Abstract
IMPORTANCE: Type 2 diabetes is common and associated with negative financial health. OBJECTIVE: To investigate the association of type 2 diabetes with adverse financial outcomes and identify patient groups at risk. DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation study analyzed electronic health records linked to credit records of adults aged 18 years or older with at least 1 medical encounter at a primary care medical center in Ohio from October 1, 2017, to December 31, 2021. Patient health records were included if they reported a glycated hemoglobin value, diagnostic code for type 2 diabetes, or a prescription for antidiabetic medications. EXPOSURE: Type 2 diabetes. MAIN OUTCOME AND MEASURES: The main outcome was adjusted probability of any adverse financial outcomes, below-prime credit score, nonmedical and medical debt in collections, delinquent debt, debt charge-offs, bankruptcy filing, and foreclosure. Adjustments included age, sex, race, Hispanic ethnicity, wage earnings, health insurance type, exposure period, and quarter-year indicators. RESULTS: The study population included 166 285 patients (mean [SD] age, 52.3 [15.3] years; 55.0% female; 0.2% of American Indian or Alaska Native or Native Hawaiian or Pacific Islander, 3.5% Asian, 19.1% Black, and 73.2% White race; 0.8% identifying as multiracial; 2.1% of Hispanic and 97.9% of non-Hispanic ethnicity), of whom 41.7% were diagnosed with type 2 diabetes. In the analytic sample, 50.8% lacked earned income, and 32.6% had Medicare coverage. For patients with vs without diabetes, estimated probabilities were significantly higher for any adverse financial outcomes (64.5% [95% CI, 64.1%-64.9%] vs 49.9% [95% CI, 49.6%-50.2%]), below-prime credit score (59.7% [95% CI, 59.3%-60.1%] vs 45.9% [95% CI, 45.6%-46.2%]), medical collections (36.9% [95% CI, 36.5%-37.3%] vs 23.9% [95% CI, 23.7%-24.2%]), nonmedical collections (38.4% [95% CI, 38.0%-38.8%] vs 27.7% [95% CI, 27.5%-28.0%]), delinquent debt (23.3% [95% CI, 22.9%-23.7%] vs 15.6% [95% CI, 15.4%-15.8%]), debt charge-offs (15.4% [95% CI, 15.1%-15.8%] vs 10.1% [95% CI, 9.9%-10.2%]), bankruptcy filings (2.1% [95% CI, 2.0%-2.3%] vs 1.4% [95% CI, 1.3%-1.5%]), and foreclosures (0.5% [95% CI, 0.5%-0.6%] vs 0.3% [95% CI, 0.2%-0.4%]). Patients with diabetes experienced more adverse financial outcomes (1.9 vs 1.2) and had lower credit scores (mean [SE], 618.7 [0.4] vs 664.2 [0.5]) than those without diabetes. For patients with vs without diabetes, the maximum amount of nonmedical debt in collection was higher ($1875 [95% CI, $1834-$1916] vs $1361 [95% CI, $1333-$1389]), as was delinquent debt ($11 387 [95% CI, $10 796-$11 977] vs $7630 [95% CI, $7305-$7955]). The adjusted prevalence of adverse financial outcomes was higher among patients of Black race, enrolled in Medicaid, of Hispanic ethnicity, younger than 65 years, without earned income, and of female sex. CONCLUSIONS AND RELEVANCE: This economic evaluation of patient health records linked to credit records and wage earnings shows a positive association of type 2 diabetes with adverse financial outcomes. These findings suggest that patients with type 2 diabetes may experience substantially more adverse financial outcomes compared with patients without diabetes, highlighting the need to consider patient financial health when treating type 2 diabetes, particularly for patient groups at higher risk.