducting a decomposition analysis which quantifies the contribution to CI by factor. We estimated crude and adjusted medical expenditures by income group, controlling for age, sex, and race/ethnicity. All expenditures were adjusted to 20 US dollars. Persons with incomes <125% FPL had significantly higher health medical expenditures in total and across all service categories than the other three income groups (P<0.05) . After adjustments, the lowest income group spent $2828 more per person per year than the other three income groups (P<0.05) while no significant differences in expenditures were found among the other three groups. The estimated CI value was -0.022, indicating expenditures more concentrated in the lower income group About a half (49.1%) of the disparity was explained by higher public insurance coverage (28.6%) and poorer physical (13.3%) and mental (7.2%) health status. Diabetes-related medical expenditures are disproportionately concentrated among low-income group. Improving physical and mental health for low-income populations may help to reduce the disparity in medical expenditures of diabetes.


Y.Wang: None. H.Shao: Board Member; BRAVO4HEALTH, LLC. G.Imperatore: None. C.S.Holliday: None. P.Zhang: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at