OBJECTIVE To update state-specific estimates of diabetes-attributable costs in the U.S. and assess changes in spending from 2013 to 2021. RESEARCH DESIGN AND METHODS We used an attributable fraction approach to estimate direct medical costs of diagnosed diabetes using the 2021 State Health Expenditure Accounts, the 2021 Behavioral Risk Factor Surveillance System, and the Centers for Medicare and Medicaid Services 2018–2019 Minimum Data Set. We estimated diabetes-attributable productivity losses from morbidity and mortality using the 2016–2021 National Health Interview Survey and the 2021 mortality data from the Centers for Disease Control and Prevention. Costs were adjusted to 2021 U.S. dollars. RESULTS Total diabetes-attributable cost in 2021 was $640 billion ($335 billion in direct medical costs and $305 billion in indirect costs). The median state-level total diabetes-attributable cost was $8.2 billion (range $842 million to $81 billion). The median state-level per-person cost was $21,082, ranging from $17,452 to $37,090. Total diabetes-attributable cost increased by a median of 33% between 2013 and 2021, ranging from 16 to 68% across states. Medical costs increased by 50% overall (range 33–79%) and by 27% (range 15–41%) for per person with diabetes. Costs paid by Medicaid experienced the highest increase between 2013 and 2021 (median 153%; range 41–483%). CONCLUSIONS State economic costs of diagnosed diabetes are substantial and increased over the last decade. These costs and their growth vary considerably across states. These findings may help state policy makers in developing evidenced-based public health interventions in their respective states to prevent and control the prevalence of diabetes.

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美国各州和哥伦比亚特区因确诊糖尿病而造成的经济成本：2021 年


目标 更新美国各州糖尿病归因成本的估计，并评估 2013 年至 2021 年支出的变化。 研究设计和方法 我们使用 2021 年州卫生支出账户，采用归因分数法来估计诊断糖尿病的直接医疗成本、2021 年行为风险因素监测系统以及医疗保险和医疗补助服务中心 2018-2019 年最低数据集。我们利用 2016-2021 年全国健康访谈调查和疾病控制与预防中心的 2021 年死亡率数据，估计了糖尿病导致的发病率和死亡率造成的生产力损失。成本调整为2021美元。结果 2021 年糖尿病造成的总成本为 6400 亿美元（直接医疗成本 3350 亿美元，间接成本 3050 亿美元）。州级糖尿病总成本中位数为 82 亿美元（范围为 8.42 亿至 810 亿美元）。州级人均费用中位数为 21,082 美元，从 17,452 美元到 37,090 美元不等。 2013 年至 2021 年间，糖尿病引起的总成本中位数增加了 33%，各州的增幅从 16% 到 68% 不等。糖尿病患者的医疗费用总体增加了 50%（范围 33-79%），人均医疗费用增加了 27%（范围 15-41%）。 2013 年至 2021 年间，医疗补助支付的费用增幅最大（中位数 153%；范围 41-483%）。结论 确诊糖尿病给国家带来的经济成本是巨大的，并且在过去十年中有所增加。这些成本及其增长在各州之间差异很大。这些发现可能有助于州政策制定者在各自州制定基于证据的公共卫生干预措施，以预防和控制糖尿病的患病率。