128-OR: Income-Related Disparities in Medical Expenditures in U.S. Adults with Diabetes

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.