peterson-kaiser health system tracker how has diabetes care in the u.s. changed over time?

Peterson-Kaiser Health System Tracker

How has diabetes care in the U.S. changed over time?

Peterson-Kaiser Health System TrackerSource: CDC/NCHS, National Vital Statistics System, Mortality

Diabetes is among the 10 leading causes of death in the United States

Suicide

Kidney disease

Influenza and pneumonia

Diabetes

Alzheimer's disease

Stroke

Unintentional injuries

Chronic lower respiratory diseases

Cancer

Heart disease

0 20 40 60 80 100 120 140 160 180

12.6

13.2

15.9

21.2

23.5

36.2

39.4

42.1

163.2

169.8

Age-adjusted death rates for the 10 leading causes of death per 100,000 population, United States, 2013


Source: Source: Kaiser Family Foundation analysis of 2013 OECD data: "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: 10.1787/data-00540-en (Accessed on February 2, 2016). Note: Comparable countries are defined as those with above median GDP and above median GDP per capita in at least on of the past ten years.

The mortality rate for diabetes in the U.S. rose between 1990-2002 but has been declining since 2003Age-adjusted rates of diabetes mortality per 100,000 population

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100

4

8

12

16

20

24

28

32

23.923.7

19.6

16.4

United States Comparable Country Average


Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey. Statistical analysis by the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation.

Crude and age-adjusted rates of diagnosed diabetes have been steadily increasing

Crude and age-adjusted rates of diagnosed diabetes per 100 civilian, non-institutionalized population

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

2

4

6

8

3.8

7.0

4.0

6.2

Crude Rate Age-Adjusted Rate



Diagnosed diabetes has been increasing among people ages 45-74

Rates of diagnosed diabetes per 100 civilian, non-institutionalized population, by age

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

2

4

6

8

10

12

14

16

18

20

22

24

1.5

12.0

21.5

0.89

Ages 0-44 Ages 45-64 Ages 65-74 Ages 75+



Blacks and Hispanics have higher than average rates of diagnosed diabetes

Age-adjusted rates of diagnosed diabetes per 100 civilian, non-institutionalized population, by race

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

2

4

6

8

10

12

5.8

9.5

5.7

8.7

White Black Asian Hispanic


Source: Institute for Health Metrics and Evaluation. Global Burden of Disease Study Data Downloads, available here: http://ghdx.healthdata.org/global-burden-disease-study-2013-gbd-2013-data-downloads

U.S. disease burden for endocrine diseases has increased nearly 15% in the past 2 decades

Skin diseases

Neonatal*

Chronic respiratory

Nervous System

Endocrine (diabetes)

Injuries*

Musculoskeletal disorders

Cancers and tumors (Neoplasms)*

Mental and behavioral disorders

Circulatory*

- 1,000 2,000 3,000 4,000 5,000 6,000 7,000

629

672

1,424

1,487

1,773

2,519

2,804

3,133

3,266

3,920

634

922

1,460

1,426

1,542

3,519

2,657

3,862

2,948

6,007

1990 2013

Age-adjusted disability adjusted life years (DALYs) rate per 100,000 population, both sexes, 1990 and 2013


Source: Information came from the CDC's Behavioral Risk Factor Surveillance System. The data were computed by CDC's Division of Diabetes Translation personnel.

Adults with diabetes have increasingly reported poor mental and physical health

Poor Mental and Physical Health

Inability to Do Usual Activities

Poor Mental Health

Poor Physical Health

Poor Mental or Physical Health

0% 10% 20% 30% 40% 50% 60% 70%

28%

35%

38%

55%

64%

22%

28%

32%

48%

58%

1994 2011

Percentage of adults aged 18 years or older with diabetes reporting poor mental health, poor physical health, poor mental or physical health, poor mental and physical health, and inability to do usual activities at least 1 day in the past 30 days, 2011

http://www.cdc.gov/brfss/index.htm


Source: Information came from the CDC's Behavioral Risk Factor Surveillance System. The data was computed by CDC's Division of Diabetes Translation personnel.

From 1994-2010, the percent of diabetics receiving annual foot exams and self-monitoring blood glucose levels daily has increasedAge-adjusted percentage of adults aged 18 years or older with diagnosed diabetes receiving: a dilated eye exam; foot exam; visiting a doctor for diabetes in the last year; and performing daily self-monitoring of blood glucose

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

0

10

20

30

40

50

60

70

80

90

100

35.7

63.6

48.1

67.5

Dilated Eye Exam Self-Monitoring of Blood Glucose Foot Exam Doctor Visit

http://www.cdc.gov/brfss/index.htm


Rates of diabetes complications in the U.S. have decreased significantly from 1990-2010

Heart

Attack

Stroke

End-st

age r

enal

disease

(kidney

failu

re)

