The Association Between Cost-Related Insulin Rationing and Healthcare Utilization in U.S. Adults with Diabetes

Objective: To examine the association between insulin rationing and healthcare utilization.

Research Design and Methods: Cross-sectional study of all 2021 National Health Interview Survey respondents with diabetes using insulin. Logistic regression and zero-inflated negative binomial regression models examined associations between insulin rationing (skipping, delaying, or reducing insulin to save money) and 1) Emergency Department (ED) visit or hospitalization and 2) number of urgent care visits. All analyses were age-stratified and used survey weights.

Results: Among 982 respondents representing 7,593,944 U.S adults (median age 61, 47% female), 17% reported rationing. Among adults 18-64, rationing was not significantly associated with healthcare utilization. Among adults 65+, rationing was associated with more urgent care visits (RR 2.1, 95% CI 1.2-3.6) but not with odds of ED visit or hospitalization (OR 0.7, 95% CI 0.3-1.4).

Conclusions: Insulin rationing was not associated with higher healthcare utilization, but concurrent rationing of healthcare may mask a relationship.