Economic Costs Attributed to Diagnosed Diabetes in Each US State and the District of Columbia, 2021

Objective: To update state-specific estimates of diabetes-attributable costs in the United States and assess changes in spending from 2013 to 2021.

Research Design and Methods: We used an attributable fraction approach to estimate direct medical costs of diagnosed diabetes using the 2021 State Health Expenditure Accounts, the 2021 Behavioral Risk Factor Surveillance System, and the Centers for Medicare & Medicaid Services’ 2018-2019 Minimum Data Set. We estimated diabetes-attributable productivity losses from morbidity and mortality, using the 2016–2021 National Health Interview Survey and the 2021 mortality data from the Centers for Disease Control and Prevention. Costs were adjusted to 2021 U.S. dollars.

Results: Total diabetes-attributable costs in 2021 were $640B ($335B in direct medical costs and $305B in indirect costs). The median state-level total diabetes-attributable costs in were $8.2B (range: $842M–$81B). The median state-level per-person cost was $21,082, ranging from $17,452 to $37,090. Total diabetes-attributable costs increased by a median of 33% between 2013 and 2021, ranging from 16% to 68% across states. Medical costs increased by 50% overall (range: 33%–79%) and by 27% (range: 15%–41%) for per person with diabetes. Costs paid by Medicaid experienced the highest increase between 2013 and 2021 (median: 153%, range: 41–483%).

Conclusions: State economic costs of diagnosed diabetes are substantial and increased over the past decade. These costs and their growth vary considerably across states. These findings may help state policymakers in developing evidenced-based public health interventions in their respective state to prevent and control the prevalence of diabetes.