-80%

-70%

-60%

-50%

-40%

-30%

-20%

-10%

0%

-68% -64%

-53% -51%

-28%

Percent change in age-adjusted rates of diabetes complications among adults ages 20 and older with diagnosed diabetes , 1990 - 2010

Source: Adapted from Gregg EW, Li Y, Wang J, et al. “Changes in Diabetes-Related Complications in the United States, 1990-2010”, New England Journal of Medicine. 2014; 370:1514-1523. Notes: Numerators for rates of acute myocardial infarction, stroke, and amputation are from the National Hospital Discharge Survey. Numerators for rates of end-stage renal disease are from the U.S. Renal Data System, and numerators for death from hyperglycemic crisis are from the National Vital Statistics System. Denominators are from the National Health Interview Survey. Rates were age-standardized to the U.S. population in the year 2000.


Uncontrolled Diabetes Diabetes Complications0

10

20

30

40

50

60

70

80

19

6569

18


Source: OECD (2013), "OECD Health Data: Health status: Health quality indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on March 2, 2015).

The U.S. hospitalization rate for uncontrolled diabetes is lower than in comparable countries, and higher for diabetes complicationsAge-adjusted hospital admission rate per 100,000 population, for uncontrolled diabetes, and diabetes short term complications, ages 15 and older, 2010


Source: Data from the National Hospital Discharge Survey and the National Health Interview Survey, National Center for Health Statistics, Centers for Disease Control and Prevention. Data computed by personnel in CDC's Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion.

Hospitalization for diabetic ketoacidosis is highest among those aged 0-44

Hospital discharge rates for Diabetic Ketoacidosis (DKA) as First Listed Diagnosis per 1,000 Diabetic Population, by Age

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

0

10

20

30

40

50

6052.7

32.4

4.13.3

3.5 1.4

0-44 45-64 65+


Source: Data from the National Hospital Discharge Survey, National Center for Health Statistics, Centers for Disease Control and Prevention. Data computed by personnel in CDC's Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion.

Average length of stay of hospital discharges with diabetes or diabetic ketoacidosis has been decreasingAverage length of stay of Hospital Discharges with Diabetes as First Listed Diagnosis, in Days

Average length of stay of Hospital Discharges with Diabetic Ketoacidosis (DKA) as First Listed Diagnosis, in Days

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

0

1

2

3

4

5

6

7

8

98.2

5

5.7

3.4

Diabetes DKA


Source: Centers for Disease Control and Prevention (CDC), National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey. Data analyzed by personnel in the CDC's Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion.

Death rates for hyperglycemic crises have decreased among all age groupsDeath rates for hyperglycemic crises as underlying cause per 100,000 diabetic population

1980

1981

1982

1983

1984

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

0

20

40

60

80

100

120

140

160Ages 0-44 Ages 45-64 Ages 65-74 Ages 75+ All diabetics


Black Hispanic White0

50

100

150

200

250

300

350

400

450

500462

272

171

305

206

132

Male Female


End-stage renal disease related to diabetes is highest among black men and womenAge-adjusted incidence of end-stage renal disease related to Diabetes Mellitus per 100,000 diabetic population, by Race, Ethnicity, and Sex, 2008


2006 2008 20100

5

10

15

20

25

30

35

4037.5

34.5

17.114.7

8.5 7.4


Source: OECD (2013), "OECD Health Data: Health status: Health quality indicators", OECD Health Statistics (database). doi: 10.1787/data-00349-en (Accessed on March 2, 2015). Notes: Data for 2006 Comparable Country Average are from 2007.

Foot and leg amputations due to diabetes are decreasing in the U.S. and comparable countriesAge-adjusted diabetes lower extremity amputation rate per 100,000 population, ages 15 and older, in years 2006, 2008, and 2010



More men than women with diabetes report using diabetes medication

Percentage of adults aged 18 years or older with diagnosed diabetes reporting any diabetes medication use (pills, insulin, or both), all and by sex

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011

60%

65%

70%

75%

80%

85%

90% % Males using medication % Females using medication


Some diabetes injectable prescription costs have increased between 77% and 380% from 2010 – 2015 Diabetes injectable prescription costs per mL, 2010 and 2015

NovoLog Victoza Humulin R U-500$0

$10

$20

$30

$40

$50

$60

$70

$80

$90

$12

$48

$15

$27

$85

$72

2010 2015

Source: Alliance of Community Health Plans presentation “High –Cost Drugs: A CEO’s Perspective”, October 16, 2015. Notes: Presentation data on diabetes drug pricing based on Medispan AWP (August 2015)


The monthly price of Glumetza tablets increased 500% in one year

Glumetza prescription costs (1000 mg tablets), monthly (based on typical dose)

June 2014 June 2015 July 2015$0

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

$8,000

$9,000

$890

$5,344

$8,016

Source: Alliance of Community Health Plans presentation “High –Cost Drugs: A CEO’s Perspective”, October 16, 2015. Notes: Presentation data on diabetes drug pricing based on Medispan AWP (August 2015)


