The Council of State governments

JULY 2013

CAPITOL facts & figures

EAST | Health

Diabetes: A Costly Epidemic

Nineteen million people in the United States were diagnosed with Type I and Type II diabetes in 2010, although the number of people diagnosed varies by region.1 Diabetes cost the U.S. $245 billion in 2012 in both direct and indirect costs.2 Costs associated with diabetes also vary by region. Direct medical costs include such things as hospital or nursing home stays, ambulance services, home health services, as well as insulin and other diabetic supplies and treatments, while indirect costs refer to absenteeism, unemployment and reduced productivity.

National Analysis
The Centers for Disease Control and Prevention estimated 7 million people had prediabetes in 2010.3 In 2010, 8 percent of the population over age 18 was diagnosed with diabetes in the U.S.4 The number of people diagnosed with diabetes grew 82 percent from 1995 to 2010.5 In 2011, 10 percent of adults had previously been told by a doctor that they have diabetes.6 As the nations population ages, more people are being diagnosed with diabetes. The CDC estimates 27 percent of people age 65 and older have the disease. 14 percent of people ages 45 to 64 have diabetes. People ages 20 to 44 are the least likely to have diabetes. An estimated 4 percent of people in this age group have the disease.7 Racial and ethnic health disparities exist in the prevalence of diagnosed and undiagnosed diabetes. In 2010, 19 percent of African-Americans and 10 percent of whites over age 20 had diabetes.8

Regional Analysis
Diagnosed diabetes prevalence in 2010 varied in the Eastern region from 6 percent in Vermont to 9 percent in Pennsylvania. In 2010, the Eastern states with the highest diagnosed diabetes prevalence after Pennsylvania were Maryland and New Jersey, both slightly less than 9 percent. The growth in diagnosed diabetes in Eastern states between 1995 and 2010 ranged from 27 percent in Vermont to 117 percent in Maine. After Maine, the states where diabetes increased the most between 1995 and 2010 are Maryland with a 102 percent increase and New York with a 91 percent increase. In a 2013 report, the American Diabetes Association estimated the total annual costs of diabetes in 2010 ranged from $370 million in Vermont to $16 billion in New York. After New York, states with top total cost estimates in 2010 were Pennsylvania at $10 billion and New Jersey at $7 billion.

Increase in Diagnosed Diabetes, U.S., 1995-2010

9 8 7 6 5 4 3 2 1 0

Delaware

Massachusetts

Connecticut

New Hampshire

New Jersey

Maine

Maryland

Pennsylvania

Rhode Island

New York

1995

2000

YEAR

2005

2010

Source: Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Nov. 16, 2012, Vol. 16, No. 45 http://www.cdc.gov/mmwr/pdf/wk/mm6145.pdf

Vermont

10 9 8 7 6 5 4 3 2 1 0

Diagnosed Diabetes Prevalence 2010

National Median

PERCENT

PERCENT

The Council of State governments

JULY 2013

CAPITOL facts & figures

MIDWEST | Health

Diabetes: A Costly Epidemic

Nineteen million people in the United States were diagnosed with Type I and Type II diabetes in 2010, although the number of people diagnosed varies by region.1 Diabetes cost the U.S. $245 billion in 2012 in both direct and indirect costs.2 Costs associated with diabetes also vary by region. Direct medical costs include such things as hospital or nursing home stays, ambulance services, home health services, as well as insulin and other diabetic supplies and treatments, while indirect costs refer to absenteeism, unemployment and reduced productivity.

National Analysis
The Centers for Disease Control and Prevention estimated 7 million people had prediabetes in 2010.3 In 2010, 8 percent of the population over age 18 was diagnosed with diabetes in the U.S.4 The number of people diagnosed with diabetes grew 82 percent from 1995 to 2010.5 In 2011, 10 percent of adults had previously been told by a doctor that they have diabetes.6 As the nations population ages, more people are being diagnosed with diabetes. The CDC estimates 27 percent of people age 65 and older have the disease. 14 percent of people ages 45 to 64 have diabetes. People ages 20 to 44 are the least likely to have diabetes. An estimated 4 percent of people in this age group have the disease.7 Racial and ethnic health disparities exist in the prevalence of diagnosed and undiagnosed diabetes. In 2010, 19 percent of African-Americans and 10 percent of whites over age 20 had diabetes.8

Regional Analysis
Diagnosed diabetes prevalence in 2010 varied in the Midwestern region from 6 percent in South Dakota to 10 percent in Michigan. In 2010, the Midwestern states with the highest diagnosed diabetes prevalence after Michigan were Indiana and Ohio, both slightly more than 9 percent. The growth in diagnosed diabetes in Midwestern states between 1995 and 2010 ranges from 36 percent in Iowa to 121 percent in both Ohio and South Dakota. After Ohio and South Dakota, the states where diabetes increased the most between 1995 and 2010 are Minnesota with a 106 percent increase and North Dakota with a 92 percent increase. In a 2013 report, the American Diabetes Association estimated the total annual cost of diabetes in 2010 ranged from $410 million in North Dakota to $9 billion in Ohio. After Ohio, states with top total cost estimates in 2010 were Illinois at $8 billion and Michigan at $8 billion.

