Economic Costs of Diabetes in the U.S. in 2022

OBJECTIVE

This study updates previous estimates of the economic burden of diagnosed diabetes, with calculation of the health resource use and indirect costs attributable to diabetes in 2022.

RESEARCH DESIGN AND METHODS

We combine the demographics of the U.S. population in 2022 with diabetes prevalence, from national survey data, epidemiological data, health care cost data, and economic data, into a Cost of Diabetes Economic Model to estimate the economic burden at the population and per capita levels. Health resource use and associated medical costs are analyzed by age, sex, race/ethnicity, comorbid condition, and health service category. Data sources include national surveys (2015-2020 or most recent available), Medicare standard analytic files (2020), and administrative claims data from 2018 to 2021 for a large commercially insured population in the U.S.

RESULTS

The total estimated cost of diagnosed diabetes in the U.S. in 2022 is $412.9 billion, including $306.6 billion in direct medical costs and $106.3 billion in indirect costs attributable to diabetes. For cost categories analyzed, care for people diagnosed with diabetes accounts for 1 in 4 health care dollars in the U.S., 61% of which are attributable to diabetes. On average people with diabetes incur annual medical expenditures of $19,736, of which approximately $12,022 is attributable to diabetes. People diagnosed with diabetes, on average, have medical expenditures 2.6 times higher than what would be expected without diabetes. Glucose-lowering medications and diabetes supplies account for ∼17% of the total direct medical costs attributable to diabetes. Major contributors to indirect costs are reduced employment due to disability ($28.3 billion), presenteeism ($35.8 billion), and lost productivity due to 338,526 premature deaths ($32.4 billion).

CONCLUSIONS

The inflation-adjusted direct medical costs of diabetes are estimated to rise 7% from 2017 and 35% from 2012 calculations (stated in 2022 dollars). Following decades of steadily increasing prevalence of diabetes, the overall estimated prevalence in 2022 remains relatively stable in comparison to 2017. However, the absolute number of people with diabetes has grown and contributes to increased health care expenditures, particularly per capita spending on inpatient hospital stays and prescription medications. The enormous economic toll of diabetes continues to burden society through direct medical and indirect costs.

Stage III colon cancers: why adjuvant chemotherapy is not offered to elderly patients

HYPOTHESIS

Adjuvant chemotherapy is not offered to elderly patients with stage III colon cancer.

DESIGN

A retrospective review of hospital and office records.

SETTING

A suburban community hospital.

PATIENTS

The medical records of 69 patients with stage III colon cancer were reviewed. All identified from the Tumor Registry at Jersey Shore Medical Center, Neptune, NJ, were included in this study.

RESULTS

Thirty-five patients (51%) did not receive adjuvant chemotherapy. After adjusting for age, women were 5.8 times less likely to receive chemotherapy (P = .002). Patients not receiving chemotherapy were significantly older (78.7 vs 70.4 years; P = .003) than those who received adjuvant chemotherapy. There was no relation found between the year of diagnosis and the administration of chemotherapy. There were 4 major reasons for not receiving chemotherapy: (1) not offered (n = 12, 34%), (2) refused (n = 11, 31%), (3) too old (n = 7, 20%), and (4) significant concomitant disease (n = 5, 14%).

CONCLUSIONS

A large group of elderly patients who had been surgically treated for colon cancer and who were eligible for adjuvant chemotherapy either were not referred for treatment or refused treatment. This suggests a bias on the part of surgeons, primary care physicians, and patients against the use of chemotherapy in elderly patients.

Mast cells and nerve fibers in interstitial cystitis (IC): an algorithm for histologic diagnosis via quantitative image analysis and morphometry (QIAM)

OBJECTIVE

To develop and evaluate a diagnostic algorithm based on the alteration of mast cell and nerve fiber observed in bladder tissue of patients with interstitial cystitis (IC).

MATERIALS AND METHODS

Non-IC samples from 6 control groups (N = 10, 10, 13, 2, 11, and 3, respectively) and nonclassic interstitial cystitis (NC-IC, N = 20) were stained with Giemsa stain in order to calculate the detrusor to mucosa mast cell ratio (DMMCR) using quantitative image analysis and morphometry (QIAM). Immunohistochemical staining for S-100 protein was also performed to quantify nerve fiber proliferation in the detrusor muscle of the bladder.

