(144) Racial Disparities associated with Total Healthcare Expenditures (THEs) in Type 2 Diabetes Mellitus (T2DM): Impact of GLP1 RAs

Background: : GLP-1 RAs are increasingly used for type 2 diabetes, yet their high cost raises concerns about access and equity. Evidence remains limited on whether racial and ethnic differences are associated with total healthcare expenditures (THEs) overall, as well as with expenditure differences among GLP-1 RA users.

Objective: : To examine association of racial and ethnic differences and total healthcare expenditures among U.S. adults with type 2 diabetes mellitus (T2DM), including subgroup analyses of GLP-1 RA users.

Methods: : We analyzed pooled 2018–2022 MEPS data for adults aged 18–65 years with diabetes who self-identified as Hispanic, NHB, or NHW. To address zero values for THEs, $1 was added and log transformation applied. Survey-weighted descriptive statistics and mean THEs were calculated, and multivariable linear regression of log-transformed THE, adjusted for key covariates and GLP-1 RA use, was performed using SAS 9.4 with complex survey design adjustments.

Results: : The analytic cohort included 11,436 U.S. adults with T2DM (weighted N=22,771,988): 18.2% Hispanic, 16.4% NHB, and 65.4% NHW. Mean annual THEs were lowest among Hispanics ($13,713; 95% CI: $11,809–15,617), followed by NHBs ($16,506; 95% CI: $15,076–17,936), and highest among NHWs ($19,575; 95% CI: $18,614–20,537) (p < 0.0001). In adjusted analyses, compared with NHWs, expenditures were 22.5% lower among NHBs (77.49%; 95% CI: 69.24–86.73; p< 0.0001) and 34.8% lower among Hispanics (65.24%; 95% CI: 56.17–75.76; p< 0.0001). In comparison to NHBs, Hispanics had lower expenditures (84.18%; 95% CI: 71.31–99.39; p=0.0422). Compared with GLP-1 RA users, expenditures were 54.9% lower among non–GLP-1 RA users (45.13%; 95% CI: 41.38–49.22; p< 0.0001) and 57.2% lower among those who are not using any antidiabetic medication (42.78%; 95% CI: 36.41–50.26; p< 0.0001). Higher THEs were also significantly associated with unemployment, physical inactivity, greater comorbidity burden, and longer duration of diabetes. Significantly lower expenditures were observed among uninsured adults and those living in the South or West compared with the Northeast. Among GLP-1 RA users, adjusted THEs were significantly 73.81% (95% CI: 61.87–88.05; p=0.0008) lower for Hispanics compared with NHWs (73.81%; 95% CI: 61.87–88.05; p=0.0008), while no significant difference was observed between Hispanics and NHBs or between NHBs and NHWs.

Conclusions: : THEs were lowest in Hispanics, higher in NHBs, and highest in NHWs; notable racial differences persisted, with Hispanics incurring significantly lower expenditures than NHWs among GLP-1 users.

Sponsorship:: None.