Date of Award


Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Shi-Yi Wang




Diabetes is a critical chronic disease that has exerted considerable health and economic influence on the United States population. Although diabetes has imposed a considerable economic burden on health systems worldwide, the incremental economic effect of certain diabetic complications has not been extensively studied and quantified. The aim of this study is to quantitatively define the economic burden resulting from the presence of diabetic eye and kidney complications.


Data was analyzed from the Medical Expenditure Panel Survey (MEPS) 2012-2016 to provide an updated evaluation on the association between several forms of annual health expenditures and the presence of diabetic kidney and eye complications. Demographic qualities of the U.S. diabetic population were analyzed by presenting weighted percentages according to complication status. Total expenditures and several component sources were analyzed by presenting mean and standard error of spending. A multivariable regression was used to evaluate effects from comorbidities and complications on total, out of pocket, and prescription-based annual spending. Out of pocket and prescription spending were chosen as supplement models to characterize the individual patient burden.


Diabetic complications were more common among the elderly, Non-Hispanic Black and Hispanic individuals, and those with related comorbid diseases. Increased spending due to the presence of these diabetic complications was generally observed in trends of total annual expenditures as well as several component sources of spending. Total annual spending increased by 74% among those with kidney complications, while the presence of eye complications was associated with a 33% increase. Diabetic kidney complications were associated with a 54% increase in annual out of pocket spending, while eye complications led to a 15% increase. Annual prescription spending was elevated by 66% in those with kidney complications, and increased by 36% among patients with diabetic eye complications.


This analysis clearly illustrates that the economic difficulty patients with diabetic complications requires targeted interventions. It is also demonstrated that these measures are likely to benefit those who are older and possess other related chronic comorbidities. The presence of diabetic kidney and eye complications generally led to increases among many components of health spending, often with the most considerable elevation among those with both conditions. More specifically, notable increases in out of pocket and prescription expenditures suggest that alleviation of the personal financial difficulty may be most critical when implementing reform to benefit these patients.


This is an Open Access Thesis.

Open Access

This Article is Open Access