We examined how patient age, health status, and IHS total treatment costs varied by diabetes stage. Eight stages were defined based on the presence of hypertension, diabetes, CVD, amputation related procedures, renal disease, and renal failure. The eight stages identified exclusive patient groups.
Persons in Stage 0 had none of the conditions. Stages 1-7 describe the presence or absence of specific conditions. For Stages 1-6, each stage excludes persons in a higher numbered stage. For example, Stage 3. Diabetes and hypertension excludes persons with diabetes and cardiovascular disease (CVD); they are included in Stage 4. However, some of the persons in Stage 4 have hypertension. Stage 7 includes persons with CVD but not diabetes. Some persons in Stage 7 have hypertension, amputation related procedures, and renal disease or renal failure.
Table B.1. shows the distribution by age of persons in each stage. The majority of persons in Stage 0. None of the listed conditions were less than 45 years of age. There were a greater percentage of older adults (i.e., aged 45-64 years and aged 65 years and older) in the higher numbered stages.
Information on the health status, health coverage, and IHS total treatment costs for adults by diabetes stage is provided in Table B.2. Data for children and adolescents were excluded from the table since the majority of children and adolescents were in Stage 0. None of the listed conditions.
Over half of adults in Stages 4-7 had Medicare or Medicaid coverage. While Stage 4 includes persons with diabetes and CVD, three-fourths or more of the adults in Stage 5. Diabetes and amputation or renal disease and Stage 6. Diabetes and renal failure had CVD. Average health risk and IHS total treatment costs increased from Stage 0 to Stage 6. For example, average health risk was 5.7 for Stage 4, 8.8 for Stage 5, and 27.0 for Stage 6.
Table B.1. Patient characteristics by diabetes stage among adults. Fiscal year 2010
| Diabetes stage | All persons a | Age group | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 18 years | 18-44 years | 45-64 years | 65+ years | Adults | ||||||||
| No. | % (col.) | No. | % (col.) | No. | % (col.) | No. | % (col.) | No. | % (col.) | No. | % (col.) | |
| 0. None of the listed conditions | 254,888 | 74.2% | 108,578 | 97.8% | 112,603 | 81.8% | 28,973 | 41.9% | 4,734 | 18.5% | 146,310 | 63.0% |
| 1. Hypertension b | 29,194 | 8.5% | 381 | 0.3% | 10,408 | 7.6% | 13,636 | 19.7% | 4,769 | 18.7% | 28,813 | 12.4% |
| 2. Diabetes alone b | 8,055 | 2.3% | 312 | 0.3% | 4,169 | 3.0% | 2,937 | 4.2% | 637 | 2.5% | 7,743 | 3.3% |
| 3. Diabetes with hypertension b | 19,520 | 5.7% | 48 | 0.0% | 4,920 | 3.6% | 10,767 | 15.6% | 3,785 | 14.8% | 19,472 | 8.4% |
| 4. Diabetes and CVD b | 8,559 | 2.5% | 10 | 0.0% | 870 | 0.6% | 4,063 | 5.9% | 3,616 | 14.2% | 8,549 | 3.7% |
| 5. Diabetes and amputation or renal diseaseb | 4,739 | 1.4% | 5 | 0.0% | 473 | 0.3% | 1,951 | 2.8% | 2,310 | 9.0% | 4,734 | 2.0% |
| 6. Diabetes and renal failureb | 1,418 | 0.4% | 1 | 0.0% | 170 | 0.1% | 718 | 1.0% | 529 | 2.1% | 1,417 | 0.6% |
| 7. CVD (no diabetes) c | 17,109 | 5.0% | 1,730 | 1.6% | 4,067 | 3.0% | 6,165 | 8.9% | 5,147 | 20.2% | 15,379 | 6.6% |
| All persons | 343,482 | 100.0% | 111,065 | 100.0% | 137,680 | 100.0% | 69,210 | 100.0% | 25,527 | 100.0% | 232,417 | 100.0% |
| All persons (row percent) | 343,482 | 100.0% | 111,065 | 32.3% | 137,680 | 40.1% | 69,210 | 20.1% | 25,527 | 7.4% | 232,417 | 67.7% |
a Data for all persons who used services in FY2010 are included in the table except for persons who lived in the two project sites that did not have Indian Health Service or Tribal inpatient services.
b Excludes persons in a higher numbered stage.
c This stage includes some persons with hypertension as well as cardiovascular disease (CVD) yet excludes those with diabetes.
CVD: Cardiovascular disease
Table B.2. Patient characteristics by diabetes stage among adults. Fiscal year 2010.
| Diabetes stage | All adults a | Health coverage | Health status | IHS Total Treatment Costs | |||||
|---|---|---|---|---|---|---|---|---|---|
| Medicaid | Medicare | Medicaid or Medicare |
CVD | Behavioral health | Health risk b | ||||
| No. | % (col.) | % (row) | % (row) | % (row) | % (row) | % (row) | Avg. | Avg. | |
| 0. None of the listed conditions | 146,310 | 63.0% | 26.0% | 5.3% | 30.2% | 0.0% | 17.5% | 1.1 | $2,765 |
| 1. Hypertension c | 28,813 | 12.4% | 14.2% | 21.3% | 32.5% | 0.0% | 29.8% | 2.1 | $4,657 |
| 2. Diabetes alone c | 7,743 | 3.3% | 29.7% | 13.4% | 40.2% | 0.0% | 23.5% | 2.2 | $5,003 |
| 3. Diabetes with hypertension c | 19,472 | 8.4% | 16.5% | 26.0% | 38.6% | 0.0% | 26.4% | 2.6 | $6,288 |
| 4. Diabetes and CVD c | 8,549 | 3.7% | 15.9% | 53.3% | 61.7% | 100.0% | 30.7% | 5.7 | $10,391 |
| 5. Diabetes and amputation or renal disease c | 4,734 | 2.0% | 22.8% | 59.0% | 70.2% | 74.3% | 30.0% | 8.8 | $14,936 |
| 6. Diabetes and renal failure c | 1,417 | 0.6% | 29.4% | 82.1% | 87.8% | 86.7% | 22.7% | 27.0 | $16,260 |
| 7. CVD (no diabetes) d | 15,379 | 6.6% | 18.9% | 41.8% | 53.9% | 100.0% | 30.5% | 5.3 | $9,125 |
| All adultsa | 232,417 | 100.0% | 23.0% | 15.0% | 35.4% | 12.3% | 21.6% | 2.1 | $4,401 |
aData for all persons who used services in FY2010 are included in the table except for persons who lived in the two project sites that did not have Indian Health Service or Tribal inpatient services.
b Health risk is a numeric score that provides an indicator of the health status or morbidity burden of the population. It is also an indicator of the relative amount of resources required to treat patients. Patients with more high-cost acute and chronic conditions have higher risk than those who do not have such conditions. The score is generated by Verisk Risksmart software. It is calibrated to the average health risk of a U.S. commercially insured population (i.e., health risk=1.0).
c Excludes persons in a higher numbered stage.
d This stage includes some persons with hypertension as well as CVD yet excludes those with diabetes.
CVD: Cardiovascular disease
IHS total treatment costs are estimated costs and include spending by Indian Health Service and tribal facilities as well as payments for Contract Health Services.
