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Diabetes in America, 3rd Edition
Chapter 40: HEALTH CARE UTILIZATION AND COSTS OF DIABETES


Figure 40.1 -- 
Bar charts showing the rate of visits to office-based physicians increased with age when diabetes was listed as any diagnosis but was similar when diabetes was listed as a primary diagnosis. 


Figure 40.2 -- 
Bar charts showing no difference in the rates of visits to office-based physicians between men and women when diabetes was listed as either the primary or as any listed diagnosis.


Figure 40.3
 -- Bar charts showing no difference in the rates of visits to office-based physicians by race or ethnicity when diabetes was listed as either the primary or as any listed diagnosis.


Figure 40.4 -- 
Line graph showing that when diabetes was the primary diagnosis the rate of visits to office-based physicians decreased between 1990 and 2010 for all age groups.

Figure 40.5 -- 
Line graph showing that when diabetes was listed as any diagnosis the rate of visits to office-based physicians decreased between 1990 and 2010 for all age groups.

Figure 40.6 -- 
Line graph showing the rate of visits to office-based physicians when diabetes was listed as the primary diagnosis was much higher for men than for women in 1990 but was similar by sex in 2010.

Figure 40.7 -- 
Line graph showing the rate of visits to office-based physicians when diabetes was listed as any diagnosis was much higher for men than for women in 1990 but was similar by sex in 2010.


Figure 40.8 -- 
Line graph showing the rate of visits to office-based physicians when diabetes was listed as the primary diagnosis decreased over time for non-Hispanic whites and blacks and Hispanics.

Figure 40.9 -- 
Line graph showing the rate of visits to office-based physicians when diabetes was listed as any diagnosis decreased over time for non-Hispanic whites and blacks and Hispanics.

Figure 40.10 -- 
Bar graph showing that the proportion of diabetes patients with no outpatient visits in the past 12 months decreased with age and the proportion with 13 or more visits was similar by age.


Figure 40.11 -- 
Bar graph showing that the distribution of physician visits for adults with diabetes was similar across racial and ethnic groups.
Figure 40.12 -- 
Bar graph showing that the proportion of adults with diabetes with no physician visits in the past 12 months decreased with age and the proportion with 13 or more visits increased with age. 

Figure 40.13 -- 
Bar graph showing that the distribution of physician visits for adults with diabetes was similar across racial and ethnic groups.

Figure 40.14
 -- Bar graph showing that the percentage of adults with no physician visits in the past year was more than three times lower in the population with diabetes compared to the general population.

Figure 40.15
 -- Bar graph showing that the percentage of adults with no physician visits in the past year was more than three times lower in the population with diabetes compared to the general population.


Figure 40.16 -- 
Bar graph showing that 89 percent of adults with diabetes had at least one visit to a primary care physician in the past year, but only 57 percent saw an eye doctor and 53 percent saw a dentist.


Figure 40.17 -- 
Bar graph showing that 47 percent of visits to office-based physicians in which diabetes was the primary diagnosis were less than 15 minutes duration and 89 percent were less than 30 minutes. 

Figure 40.18 -- 
Bar graph showing that 70 percent of adults with diabetes reported no emergency department visits in the past year, 17 percent reported one visit, and 13 percent reported two or more visits.

Figure 40.19 -- 
Bar graph showing that the distribution of emergency department visits were similar across racial and ethnic groups except non-Hispanic blacks were more likely to have multiple visits.


Figure 40.20 -- 
Bar graph showing that the distribution of emergency department visits among adults with diabetes were similar across age groups.
Figure 40.21 -- 
Bar graph showing that the distribution of emergency department visits among adults with diabetes were similar across racial and ethnic groups.

Figure 40.22 -- 
Bar graph showing that adults with diabetes were less likely to report no emergency department visits in the last year compared to the general population with a similar pattern by sex.


Figure 40.23 -- 
Bar graph showing that adults with diabetes were less likely to report no emergency department visits in the last year compared to the general population with a similar pattern by sex.


Figure 40.24 -- 
Bar graph showing that almost three-quarters of hospitalizations with diabetes as the primary diagnosis occurred in adults age 45 years or older.


Figure 40.25 -- 
Bar graph showing that the hospital discharge rate with diabetes as the primary diagnosis was more than double for adults age 18 to 44 years compared to those age 45-64 or 65 years or older.


Figure 40.26
 -- Bar graph showing that younger women tended to have a higher rate of hospitalization with the primary diagnosis of diabetes compared to younger men.

Figure 40.27 -- 
Bar graph showing that the rate of hospitalization with diabetes as the primary diagnosis was highest in non-Hispanic blacks, especially those age 18 to 44 years.

