Racial differences in the effects of hypertension and obesity on health expenditures by diabetes patients in the US

Abstract

Using a representative sample of US diabetes patients with comorbid hypertension and obesity, we estimate the determinants of health care expenditures. The hypothesis is that the presence of comorbid obesity and hypertension is associated with higher expenditures in the health care system. We are unaware of any study that examines the effects of these conditions taken together. The results confirm our hypothesis. For all races/ethnicities, the addition of hypertension and/or obese to diabetes substantially increases health care expenditures: by over 25% for whites, by over 70% for Blacks and by over 48% for Hispanics. We further find that interactions of obesity and hypertension with race indicate lower health expenditures by minorities compared to whites having the same combination of conditions. Diabetic-obese-not-hypertensive blacks spend 37.7% ($4224 per year) less than their white counterparts. Diabetic-obese-not-hypertensive Hispanics spend 41% ($4591 per year) less than diabetic-obese-not-hypertensive whites. Blacks and Hispanics who are diabetic but not obese or hypertensive spend $5923 and $6409 less than whites with equivalent conditions. The results have implications for efficiency and equity in the health care system.

Keywords:

• diabetes
• race/ethnicity
• health care expenditures
• obesity
• hypertension

JEL Classification:

• I10
• I11
• I18

Notes

¹ Of which is Type 2 is dominant, CDC (2011).

² BMI greater than or equal to 25 kg/m² but less than 30 kg/m².

³ BMI greater than or equal to 30 kg/m².

⁴ Over 70% of T2DM patients have hypertension (>130/80 mm Hg) (Hogan et al., 2003).

⁵ http://www.cdc.gov/healthyweight/assessing/index.html; http://apps.who.int/bmi/index.jsp?introPage=intro_3.html

⁶ Underweight persons were excluded from the regressions because the sample was too small (less than 2% of the total population and less than 0.5% of the diabetes patient population).

⁷ For example, an individual with a chronic pulmonary condition (weight of 1) and lymphoma (weight of 2) has an index score of 3. The index is applied to the MEPS data based on survey respondents’ conditions.