Diagnosed Diabetes Prevalence 2010 Increase in Diagnosed Diabetes, U.S., 1995-2010

9 8 7 6 5 4 3 2 1 0
11 10 9 8 7 6 5 4 3 2 1 0 National Median

PERCENT

PERCENT

North Dakota

1995

2000

YEAR

2005

2010

Source: Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Nov. 16, 2012, Vol. 16, No. 45 http://www.cdc.gov/mmwr/pdf/wk/mm6145.pdf

South Dakota

Minnesota

Wisconsin

Illinois

Indiana

Michigan

Nebraska

Kansas

Iowa

Ohio

The Council of State governments

JULY 2013

CAPITOL facts & figures

SOUTH | Health

Diabetes: A Costly Epidemic

Nineteen million people in the United States were diagnosed with Type I and Type II diabetes in 2010, although the number of people diagnosed varies by region.1 Diabetes cost the U.S. $245 billion in 2012 in both direct and indirect costs.2 Costs associated with diabetes also vary by region. Direct medical costs include such things as hospital or nursing home stays, ambulance services, home health services, as well as insulin and other diabetic supplies and treatments, while indirect costs refer to absenteeism, unemployment and reduced productivity.

National Analysis
The Centers for Disease Control and Prevention estimated 7 million people had prediabetes in 2010.3 In 2010, 8 percent of the population over age 18 was diagnosed with diabetes in the U.S.4 The number of people diagnosed with diabetes grew 82 percent from 1995 to 2010.5 In 2011, 10 percent of adults had previously been told by a doctor that they have diabetes.6 As the nations population ages, more people are being diagnosed with diabetes. The CDC estimates 27 percent of people age 65 and older have the disease. 14 percent of people ages 45 to 64 have diabetes. People ages 20 to 44 are the least likely to have diabetes. An estimated 4 percent of people in this age group have the disease.7 Racial and ethnic health disparities exist in the prevalence of diagnosed and undiagnosed diabetes. In 2010, 19 percent of African-Americans and 10 percent of whites over age 20 had diabetes.8

Regional Analysis
Every state in the Southern region, diabetes prevalence is above the national median. Diagnosed diabetes prevalence varied in the Southern region from 8 percent in Virginia to 12 percent in Mississippi.9 In 2010, the Southern states with the highest diagnosed diabetes prevalence after Virginia were Alabama and Tennessee, both at 11 percent. The growth in diagnosed diabetes in Southern states between 1995 and 2010 ranged from 46 percent in Louisiana to 227 percent in Oklahoma. In a 2013 report, the American Diabetes Association estimated the total annual costs of diabetes in 2010 ranged from $2 billion in West Virginia to more than $18 billion in Florida. After Florida, states with top total cost estimates in 2010 were Texas at $18 billion and North Carolina at $8 billion.

Diagnosed Diabetes Prevalence 2010 Increase in Diagnosed Diabetes, U.S., 1995-2010

9 8 7 6 5 4 3 2 1 0
12 11 10 9 8 7 6 5 4 3 2 1 0

National Median

PERCENT

PERCENT

Mississippi

Arkansas

Kentucky

Alabama

Louisiana

Missouri

Virginia

Texas

North Carolina

1995

2000

YEAR

2005

2010

Source: Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Nov. 16, 2012, Vol. 16, No. 45 http://www.cdc.gov/mmwr/pdf/wk/mm6145.pdf

South Carolina

West Virginia

Tennessee

Oklahoma

Florida

Georgia

The Council of State governments

The Council of State Governments

JULY 2013

CAPITOL facts & figures

WEST | Health

Diabetes: A Costly Epidemic

Nineteen million people in the United States were diagnosed with Type I and Type II diabetes in 2010, although the number of people diagnosed varies by region.1 Diabetes cost the U.S. $245 billion in 2012 in both direct and indirect costs.2 Costs associated with diabetes also vary by region. Direct medical costs include such things as hospital or nursing home stays, ambulance services, home health services, as well as insulin and other diabetic supplies and treatments, while indirect costs refer to absenteeism, unemployment and reduced productivity.

