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. 2018 Jul;41(7):1455-1461.
doi: 10.2337/dc17-2028. Epub 2018 May 14.

Diabetes-Attributable Nursing Home Costs for Each U.S. State

Simon J Neuwahl  1 , Amanda A Honeycutt  2 , Diana C Poehler  2 , Sundar S Shrestha  3 , Ping Zhang  3 , Thomas J Hoerger  2
Affiliations

Diabetes-Attributable Nursing Home Costs for Each U.S. State

Simon J Neuwahl et al. Diabetes Care. 2018 Jul.

Abstract

Objective: To estimate the diabetes-attributable nursing home costs for each state.

Research design and methods: We used a diabetes-attributable fraction (AF) approach to estimate nursing home costs attributable to diabetes (in 2013 dollars) in aggregate and per person with diabetes in each state. We calculated the AFs as the difference in diabetes prevalence between nursing homes and the community. We used the Centers for Medicare & Medicaid Services 2013-2015 Minimum Data Set to estimate the prevalence of diabetes in nursing homes and to adjust for the intensity of care among people with diabetes in nursing homes. Community prevalence was estimated using the Behavioral Risk Factor Surveillance System (BRFSS). State nursing home expenditures were from the 2013 State Health Expenditure Accounts.

Results: The fraction of total nursing home expenditures attributable to diabetes ranged from 12.3% (Illinois) to 22.5% (Washington, DC; median AF of 15.6%, New Jersey). The median AF was highest in the 19-64 years age-group and lowest in the 85 years or older age-group. Nationally, diabetes-attributable nursing home costs were $18.6 billion. State-level diabetes-attributable costs ranged from $21 million in Alaska to $2.0 billion in California. Diabetes-attributable nursing home costs per person ranged from $374 in New Mexico to $1,610 in Washington, DC (median of $799 in Maine).

Conclusions: Our estimates provide state policymakers with an improved understanding of the economic burden of diabetes in each state's nursing homes. These estimates could serve as critical inputs for planning and evaluating diabetes prevention and management interventions that can keep people healthier and living longer in their communities.

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Conflict of interest statement

Duality of Interest. No potential conflicts of interest relevant to this article were reported.

Figures

Figure 1—
Figure 1—
RUG-weighted diabetes AFs for nursing home expenditures by state.
Figure 2—
Figure 2—
Cost of diabetes in nursing homes per person with diabetes (in the community and in nursing homes).
See this image and copyright information in PMC

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