Source: “Penny-wise, pound-foolish: Association between Medication Adherence, Out-of-Pocket Expenses, and Health Care Costs in Medicare Patients with Type 2 Diabetes.” Abstract presented by Joanna P. MacEwan at the 74th Scientific Session of the American Diabetes Association. Notes: For more information the abstract can be found here: http://app.core-apps.com/tristar-ada15/abstract/160858d53930b598d64b10f393081d64

Diabetic Medicare patients who are less adherent to prescribed medication have higher medical spendingPharmacy costs, medical expenditures, and total expenditures for Medicare beneficiaries ages 65 and older with type 2 diabetes mellitus, 2006-2009

Pharmacy Costs Medical Expenditures Total Expenditures$0

$5,000

$10,000

$15,000

$20,000

$25,000

$30,000

$4,839

$7,692

$12,531

$3,046

$21,421

$24,468

Highly adherent patients Lower adherent patients


Source: Kaiser Family Foundation analysis of Bureau of Economic Analysis Health Care Satellite Account (Blended Account)Note: Expenditures on nursing home and dental care are not included in health services spending by disease. Data last updated January 25, 2016.

Endocrine diseases, including diabetes, are a leading driver of medical services spending growth from 2000-2012

Contribution to medical services expenditure growth, by disease, 2000-2012

Pregnancy/childbirth

Dermatological

Mental illness

Infectious diseases

Digestive

Injury and poisoning

Genitourinary

Other

Cancer

Respiratory

Nervous system

Endocrine

Circulatory

Musculoskeletal

Ill-defined conditions

0% 2% 4% 6% 8% 10% 12% 14% 16% 18%

1.7%

2.3%

4.1%

4.4%

5.1%

5.3%

5.9%

6.2%

6.3%

6.5%

7.4%

8.5%

8.6%

11.0%

16.6%


Ill-defined conditions; $247

Circulatory, $243

Musculoskeletal, $188

Respiratory, $158

Endocrine (Diabetes); $138Nervous system; $133

Cancers; $124

Injury; $118

Genitourinary; $113

Digestive; $107Mental Illness; $80

Infectious diseases; $67Dermatological; $44

Pregnancy, birth; $39Other; $93

Source: Bureau of Economic Analysis Health Care Satellite Account (Blended Account) and National Health Expenditure Data Note: Spending on dental services, nursing homes, and prescriptions that cannot be allocated to a specific disease not included above. Data last updated January 25, 2016.

Spending on endocrine diseases accounts for more than 7% of disease based health expendituresTotal expenditures in US $ billions by disease category, 2012


2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012$0

$50

$100

$150

$200

$250

$300

$350

$400

$450

$500

$192$222

$256$276

$304$326

$353$372

$388 $398$413

$429 $440

Source: Kaiser Family Foundation analysis of Bureau of Economic Analysis Health Care Satellite Account (Blended Account)Note: Expenditures on nursing home and dental care are not included in health services spending by disease. Data last updated February 4, 2016.

On a per capita basis, the U.S. spends about $440 per year to treat endocrine diseases, up from $192 in 2000Per capita expenditures on the treatment of endocrine, nutritional, and metabolic diseases and immunity disorders, US $, 2000 - 2012


Diagnosis with a serious or chronic health condition is associated with higher health spending

Stroke Emphysema Diabetes Heart Disease

Cancer Arthritis High Blood Pressure

High Cholesterol

Asthma$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$14,

868

$13,

947

$12,

913

$12,

166

$11,

516

$10,

253

$8,7

42

$8,2

85

$6,7

33

$4,7

73

$4,9

76

$4,3

49

$3,4

32

$4,4

11

$3,3

66

$3,3

17

$3,7

40

$4,1

71

Ever been diagnosed Never diagnosed

Source: Kaiser Family Foundation analysis of Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services

Average health spending per person based on diagnosis status, in U.S. Dollars, 2013


People with a diagnosis of a serious or chronic health condition face higher average out-of-pocket costs

Cancer Heart Disease

Stroke Emphysema Diabetes Arthritis High Cholesterol

High Blood Pressure

Asthma$0

$200

$400

$600

$800

$1,000

$1,200

$1,400

$1,600

$1,4

19

$1,3

73

$1,3

36

$1,3

02

$1,2

59

$1,2

21

$1,0

63

$1,0

44

$836

$635

$680

$693

$706

$661

$540

$561

$550

$586

Ever been diagnosed Never diagnosed

Source: Kaiser Family Foundation analysis of Medical Expenditure Panel Survey, Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services

Average out-of-pocket spending per person based on diagnosis status, in U.S. Dollars, 2013

peterson-kaiser health system tracker how has diabetes care in the u.s. changed over time?

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