Figure 40.28 -- 
Bar graph showing that between 1990 and 2010 the number of hospital discharges with diabetes as the primary diagnosis increased 53 percent and those age 45 to 64 had the greatest increase.

Figure 40.29
 -- Bar graph showing that between 1990 and 2010 the number of hospital discharges with diabetes as the primary diagnosis increased more for men compared to women.


Figure 40.30
 -- Bar graph showing that between 1990 and 2010 the number of hospital discharges with diabetes as the primary diagnosis increased more for blacks compared to whites.


Figure 40.31 -- 
Line graph showing that the rate of hospital discharges with diabetes listed as the primary diagnosis has decreased between 1990 and 2010 for all age groups.

Figure 40.32 -- 
Line graph showing that that the rate of hospital discharges with diabetes listed as the primary diagnosis decreased for both men and women with women having a slightly greater decrease.


Figure 40.33 -- 
Line graph showing that that the rate of hospital discharges with diabetes listed as the primary diagnosis decreased for both whites and blacks although rates were higher for blacks.

Figure 40.34 -- 
Bar graph showing that the number of hospitalizations with diabetes as any listed diagnosis increased 88 percent between 1990 and 2010, with those age 45 to 64 having the greatest increase.


Figure 40.35 -- 
Bar graph showing that the number of hospitalizations with diabetes as any listed diagnosis increased for both men and women with men having a greater increase than women between 1990 and 2010.

Figure 40.36 -- 
Bar graph showing that the number of hospitalizations with diabetes as any listed diagnosis increased 225 percent for blacks compared to 70 percent for whites between 1990 and 2010. 


Figure 40.37 -- 
Line graph showing that the rate of hospital discharges with diabetes listed as any diagnosis decreased over time for all age groups with a greater decrease for older adults.

Figure 40.38 -- 
Line graph showing that the rate of hospital discharges with diabetes listed as any diagnosis decreased for both men and women between 1990 and 2010 with women having a greater decrease.

Figure 40.39 -- 
Line graph showing that the rate of hospital discharges with diabetes listed as any diagnosis decreased similarly for both whites and blacks.


Figure 40.40
 -- Line graph showing that macrovascular disease is the most common diabetic complication with an increase in number of hospital discharges between 1990 and 2002 and a decrease through 2010.


Figure 40.41 -- 
Line graph showing that the rates of hospital discharges for cardiovascular disease and diabetes reached their peak in 1996 and have declined since then, particularly since 2004.

Figure 40.42 -- 
Line graph showing that the number of hospital discharges among people with diabetes that listed cardiac catheterization has increased over time with a slight decrease since 2002.

Figure 40.43 -- 
Line graph showing the rate of hospital discharges listing both diabetes and a cardiovascular procedure generally decreasing from 1990 to 2010

Figure 40.44 -- 
Bar graphing showing that adults with diabetes are more likely to be hospitalized than those without diabetes

Figure 40.45 -- 
Bar graphing showing that adults with diabetes are more likely to be hospitalized than those without diabetes

Figure 40.46 -- 
Bar graphing showing the percent hospitalized was generally highest for type 1 diabetes, followed by type 2 diabetes treated with insulin, and lowest in type 2 diabetes without insulin

Figure 40.47
 -- Bar graph showing the percent hospitalized in the past year was higher among people with diabetes than without diabetes in each age and sex strata

Figure 40.48 -- 
Bar graph showing the percent hospitalized in the past year was higher among people with diabetes than without diabetes in each age and sex strata

Figure 40.49 -- 
Bar graph showing the percent hospitalized in the past year was higher among people with diabetes than without diabetes in each age and race/ethnicity strata

Figure 40.50 -- 
Bar graph showing the percent hospitalized in the past year was higher among people with diabetes than without diabetes in each age and race/ethnicity strata

Figure 40.51 -- 
Bar graph showing the duration of diabetes was generally shorter for those hospitalized who did not use insulin compared to those hospitalized who were insulin-treated


Figure 40.52 -- 
Bar graph showing that among adults with diabetes hospitalized in the past year, approximately 60% were hospitalized once, 20% twice, and 20% were 3 or more times in the past year


Figure 40.53
 -- Bar graph showing that among adults with diabetes hospitalized in the past year, 70 to 75% were hospitalized once, 15 to 20% twice, and 5 to 15% were 3 or more times in the past year 


Figure 40.54 -- Line graph showing the average length of hospital stay decreased from around 8 days in 1990 to 5 in 2010 for those with diabetes as the primary diagnosis and those with it as any diagnosis

