Racial Disparities in the Burden of End-Stage Renal Disease due to Diabetes among Medicare Beneficiaries
Diabetes disproportionately impacts minority populations in the United States. In particular, Hispanics are almost twice as likely as non-Hispanic whites to be diagnosed with diabetes and have higher rates of end-stage renal disease (ESRD) due to diabetes. We analyzed data from the Medicare 5% sample file by race/ethnicity for type 1 (T1D) and type 2 diabetes (T2D) to determine the economic burden of ESRD.
For the years 2012-13 we identified 1,397,933 enrollees from the publicly-available Medicare 5% sample > 65 years without Medicare Advantage coverage (HMO).
The prevalence of T1D was 2.0% and 21.9% for T2D. ESRD affected 5.4% of the T1D and 1.9% of T2D populations. Rates of ESRD were significantly higher for other races for both T1D and T2D compared to whites.
Comparing costs, allowed amount (claims less discounts/ineligible charges) for treating ESRD was higher for T1D Hispanics than T1D whites ($8,946 vs. $8,332 per member/month, P<0.001). In contrast to other races, T2D Hispanics with ESRD were not more costly than whites ($6,634 vs. $6,542). Similar results were seen for net paid costs taking into account cost-sharing. Average cost-sharing for all patients with ESRD was $730 (no diabetes), $1,177 (T1D) and $939 (T2D) per member/month respectively.
In conclusion, the burden of ESRD due to T1D and T2D and the associated cost for T1D with ESRD were higher for Hispanics than for white Medicare enrollees.