National Analysis
The Centers for Disease Control and Prevention estimated 7 million people had prediabetes in 2010.3 In 2010, 8 percent of the population over age 18 was diagnosed with diabetes in the U.S.4 The number of people diagnosed with diabetes grew 82 percent from 1995 to 2010.5 In 2011, 10 percent of adults had previously been told by a doctor that they have diabetes.6 As the nations population ages, more people are being diagnosed with diabetes. The CDC estimates 27 percent of people age 65 and older have the disease. 14 percent of people ages 45 to 64 have diabetes. People ages 20 to 44 are the least likely to have diabetes. An estimated 4 percent of people in this age group have the disease.7 Racial and ethnic health disparities exist in the prevalence of diagnosed and undiagnosed diabetes. In 2010, 19 percent of African-Americans and 10 percent of whites over age 20 had diabetes.8

Regional Analysis
In all but one state in the Western region, diabetes prevalence is below the national median. Diagnosed diabetes prevalence varied in the Western region from 6 percent in Alaska to nearly 9 percent in California.9 In 2010, the Western states with the highest diagnosed diabetes prevalence after California were Nevada and Idaho, both at 8 percent. The growth in diagnosed diabetes in Western states between 1995 and 2010 ranged from 38 percent in California to 136 percent in Washington. In a 2013 report, the American Diabetes Association estimated the costs of diabetes ranged from $360 million in Wyoming to $27.5 billion in California in 2010.10 After California, states with top cost estimates were Washington at $5.1 billion and Arizona at slightly more than $4.7 billion.

Increase in Diagnosed Diabetes, U.S., 1995-2010

9 8 7 6 5 4 3 2 1 0 9 8 7 6 5 4 3 2 1 0

Diagnosed Diabetes Prevalence 2010

National Median

PERCENT

PERCENT

Idaho

New Mexico

California

1995

2000

YEAR

2005

2010

Source: Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Nov. 16, 2012, Vol. 16, No. 45 http://www.cdc.gov/mmwr/pdf/wk/mm6145.pdf

Washington

Wyoming

Alaska

Arizona

Colorado

Montana

Nevada

Hawaii

Oregon

Utah

Diabetes: A Costly Epidemic

Prevalence of Diagnosed Diabetes, Adults Ages 18 and Over State 1995 4.5 4.3 4.4 3.5 4.4 3.9 5.1 4.5 4.4 5.5 4.6 4.8 5.4 5.1 5 4.7 5.6 3.1 4.4 3.6 4.2 2.8 4.6 4.7 5 4.8 4 3.6 6.7 6.3 4.2 4.8 3 5 5.3 5.7 4.2 4.5 4.2 4.8 6.2 3.7 3.5 3.6 2.9 5 5.7 4 4.2 3.1 3.3 2000 6 5.2 6.3 5.8 6.5 5.7 4.6 5.6 6.2 6.5 5.8 4.4 6.2 6 5.6 5.7 7 4.8 4.8 5 6.1 5.4 5.9 7.3 5.9 6.2 7.1 6.3 6.8 7.6 6.4 6.5 5.4 7.2 7 6.5 6.3 7 4.4 5.9 7.1 5.2 5.1 4.8 4.5 6.8 6.6 5.8 5.7 5.5 5 2005 7.2 6.1 8.3 6.8 7.1 6.2 6.3 7.3 7.9 7.5 6.2 5.7 7.9 8.1 6.3 6.7 7.9 5.7 7.1 6.2 7.3 6 6.3 9.3 7.7 7.9 8.9 8.6 9.1 9.6 7.5 8.4 8.6 10.1 8.8 8.3 7 9.6 5.6 7.3 7.4 5.1 7 6.8 5.2 7.1 7 6.5 6.4 6.3 6.3 2010 8.2 6.7 7.9 7.6 8.9 7 7.3 8.5 8.4 9.2 7.3 6.1 8.5 9.3 6.8 7.9 9.6 6.4 7.2 6.9 9.3 6.2 6.6 11.3 8.9 8.6 9.8 9.3 9.8 11.7 8.7 9.4 9.8 10 10.6 10 8.3 10.4 6 7.5 8.6 6.1 7.6 7.7 6.3 8.4 8 6.6 7.3 7.3 6.8 % Change 1995-2010 82.2 55.8 79.5 117.1 102.3 79.5 43.1 88.9 90.9 67.3 58.7 27.1 57.4 82.4 36 68.1 71.4 106.5 63.6 91.7 121.4 121.4 43.5 140.4 78 79.2 145 158.3 46.3 85.7 107.1 95.8 226.7 100 100 75.4 97.6 131.1 42.9 56.3 38.7 64.9 117.1 113.9 117.2 68 40.4 65 73.8 135.5 106.1 % Change 2010 - 2025* NA 61.8 64.9 46.8 62.4 60.6 72.8 48.8 43.9 40.6 59.4 70.5 44.7 41.3 55.0 53.6 41.8 99.6 105.0 51.5 44.0 62.9 68.3 31.3 45.4 85.1 57.0 35.6 34.0 28.5 47.4 65.8 37.3 46.7 40.3 66.3 69.3 17.2 90.2 108.9 70.2 107.3 54.0 74.2 73.6 105.0 60.1 87.5 118.5 88.4 55.7 Cost (in millions $) Medical 175,800 2,090 600 880 3,450 4,340 690 5,420 11,380 7,430 570 260 6,590 3,690 1,390 1,420 5,760 2,300 790 290 6,710 420 3,280 3,010 1,670 14,370 5,470 2,660 3,020 1,910 3,240 6,100 2,070 3,020 3,620 13,350 4,430 1,440 320 3,480 19,320 1,830 770 720 420 1,360 1,160 2,160 860 3,750 260 Indirect 68,600 830 260 360 1,630 1,720 310 2,430 5,060 2,810 250 110 2,390 1,430 530 560 2,240 840 320 120 2,570 140 1,090 1,300 720 4,530 2,160 1,190 1,180 820 1,240 2,200 770 1,130 1,480 4,890 1,770 570 130 1,280 8,230 690 340 270 140 470 370 840 330 1,360 100 Total 245,000 2,920 860 1,240 5,070 6,070 1,000 7,850 16,430 10,240 820 370 8,980 5,120 1,920 1,980 8,000 3,140 1,110 410 9,280 560 4,360 4,310 2,390 18,900 7,630 3,850 4,190 2,740 4,490 8,300 2,840 4,160 5,100 18,240 6,190 2,010 450 4,760 27,550 2,520 1,110 990 560 1,820 1,530 2,990 1,190 5,110 360

