Diabetes mellitus is a group of diseases characterized by high levels Diabetes is associated with a number of other health …
Medical Expenditure Panel Survey
Agency for Healthcare Research and Quality
STATISTICAL BRIEF 105
December 2005
Diabetes Management: Tests and Treatments among the 18 and Older US Civilian Noninstitutionalized Population in 2003
Anita Soni, PhD
Highlights
In 2003, 66 percent of the US civilian noninstitutionalized population over 18 142 million people reported being diabetic Men and women had comparable reported rates of diagnosed diabetes 66 percent versus 67 percent, respectively The reported rate of diagnosed diabetes for those age 65 and older 166 percent was 35 times as likely as the rate for those age 18 to 64 47 percent Non-Hispanic blacks had higher rates of reported diagnosed diabetes than Hispanics or non-Hispanic whites 95 percent versus 65 percent and 61 percent, respectively Adults reported to having been diagnosed with diabetes were three times as likely to have cardiovascular disease or stroke as the overall adult population
Introduction
Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both Diabetes is associated with a number of other health problems,
including heart disease, stroke, high blood pressure, kidney disease, and blindness If diagnosed and treated effectively, these complications and co-morbidities could be delayed or treated This Statistical Brief uses data from the Household Component of the 2003 Medical Expenditure Panel Survey MEPS-HC to estimate the health status, preventive health practices, and treatment regimens of adults who reported having been diagnosed with diabetes Rates at which persons with diabetes obtain preventive medical care and recommended tests are presented It should be noted that all references to diabetics in this brief refer to those reported to have ever been diagnosed with this disease by a physician All comparisons discussed in the text are statistically significant at the 05 level unless otherwise noted
Findings
Diabetes can affect many parts of the body and can lead to serious complications, such as blindness, kidney damage, and lower-limb amputations Working together, people with diabetes and their health care providers can reduce the occurrence of these and other diabetic complications by monitoring and controlling the levels of blood glucose, blood pressure, and blood lipids Among
several methods of monitoring and controlling are the yearly hemoglobin A1c test, dilated eye exams, and foot exams for all diabetics Demographics
In 2003, 66 percent of the adult US civilian noninstitutionalized population 142 million was reported to be diabetic Men and women had comparable reported rates of diagnosed diabetes 66 percent versus 67 percent, respectively
Diabetes was found to be strongly correlated with age The reported rate of diagnosed diabetes for those aged 65 and older 166 percent was 35 times as likely as the rate for those aged 18 to 64 47 percent When men and women were compared, even though the percentages were similar for the 1864 age group 301 percent of men versus 293 percent of women, there were more women who reported having diabetes in the 65 and older age group than men 231 percent versus176 percent figure 1 With respect to race/ethnicity, non-Hispanic blacks were more likely to have been diagnosed with diabetes 95 percent than Hispanics 65 percent and non-Hispanic whites 61 percent figure 2 Management: Diagnostic tests In 2003, 417 percent of adults with diagnosed diabetes reported having received all three recommended tests hemoglobin A1C,
dilated eye exam, and foot exam figure 3 However, the majority of the adult diabetic population received only one or two of these tests 501 percent There were a small percentage of persons 46 percent who did not obtain any of the recommended diagnostic tests It should be noted that 36 percent of diabetics did not know whether they had received one or more of these tests for diabetic screening Non-Hispanic whites were somewhat more likely than non-Hispanic blacks or Hispanics to report having received all three tests 454 percent versus 320 percent and 357 percent, respectively There were significant age-related differences in diagnosed diabetes Adult diabetics between the ages of 18 and 64 were much less likely 385 percent to have received all three tests when compared with people age 65 and above 467 percent Adults between the ages of 18 and 64 with private insurance were much more likely to have received all three tests when compared with those of the same age group with public insurance or who were uninsured 442 percent versus 266 percent and 235 percent, respectively For persons ages 65 and above, those with Medicare plus private including TRICARE insurance were more likely to
