According to the data from the investigation in some rural areas in Huaian, we analyzed the risk and related factors of catastrophic health expenditure of families with diabetic patients in rural areas, and calculated the inequality of catastrophic health expenditure by using concentration index. Families with diabetes in rural areas of Jiangsu Province had a relatively higher risk of catastrophic health expenditure which was more inclined to the low?income families. The lower the income of diabetic families in rural areas of Jiangsu Province, the higher the incidence and intensity of catastrophic health expenditure, which indicated that catastrophic health expenditures was unequal and easy to happen to the poor. Therefore, the government should improve the medical insurance system in rural areas to provide certain economic risk protection for diabetic families in rural areas, and reduce the economic burden of disease.