United States EAST REGION Connecticut Delaware Maine Maryland Massachusetts New Hampshire New Jersey New York Pennsylvania Rhode Island Vermont MIDWEST REGION Illinois Indiana Iowa Kansas Michigan Minnesota Nebraska North Dakota Ohio South Dakota Wisconsin SOUTH REGION Alabama Arkansas Florida Georgia Kentucky Louisiana Mississippi Missouri North Carolina Oklahoma South Carolina Tennessee Texas Virginia West Virginia WEST REGION Alaska Arizona California Colorado Hawaii Idaho Montana Nevada New Mexico Oregon Utah Washington Wyoming

Marina Byrd, CSG Research Assistant mbyrd@csg.org REFERENCES

1 Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Nov. 16, 2012, Vol. 16, No. 45 http://www.cdc.gov/mmwr/pdf/wk/mm6145.pdf 2 American Diabetes Association. http://care. diabetesjournals.org/content/early/2013/03/05/ dc12-2625.abstract http://care.diabetesjournals. org/content/suppl/2013/03/05/dc12-2625.DC1/ DC122625SupplementaryData.pdf 3 CDC. Morbidity and Mortality Weekly Report 4 CDC. Morbidity and Mortality Weekly Report 5 CDC. Morbidity and Mortality Weekly Report 6 Kaiser Family Foundation. Percent of Adults Who Have Been Ever Been Told by a Doctor that They Have Diabetes. http://kff.org/other/state-indicator/adultswith-diabetes/ 7 Centers for Disease Control and Prevention. National Diabetes Fact Sheet 2011. http://www.cdc.gov/diabetes/ pubs/pdf/ndfs_2011.pdf 8 CDC. National Diabetes Fact Sheet 2011. 9 CDC. Morbidity and Mortality Weekly Report 10 American Diabetes Association.

Source for Prevalence: CDC. Morbidity and Mortality Weekly Report. Nov. 16, 2012, Vol. 16, No. 45 http://www.cdc.gov/mmwr/pdf/wk/mm6145.pdf Source for column % Change 2010-2025: Authors calculations based on data from Institute for Alternative Futures. How is Diabetes Affecting your State? http://www.changingdiabetesbarometer.com/docs/Diabetes-2025-State-Summary-0513-00016036.pdf Source for cost of diabetes: American Diabetes Association. http://care.diabetesjournals.org/content/early/2013/03/05/dc12-2625.abstract http://care.diabetesjournals.org/content/suppl/2013/03/05/dc12-2625.DC1/DC122625SupplementaryData.pdf *Percent changes based on future estimates of diagnosed and undiagnosed diabetes.