{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T17:54:47Z","timestamp":1781805287892,"version":"3.54.5"},"reference-count":23,"publisher":"American Diabetes Association","issue":"1","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"vor","delay-in-days":19,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Individuals with diabetes face substantial health-related financial burdens, but a comprehensive understanding of these burdens remains limited. This study compared the prevalence of health care financial hardship among nonelderly adults by diabetes status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>We conducted a cross-sectional analysis using data from the 2018\u20132022 Medical Expenditure Panel Survey, including 67,782 adults aged 18\u201364 years. Diabetes status was self-reported. Financial hardship was measured by three indicators: high out-of-pocket cost burden, medical debt, and unaffordability of care. We calculated the prevalence of single indicators and concurrent indicators. We also compared the prevalence of financial hardships between individuals with and without diabetes across income levels and insurance coverages.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The study sample included 6,091 individuals with diabetes and 61,691 individuals without diabetes. Nonelderly adults with diabetes experienced significantly higher rates of financial hardship than those without. Specifically, 40.3% (95% CI 38.4\u201342.3) of individuals with diabetes reported at least one form of financial hardship, compared with 28.1% (95% CI 27.3\u201328.9) of those without diabetes (P &amp;lt; 0.01). Among individuals with diabetes, 13.0% (95% CI 11.6\u201314.5) reported multiple concurrent financial hardships, whereas 5.6% (95% CI 5.3\u20135.9) of those without diabetes reported the same (P &amp;lt; 0.01). Notably, financial hardship was observed not only in economically disadvantaged groups but also among higher-income and privately insured individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>This study highlights widespread health care financial hardships among nonelderly U.S. adults with diabetes compared with those without, affecting all income and insurance groups. Policies to reduce financial challenges are needed for diabetes management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/doc25-0037","type":"journal-article","created":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T22:09:36Z","timestamp":1768946976000},"page":"104-109","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Health Care Financial Hardship Among Nonelderly U.S. Adults by Diabetes Status"],"prefix":"10.2337","volume":"1","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3131-5948","authenticated-orcid":false,"given":"Xilin","family":"Zhou","sequence":"first","affiliation":[{"name":"Division of Diabetes Translation, Centers for Disease Control and Prevention , Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4740-6406","authenticated-orcid":false,"given":"Yu","family":"Wang","sequence":"additional","affiliation":[{"name":"Division of Diabetes Translation, Centers for Disease Control and Prevention , Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Diabetes Translation, Centers for Disease Control and Prevention , Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah B.","family":"Rolka","sequence":"additional","affiliation":[{"name":"Division of Diabetes Translation, Centers for Disease Control and Prevention , Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8429-6301","authenticated-orcid":false,"given":"Ping","family":"Zhang","sequence":"additional","affiliation":[{"name":"Division of Diabetes Translation, Centers for Disease Control and Prevention , Atlanta, GA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"2026061813215327300_B1","unstructured":"Centers for Disease Control and Prevention\n          . National Diabetes Statistics Report, 2024. Accessed 4 August 2025. 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