receive all three tests 523 percent when compared with persons with Medicare only coverage or persons with Medicare plus other public insurance coverage 452 percent and 331 percent Management: Treatments While diabetes can be controlled by following a careful diet and taking oral medications, in some cases, it is necessary to have insulin delivered by injections or a pump MEPS data indicated that over 80 percent 807 percent of adult diabetics used diet modification to help control their diabetes figure 4 Almost three-fourths 736 percent of diabetics were taking oral medications to keep their diabetes in control, while only about one-quarter of the population 259 percent was using insulin for treatment of their diabetes A small percentage of diabetics 45 percent did not use any of these three methods to treat and/or control their diabetes Complications In 2003, 811 percent of diabetic adults were overweight/obese compared with 577 percent of nondiabetic adults figure 5 In addition, adult diabetics were more likely than non-diabetic adults to have reported a number of other chronic health conditions Diabetics were three times as likely to have hypertension 644 percent versus 188
percent and were almost four times as likely as the non-diabetic adult population to have had cardiovascular disease or stroke 367 percent versus 97 percent
Data Source
The estimates in this Statistical Brief are based upon data from the MEPS 2003 Full-Year Population Characteristics data file HC-073 Specifically, the preventive care and treatment data analyzed in this brief were ascertained in a short self-administered questionnaire the Diabetes Care Supplement, which was distributed in Rounds 3/5 of the MEPS to adults identified as having physician-diagnosed diabetes in the previous MEPS round
Definitions
Cardiovascular disease and stroke The indicator for cardiovascular disease and stroke was drawn from variables indicating presence of heart disease coronary heart disease, angina, heart attack, stroke, or any other heart-related disease For each of the conditions listed, the following question was asked: Have/Has PERSON ever been told by a doctor or other health professional that PERSON had [condition] Racial and ethnic classifications Classification by race and ethnicity was based on information reported for each family member Respondents were asked if each family members
race was best described as American Indian, Alaska Native, Asian or Pacific Islander, black, white, or other They also w 
ere asked if each family members main national origin or ancestry was Puerto Rican; Cuban; Mexican, Mexicano, Mexican American, or Chicano; other Latin American; or other Spanish All persons whose main national origin or ancestry was reported in one of these Hispanic groups, regardless of racial background, were classified as Hispanic Since the Hispanic grouping can include black Hispanic, white Hispanic, Asian and Pacific Islanders Hispanic, and other Hispanic, the race categories of black, white, Asian and Pacific Islanders, and other do not include Hispanic MEPS respondents who reported other single or multiple races and were nonHispanic were included in the other category Health insurance status Individuals under age 65 were classified in the following three insurance categories, based on household responses to health insurance status questions: Any private health insurance: Individuals who, at any time during the year, had insurance that provides coverage for hospital and physician care other than Medicare, Medicaid, or other public hospital/physician
coverage were classified as having private insurance Coverage by TRICARE Armed Forcesrelated coverage was also included as private health insurance Insurance that provides coverage for a single service only, such as dental or vision coverage, was not included Public coverage only: Individuals were considered to have public coverage only if they met both of the following criteria: 1 they were not covered by private insurance at any time during the year, and 2 they were covered by one of the following public programs at any point during the year: Medicare, Medicaid, or other public hospital/physician coverage Uninsured: The uninsured were defined as people not covered by private hospital/physician insurance, Medicare, TRICARE, Medicaid, or other public hospital/physician programs at any time during the entire year or period of eligibility for the survey For individuals 65 and older, the following insurance categories were used: Medicare only: Individuals who, at any time during the year, were covered by Medicare only For analytic purposes, this classification also includes a very small number of persons ages 65 and over who did not report Medicare coverage Medicare plus private
