Article 9 LitR
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Article 9
The article titled "Racial and Ethnic Differences in Out-of-Pocket Costs Among Adults with
Diabetes: A Cross-Sectional Study Using the Medical Expenditure Panel Survey" explores the
disparities in out-of-pocket (OOP) costs among adults with diabetes based on racial and ethnic
backgrounds. The study utilizes data from the Medical Expenditure Panel Survey Household
Component spanning the years 2002 to 2011, focusing on a nationally representative sample of
17,702 adults with diabetes. Here's a breakdown of the key components of the article for a
literature review:
1. **Background:**
- The introduction highlights the increasing prevalence of diabetes in the United States,
affecting over 30 million Americans and the expected rise in the future.
- Points out the economic burden of diabetes, estimating annual costs at $245 billion, with the
average person with diabetes paying significantly more in direct medical expenditures
compared to those without diabetes.
- Emphasizes the relevance of studying racial and ethnic differences in diabetes, given
historically higher prevalence, adverse complications, and worse health outcomes in minority
groups compared to Non-Hispanic Whites (NHW).
2. **Objective of the Study:**
- The primary objective is to assess racial and ethnic differences in out-of-pocket (OOP) costs
among a nationally representative sample of adults with diabetes.
3. **Methods:**
- Data Source: The study uses data from the Medical Expenditure Panel Survey Household
Component (MEPS-HC) from 2002 to 2011, a nationally representative survey.
- Sample: 17,702 adults aged 18 years and older with self-reported diabetes.
- Analytical Approach: Utilizes a two-part model to estimate adjusted incremental OOP
expenses, considering sociodemographic characteristics, comorbid conditions, and time.
- Variables: Examines variables of interest, including race/ethnicity, age, sex, marital status,
education, health insurance, region, income level, and comorbidities.
4. **Results:**
- Describes the demographic characteristics of the sample population, highlighting the
distribution across racial and ethnic groups, age groups, gender, education, and insurance
status.
- Presents unadjusted means for OOP expenditures over time, demonstrating a significant
decrease in overall OOP expenses for all racial and ethnic groups.
- Discusses the results of the adjusted two-part model, emphasizing that racial and ethnic
minority groups, including Non-Hispanic Blacks (NHBs), Hispanics, and individuals in the 'Other'
category, had significantly lower OOP costs compared to NHWs.
5. **Discussion:**
- Interpretation of Findings: Discusses the observed differences in OOP expenditures among
racial and ethnic groups, suggesting that higher healthcare utilization among NHWs might
contribute to these variations.
- Implications: Highlights the importance of understanding the factors influencing racial and
ethnic disparities in OOP expenses and the need for continued research to inform policies and
interventions.
- Contribution to Literature: Emphasizes the study's contribution to the literature by providing
valuable information to guide efforts in narrowing health disparities gaps between racial groups
and tailoring approaches to diabetes management.
6. **Conclusion:**
- Summarizes the key findings of the study, including the significantly lower OOP expenses
among racial and ethnic minority groups and the observed decrease in OOP expenditures over
time.
- Calls for future research to delve into the factors contributing to these disparities and
underscores the importance of ongoing efforts to address health disparities among diverse
populations.
Incorporating these key elements into your literature review will provide a comprehensive
overview of the study and its contribution to the understanding of racial and ethnic differences
in out-of-pocket costs among adults with diabetes.
Limitatons
The study has several limitations that warrant consideration in the interpretation of its findings.
Firstly, its cross-sectional design precludes the establishment of causal relationships, offering
only a snapshot of data at a single point in time. Longitudinal studies would be essential for a
more comprehensive understanding of changes over time. Additionally, reliance on self-
reported data introduces the potential for response bias. While the dataset undergoes
validation, inherent limitations in self-reporting should be acknowledged. Another noteworthy
limitation is the lack of differentiation between types 1 and 2 diabetes in the dataset. Although
assumed to be representative given the prevalence of type 2 diabetes, a more nuanced analysis
could be achieved by distinguishing between diabetes types. The study also falls short of
establishing causation due to its cross-sectional nature, given the complexity of factors
influencing out-of-pocket costs. Despite being based on a nationally representative sample,
caution is advised in generalizing findings to the entire U.S. population, considering potential
sampling variations and regional healthcare access disparities. Furthermore, the study offers a
broad suggestion that racial and ethnic differences in healthcare utilization might explain
variations in out-of-pocket costs without delving into the specific patterns of healthcare
utilization and underlying reasons. The analysis adjusts for several sociodemographic and
comorbid factors, yet potential unmeasured confounding variables remain a concern.
Additionally, the study does not distinguish between short-term and long-term costs associated
with diabetes treatment and management, a differentiation that could yield valuable insights
into cost variations over time. Recognizing these limitations is imperative for a nuanced
interpretation of the study's outcomes and for guiding future research endeavors in this field.
Simmons, M., Bishu, K. G., Williams, J. S., Walker, R. J., Dawson, A. Z., &
Egede, L. E. (2019). Racial and Ethnic Differences in Out-of-Pocket Expenses
among Adults with Diabetes.
Journal of the National Medical
Association
,
111
(1), 28–36.
https://doi.org/10.1016/j.jnma.2018.04.004
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