Healthcare expenditures associated with cardiovascular, chronic kidney, and diabetic conditions, 2021-2023

The rising burden of Type 2 diabetes mellitus (DM), heart disease, and chronic kidney disease (CKD) is associated with substantial healthcare expenditures among U.S. adults. We described total healthcare, out-of-pocket (OOP) healthcare, and OOP prescription medication expenditure among individuals with DM, heart disease, CKD, or ≥ 2 of these conditions.

We pooled data from the 2021, 2022, and 2023 Medical Expenditure Panel Survey (MEPS). DM, heart disease, and CKD were identified using ICD-10 codes in the Medical Conditions file. The analytic sample included adults with DM only (n = 4805), heart disease only (n = 3229), CKD only (n = 44), or ≥ 2 of these conditions (n = 1423). Generalized linear and two-part models were used to estimate the predicted mean annual total healthcare expenditure and OOP prescription medication expenditure associated with these conditions, adjusting for participants' socio-demographic characteristics.

Participants with DM only, heart disease only, and CKD only represented 50.57%, 33.99%, and 0.46% of the sample, respectively; 14.98% had ≥ 2 conditions. Approximately half of the participants were female (~ 49.61%), about half were ≥ 65 years (60.18%), most were non-Hispanic White (62.49%), and nearly two-fifths lived in the South (39.17%). Adjusted mean OOP prescription medication expenditure was lowest among adults with CKD only ($341.87; 95% CI: $184.12 - $499.61) and highest among those with ≥ 2 conditions ($679.01; 95% CI: $584.21 - $773.95). However, CKD estimates should be interpreted with caution because of uncertainty due to low sample size. Adjusted mean total healthcare expenditure was lowest among adults with DM only ($15,481.31, 95% CI: 14,545.56-16,417.09) and highest among those with ≥ 2 conditions only ($30,618.53, 95% CI: 27,900-33,336.78 3).

Multimorbidity (≥ 2 conditions) is a growing problem in the U.S. and was associated with the highest annual total healthcare and OOP prescription medication expenditure among U.S. adults, highlighting the need for targeted financial and clinical interventions for this high-burden group.