Prevalence, severity and predictors of financial toxicity among people with diabetes in the United States

Abstract Background Financial Toxicity (FT) is a construct increasingly utilised to measure the distress associated with the incurrence of medical care-related costs. Although it has been extensively studied in cancer therapy, its application to chronic diseases like diabetes is presently limited. Aims This study examined the experience of FT among type 1 (T1DM) and type 2 (T2DM) diabetes mellitus patients in the United States of America (USA/US) using the Comprehensive Score for financial Toxicity (COST). It also looked at the factors associated with both vulnerability to FT and its severity. Methods A total of 337 diabetes patients completed an online cross-sectional survey (July 2024) using the COST questionnaire, a validated instrument for measuring FT. Logistic regression and ordered logistic regression analyses were conducted, separately for each diabetes type, to evaluate the relationships between FT and covariates. Covariates included sex, income, employment status, marital status, living arrangement, insurance status, and residence in Affordable Care Act (ACA) Medicaid expansion versus non-expansion states. Results The prevalence of FT was significantly higher in the T2DM group compared to the T1DM group (77.45% vs. 56.86%, respectively, p < 0.001). The odds that a T2DM patient experienced FT was 2.61 times higher than the odds of a T1DM patient (crude OR = 2.61, 95% CI 1.58–4.28). With respect to covariates, distinct patterns emerged across models, indicating that factors associated with the likelihood of FT differ across diseases. Socio-economic variables, including income, living arrangement and insurance status, were significant predictors of FT. Conclusion A distinct patterning of FT is evident among those with T1DM and those with T2DM indicating that the findings are consistent with the COST instrument’s ability to detect variations across different patient populations. FT was more prevalent and more severe among those with T2DM, and the role of financial vulnerability was more readily discernible here. Further research with respect to both groups and the factors that impact experience of FT is warranted.