Universal drug coverage and socioeconomic disparities in health care costs among persons with diabetes
Methods: Administrative health databases were used to examine publicly-funded health care expenditures among 698,113 younger (20-64 years) and older adults (≥65 years) with diabetes in Ontario from April 2004 to March 2014. Generalized linear models were constructed to examine relative and absolute differences in health care costs (total and non-drug-related) across neighborhood socioeconomic status (SES) quintiles, by age, adjusting for differences in age, sex, diabetes duration, and comorbidity.
Results: Unadjusted costs per person-year in the lowest (Q1) versus highest (Q5) SES quintile were 39% higher among younger adults ($5,954 vs. $4,270 Canadian dollars), but only 9% higher among older adults ($10,917 vs. $9,993). Adjusted non-drug costs (primarily for hospitalizations and physician visits) were $1,569 per person-year higher among younger adults in Q1 vs. Q5 (modeled relative cost difference: +35.7%) and $139.3 million per year among all individuals in Q1. Scenarios in which these excess costs per person-year were decreased by ≥10% or matched the relative difference among seniors suggested a potential for savings in the range of $26.0 to $128.2 million per year among all lower SES adults under age 65 (Q1-4).
Conclusions: Socioeconomic status is a predictor of diabetes-related health care costs in our setting, more so among adults under age 65, a group that lacks universal drug coverage under Ontario’s health care system. Non-drug related health care costs were more than one-third higher in younger, low SES adults, translating to >$1 billion more in health care expenditures over 10 years.