Socioeconomic factors and out-of-pocket healthcare spending among older adults with hypertension and type 2 diabetes in the US: findings from the 2018–2022 MEPS data

Abstract Background Type 2 diabetes and hypertension often co-occur significantly, adding to patients’ healthcare economic expenditure, especially among older adults. This study examined socioeconomic factors associated with annual combined total out-of-pocket (OOP) healthcare expenditures for type 2 diabetes and hypertension among adults aged 50 years and older with co-occurring hypertension and diabetes in the United States. Method This secondary data analysis used pooled, nationally representative data from the 2018–2022 Medical Expenditure Panel Survey (MEPS) and focused on U.S. adults aged 50 years and older with type 2 diabetes and hypertension. The outcome variable was the combined annual OOP cost for both type 2 diabetes and hypertension among patients with both conditions. Covariates include age, gender, race/ethnicity, insurance coverage (e.g., Medicare, Medicaid/TRICARE, private, or more than one insurance type), annual family income, region, employment status, education, marital status, perceived general health, and perceived mental health. Because the outcome variable was right-skewed, we performed a logarithmic transformation to normalize the OOP cost variable. We then applied a survey weighted linear regression model (with the log-transformed outcome) to examine the relationship between sociodemographic variables and the combined OOP medical expenditures. The model accounted for the complex sampling design of the MEPS data, including stratification, clustering, weighting structure, and inflation adjustments (reported in December 2022 U.S. dollars using the Consumer Price Index [CPI] Inflation Calculator). All analyses were conducted using SAS 9.4. Results We included 7,341 individuals with both conditions. The average weighted annual OOP costs among adults with both conditions were $474.95, $413.16 for diabetes specific expenditures, and $84.37 for hypertension specific expenditures. Adults residing in the Northeast who were aged 65 years and older, non-Hispanic White, married, had higher income, had a high school education or higher, reported poor perceived health status, and were either uninsured or had private insurance had significantly higher odds of higher OOP costs. Conclusions These findings underscore the complex interplay of health status, socioeconomic factors, and insurance coverage in driving differences in annual OOP healthcare expenditures among adults aged 50 and older with both hypertension and type 2 diabetes in the United States.