Enrollment in High-Deductible Health Plans and Incident Diabetes Complications
Authors' conclusion
This study found that an employer-driven switch to an HDHP was associated with increased odds of experiencing all diabetes complications. These findings reinforce the potential harm associated with HDHPs for people with diabetes and the importance of affordable and accessible chronic disease management, which is hindered by high out-of-pocket costs incurred by HDHPs.
Study context
- Population
- US adults with diabetes enrolled in employer-sponsored health plans, 2010–2019; HDHP switch mean age 52 years, 46.7% female; non-HDHP mean age 53 years, 44.3% female
- Participants
- 42,326 vs 202,729
- Exposure
- Employer-required switch to an HDHP vs continuous non-HDHP enrollment
- HDHP switchn = 42,326
- Non-HDHPn = 202,729reference
- Outcome
- Odds of each diabetes complication: MI, stroke, hospitalization for HF, lower-extremity complication, end-stage kidney disease, proliferative retinopathy, treatment for retinopathy, blindness
Methodological detailsadministrative claims data, inverse propensity score weighting, mixed-effects logistic regression
- Administrative claims data
- Inverse propensity score weighting
- Mixed-effects logistic regression
Main finding
As reported in the abstract
Incident diabetes complications
HDHP switch vs Non-HDHPOdds ratio (95% CI)
MI
1.11(1.06–1.16)
Stroke
1.15(1.09–1.21)
Hospitalization for HF
1.35(1.30–1.41)
End-stage kidney disease
2.53(2.38–2.70)
Lower-extremity complication
2.23(2.17–2.29)
Proliferative retinopathy
1.17(1.13–1.21)
Blindness
2.35(2.18–2.54)
Retinopathy treatment
2.28(2.15–2.41)
Observational data: associations, not effects.
Original publication
Enrollment in High-Deductible Health Plans and Incident Diabetes Complications. JAMA Netw Open. Published 4 March 2024. doi:10.
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