Incremental Healthcare Expenditures Associated with Thyroid Disorders among Individuals with Diabetes

Amit D Raval,Usha Sambamoorthi

doi:10.1155/2012/418345

Abstract

Objective. To estimate incremental healthcare expenditures associated with thyroid disorders among individuals with diabetes. Research Design and Methods. Cross-sectional study design with data on adults over 20 years of age with diabetes (N = 4, 490) from two years (2007 and 2009) of the Medical Expenditure Panel Survey (MEPS) was used. Ordinary least square regressions on log-transformed total expenditures and type of healthcare expenditures (inpatient, emergency room, outpatient, prescription drug, and other) were performed to estimate the incremental expenditures associated with thyroid disorders after controlling for demographic, socioeconomic, health status, lifestyle risk factors, macrovascular comorbid conditions (MCCs), and chronic conditions (CCs). Results. Among individuals with diabetes, those with thyroid disorders had significantly greater average annual total healthcare expenditures ($15,182) than those without thyroid disorders ($11,093). Individuals with thyroid disorders had 34.3% greater total healthcare expenditures compared to those without thyroid disorders, after controlling for demographic, socio-economic, and perceived health status. Furthermore, controlling for CCs and MCCs, this increase in expenditures was reduced to 21.4%. Conclusions. Among individuals with diabetes, thyroid disorders were associated with greater healthcare expenditures; such excess expenditures may be due to CCs and MCCs. Comanagement of CCs and reducing MCCs may be a pathway to reduce high healthcare expenditures.

Highlights

In 2011, approximately 20 million Americans were affected by thyroid disorders [1]
Individuals with diabetes and hyperthyroidism may suffer from hyperglycemia possibly due to increased metabolism of insulin, increase in glucose absorption from gut, increase in endogenous glucose production, lipolysis resulted in hepatic gluconeogenesis, increase in growth hormones, glucagon and catecholamine levels [7, 9, 14,15,16,17,18]
After adjustment of other demographic and socioeconomic characteristics, access to care, lifestyle risk factors, perceived physical health, and perceived mental health, the presence of thyroid disorders was associated with nearly one-fifth (18.7%) greater total expenditures. These findings suggest that lifestyle risk factors such as smoking, obesity, and physical activity can be modified to reduce economic burden of thyroid disorders among individuals with diabetes

Summary

Introduction

Individuals with diabetes are at greater risk for developing thyroid disorders and have a higher prevalence of thyroid disorders compared to the general population. Prevalence of thyroid disorders among individuals with diabetes ranges from 13%–32% compared to 5%–8% in the general population [2,3,4,5]. Hypothyroidism is a common disorder among individuals with diabetes [2,3,4,5], hyperthyroidism is prevalent and is estimated to be around 12% [6]. As thyroid hormones affect glucose metabolism [7,8,9,10], individuals with diabetes and hypothyroidism may suffer from frequent recurrent hypoglycemic episodes [11] and insulin resistance [12, 13]. Individuals with diabetes and hyperthyroidism may suffer from hyperglycemia possibly due to increased metabolism of insulin, increase in glucose absorption from gut, increase in endogenous glucose production, lipolysis resulted in hepatic gluconeogenesis, increase in growth hormones, glucagon and catecholamine levels [7, 9, 14,15,16,17,18]

Methods

Results

Discussion

Conclusion