peterson-kaiser health system tracker how has diabetes care in the u.s. changed over time?
DESCRIPTION
Peterson-Kaiser Health System Tracker Source: Source: Kaiser Family Foundation analysis of 2013 OECD data: "OECD Health Data: Health status: Health status indicators", OECD Health Statistics (database). doi: /data 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 but has been declining since 2003 Age-adjusted rates of diabetes mortality per 100,000 populationTRANSCRIPT
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
Peterson-Kaiser Health System Tracker
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
Peterson-Kaiser Health System Tracker
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
Peterson-Kaiser Health System Tracker
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.
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+
Peterson-Kaiser Health System Tracker
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.
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
Peterson-Kaiser Health System Tracker
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
Peterson-Kaiser Health System Tracker
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
Peterson-Kaiser Health System Tracker
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
Peterson-Kaiser Health System Tracker
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.
Peterson-Kaiser Health System Tracker
Uncontrolled Diabetes Diabetes Complications0
10
20
30
40
50
60
70
80
19
6569
18
United States Comparable Country Average
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
Peterson-Kaiser Health System Tracker
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+
Peterson-Kaiser Health System Tracker
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
Peterson-Kaiser Health System Tracker
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
Peterson-Kaiser Health System Tracker
Black Hispanic White0
50
100
150
200
250
300
350
400
450
500462
272
171
305
206
132
Male Female
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.
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
Peterson-Kaiser Health System Tracker
2006 2008 20100
5
10
15
20
25
30
35
4037.5
34.5
17.114.7
8.5 7.4
United States Comparable Country Average
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
Peterson-Kaiser Health System Tracker
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.
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
Peterson-Kaiser Health System Tracker
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)
Peterson-Kaiser Health System Tracker
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)
Peterson-Kaiser Health System Tracker
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
Peterson-Kaiser Health System Tracker
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%
Peterson-Kaiser Health System Tracker
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
Peterson-Kaiser Health System Tracker
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
Peterson-Kaiser Health System Tracker
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
Peterson-Kaiser Health System Tracker
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