including TRICARE: Individuals who at any time during the year, were covered by a combination of Medicare, TRICARE, or private insurance Medicare plus other public coverage: Individuals who, at any time during the year, were covered by Medicare in addition to some other type of public insurance
About MEPS-HC
MEPS-HC is a nationally representative longitudinal survey that collects detailed information on health care utilization and expenditures, health insurance, and health status, as well as a wide variety of social, demographic, and economic characteristics for the civilian noninstitutionalized population It is cosponsored by the Agency for Healthcare Research and Quality and the National Center for Health Statistics For more information about MEPS, call the MEPS information coordinator at AHRQ 301-427-1656 or visit the MEPS Web site at http://wwwmepsahrqgov/
References
National Center for Health Statistics, National Vital Statistics Reports: Deaths: Preliminary Data for 2003; Vol 53, No 15, February 2005 http://wwwcdcgov/nchs/data/nvsr/nvsr53/nvsr53_15pdf Agency for Healthcare Research and Quality National Healthcare Quality Report 2004 Rockville, Md: US Department of Health
and Human Services http://wwwqualitytoolsahrqgov/qualityreport/ browse/browseaspx Centers for Disease Control and Prevention National Diabetes Fact Sheet: General Information and National Estimates On Diabetes in the United States, 2003 Rev ed Atlanta, Ga: US Department of Health and Human Services, Centers for Disease Control and Prevention, 2004 http://wwwcdcgov/ diabetes/pubs/pdf/ndfs_2003pdf For a detailed description of the MEPS survey design, sample design, and methods used to minimize sources of nonsampling error, see the following publications: Cohen, J Design and Methods of the Medical Expenditure Panel Survey Household Component MEPS Methodology Report No 1 AHCPR Pub No 97-0026 Rockville, Md: Agency for Health Care Policy and Research, 1997 Cohen, S Sample Design of the 1996 Medical Expenditure Panel Survey Household Component MEPS Methodology Report No 2 AHCPR Pub No 97-0027 Rockville, Md: Agency for Health Care Policy and Research, 1997 Cohen, S Design Strategies and Innovations in the Medical Expenditure Panel Survey Medical Care, July 2003: 417 Supplement: III-5III-12
Suggested Citation
Soni, A Diabetes Management: Tests and Treatments among the 18 and Older US
Civilian Noninstitutionalized Population in 2003 Statistical Brief 105 December 2005 Agency for Healthcare Research and Quality, Rockville, MD http://mepsahrqgov/mepsweb/data_files/publications/st105/stat105pdf
AHRQ welcomes questions and comments from readers of this publication who are interested in obtaining more information about access, cost, use, financing, and quality of health care in the United States We also invite you to tell us how you are using this Statistical Brief and other MEPS data and tools and to share suggestions on how MEPS products might be enhanced to further meet your needs Please e-mail us at mepspd@ahrqgov or send a letter to the address below: Steven B Cohen, PhD, Director Center for Financing, Access, and Cost Trends Agency for Healthcare Research and Quality 540 Gaither Road Rockville, MD 20850
Figure 1 Percentage by age and sex among adults with reported diagnosed diabetes, 2003
Men 40
Women
301 30
293 231
Percent
20
176
10
0 Age 18-64 Age 65
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003 Full-Year Population Characteristics file HC-073
Figure 2 Percentage of
adults with reported diagnosed diabetes, by race/ethnicity, 2003
10
95
8 65 61
76
Percent
6
4
2
0 Hispanic Black nonHispanic White nonHispanic Other
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003 Full-Year Population Characteristics file HC-073
Figure 3 Percentage of recommended tests among adult diabetics, 2003
All tests
No tests
1 or 2 tests
Dont know
36
417
501
46
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003 Full-Year Population Characteristics file HC-073
Figure 4 Percentages of adult diabetics using various control methods, 2003
90 75 60 45 30 15 0
807 736
Percent
259
Diet
Oral medications
Insulin
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003 Full-Year Population Characteristics file HC-073
Figure 5 Chronic diseases among diabetics, nondiabetics, and all adult US population, 2003
All adults
Non-diabetic adults
Diabetic adults
90 75 644
811
Percent
60 45 30 15 0 Hypertension 215
583
577
367
188 113
97
Overweight/obese
Cardiovascular disease/stroke
Source: Center for Financing, Access, and Cost Trends, AHRQ, Household Component of the Medical Expenditure Panel Survey, 2003 Full-Year Population Characteristics file HC-073