Figure 40.55 -- 
Line graph showing the prevalence of diabetes among nursing home residents decreases with age from for both men and women

Figure 40.56
 -- Line graph showing the absolute number with diabetes among nursing home residents increased from 1995 to 2004 in each age strata

Figure 40.57 -- 
Line graph showing the prevalence with diabetes among nursing home residents increased from 1995 to 2004 in each age strata


Figure 40.58 -- 
Bar graph showing those with diabetes, compared to those without diabetes, were more likely to have cardiovascular disease, hypertension, heart disease, and cerebrovascular disease

Figure 40.59 -- 
Bar graph showing nursing home residents with and without diabetes had a similar number of chronic medical conditions

Figure 40.60 -- 
Bar graph showing the biggest limitation of nursing home residents with diabetes is dressing, followed by bathing, transferring, walking, toileting, and eating

Figure 40.61 -- 
Pie chart showing the annual expenditure for nursing home care is about 43,000 dollars, and those with diabetes paid a lower percentage of the total themselves


Figure 40.62 -- Line graph showing the prevalence of diabetes among adults receiving home health care increases from the 18-44 years age group to the 65-74 years age group, then decreases in older age groups


Figure 40.63 -- 
Line graph showing the prevalence of diabetes among adults receiving home health care increases from the 18-44 years age group to the 65-74 years age group, then decreases in older age groups

Figure 40.64 -- 
Line graph showing the prevalence of diabetes among adults receiving home health care decreased from 1996 to 1997 then increased in 2000 and 2007


Figure 40.65 -- 
Bar graph showing the most common condition was circulatory system disorders, affecting 77%, followed by 32% with musculoskeletal conditions, and 23% with nervous system conditions


Figure 40.66 -- 
Bar graph showing home health care recipients with diabetes had a similar number of chronic medical conditions as those without diabetes


Figure 40.67 -- 
Bar graph showing the biggest limitation of home health care recipients with diabetes is bathing, followed by walking or climbing stairs, dressing, transferring, toileting, and eating

Figure 40.68 -- 
Pie chart showing total U S health care expenditures of 1,334 billion dollars, of which 306 billion were for people with diabetes, which included 176 billion attributable to diabetes


Figure 40.69
 -- Bar graph showing 8% of costs attributable to diabetes incurred by people <45 years, 33% by people 45-64 years, and 59% by people 65 and older

Figure 40.70
 -- Pie chart showing 36% of direct medical costs for diabetes incurred in hospitals, 8% in nursing homes or hospices, 33% in outpatient care, and 23% at pharmacies


Figure 40.71 -- 
Bar chart showing expenditures attributable to diabetes was 7,888 dollars overall, and ranged from 4,394 dollars for those 44 years and younger to 11,825 dollars for those 65 years and older

Figure 40.72 -- 
Bar chart showing 30% of expenditures for peripheral vascular disease were attributable to diabetes, 29% for renal disease, 28% for neurological disease, and 27% for cardiovascular disease

Figure 40.73 -- 
Line graph showing the total health care expenditure attributable to diabetes nearly doubled from 127 billion dollars in 2002 to 245 billion dollars in 2012


Figure 40.74 -- 
Line graph showing the expenditures attributable to diabetes increased from 2002 to 2012 for institutional care, outpatient care, and outpatient medications and supplies

Figure 40.75
 -- Line graph showing an increase in expenditures for insulin between 2002 and 2012, while non-insulin anti-hyperglycemic agent expenditures remained relatively flat

Figure 40.76 -- 
Line graph showing trends in expenditures for antihypertensive and cholesterol-lowering medications between 2002 and 2012 were similar for people with and without diabetes


Figure 40.77 -- 
Line graph showing the annual per capita health care expenditures increased from 2007 to 2012 due to an increase in outpatient medications and supplies

Figure 40.78 -- 
Line graph showing the per capita expenditures for insulin increased around 4-fold from 2007 to 2012, while non-insulin anti-hyperglycemic agents decreased over that time period


Figure 40.79
 -- Line graph showing trends in expenditures for antihypertensive and cholesterol-lowering medications between 2002 and 2012 were similar for people with and without diabetes


Figure 40.80 -- 
Map of the world showing expenditures for diabetes varies greatly by country and is generally highest in North American and Europe

Appendix 40.6 -- Bar graph showing the percent of men with diabetes who were hospitalized in the past year was generally not different by race/ethnicity


Appendix 40.7 -- Bar graph showing the percent of women with diabetes who were hospitalized in the past year was generally not different by race/ethnicity