RESULTS

The average DMMCR of NC-IC was 1.19. Bacille Calmette-Guérin (BCG) cystitis was 0.84 and microscopically normal bladder tissue from patients with bladder or prostate cancer was 0.45. No case of IC that we examined had a DMMCR < 0.5. The number and percentage area of nerve fibers in the detrusor in IC were increased compared to controls and BCG (IC, 2.01%; BCG, 0.95%; control, 1.3%).

CONCLUSION

A diagnostic algorithm is proposed for IC based on the findings that indicate that: 1) if the DMMCR > 0.75, then IC is present; 2) if the DMMCR < 0.5, then IC is negative; and 3) if the DMMCR is between 0.5 and 0.75, a quantitative S-100 protein staining analysis can be employed to evaluate nerve fiber proliferation to detect those marginal cases of NC-IC. The findings of the study also suggest that a neuroimmune process or mediation may be involved in the pathogenesis of IC.

Apgar scores in the identification of sensorineural hearing loss

Apgar scores of 0-4 at 1 minute and 0-6 at 5 minutes have been investigated as risk criteria in the Utah High Risk Hearing Screening Program. The 1990 Joint Committee on Infant Hearing (JCIH) statement recommended only an Apgar score of 0-3 at 5 minutes be included in a risk registry for sensorineural hearing loss (SNHL). An analysis of live births indicates the more lenient Utah cut-off criteria are justified. It is concluded that both of the Utah Apgar scores, even when moderately depressed, are sensitive risk factors for SNHL in infants. These findings suggest serious consideration be given to expanding the 1990 JCIH Apgar recommendation.

The effects of mate removal on pregnancy success in prairie voles (Microtus ochrogaster) and meadow voles (Microtus pennsylvanicus)

The effects of removing the stud male have not been controlled in many studies relating pregnancy block to the presence of an unfamiliar male. We examined the effects of removing the male on pregnancy success in prairie voles and meadow voles, two species that differ in degree of paternal investment. Whereas prairie vole males provide extensive care to offspring and accelerate pup development, meadow vole males display little or no care and delay development of pups. We predicted that removal of the stud male would decrease pregnancy success in prairie voles and either have no effect or increase success in meadow voles. In experiment 1, females were in male-induced estrus, and their mates were either left with them or were removed 4 h, 1 day, 2 days, or 8 days after mating. In experiment 2, females were in postpartum estrus, and their mates were either left with them or were removed 1 day, 2 days, or 8 days after birth of their first litter. Removal of the male soon after mating in postpartum estrus decreased pregnancy success in prairie voles and increased success in meadow voles. Thus, although removal of the stud male influenced litter production, the direction of the effect varied with species.

Prolidase deficiency: a patient without hydroxyproline-containing iminodipeptides in urine

A 17-year-old girl was shown to have prolidase deficiency on the basis of the presence of large amounts of proline-containing dipeptides in urine and an almost complete absence of prolidase in plasma and erythrocytes. Unlike most earlier cases of this genetic defect our patient did not excrete hydroxyproline-containing dipeptides in her urine.

Acoustic reflex crossover artifacts in infants and young children

Crossover artifacts occur when the probe microphone of an impedance instrument directly responds to vibratory-acoustic energy that crosses the skull from the stimulus transducer on the contralateral ear. The resulting meter deflections are subjectively similar to and may be interpreted as actual acoustic reflexes (ARs) by unsuspecting examiners. In this study, infants and young children aged 10 days to 6 years 9 months were fit with earplugs to eliminate the AR and were examined for artifact incidence and threshold. Results indicate a high rate of occurrence of the crossover artifact in the youngest subjects, when probe tones of 220 and 660 Hz were used with stimuli of 500 and 1,000 Hz. Artifact thresholds were found as low as at a 92-dB hearing level, and an inverse relationship was shown between age and artifact incidence and threshold.

Function of the acoustic reflex in discrimination of intense speech

It is known that the middle ear acoustic reflex (AR) alters the transmission characteristics of the auditory system; however, disagreement exists on how these changes may influence the ears; transfer of speech stimuli. In this study, speech with and without a competing message was delivered at supra-AR levels to cat ears that demonstrated an active and a pharmaceutically inactivated middle ear reflex mechanism. Resulting cochlear potentials were tape recorded and subsequently presented to 18 human subjects with normal hearing. Findings suggest word and sentence discrimination is enhanced in the presence of a functioning AR, with implications for hearing aid use and stapedectomy procedure.