Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA.
Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA.
Aliment Pharmacol Ther. 2024 Aug;60(4):492-502. doi: 10.1111/apt.18122. Epub 2024 Jun 12.
Economic hardship associated with chronic liver disease (CLD) may delay timely access to healthcare.
To estimate the national burden of financial hardship across the spectrum of CLD in the United States (US) during the coronavirus disease 2019 (COVID-19) pandemic.
A cross-sectional analysis was performed using the 2020-2021 US National Health Interview Survey database. The questionnaire defined financial hardship from medical bills and cost-related nonadherence to medications in patients with CLD. We used weighted survey analysis to obtain the national estimates.
While 6.9% (95% confidence interval [CI]: 6.7%-7.2%) out of 60,689 US adults (weighted sample: 251 million) reported financial hardship and inability to pay medical bills; 10.6% (95% CI: 8.3%-13.4%), 18.2% (95% CI: 14.5%-22.6%), 22.6% (95% CI: 11.0%-41.0%) with hepatitis, CLD/cirrhosis, and liver cancer experienced an inability to pay their medical bills due to financial hardship, respectively. 19.8% (95% CI: 15.9%-24.5%) and 23.3% (95% CI: 12.5%-39.3%) with CLD/cirrhosis and liver cancer, respectively experienced cost-related nonadherence to medications, compared to a tenth of US adults (10.7%, 95% CI: 10.3%-11.2%). CLD/cirrhosis demonstrated an independent association with financial hardship from medical bills and cost-related nonadherence to medications. Overall, these disparities were more pronounced in individuals aged <65 years old. In addition, over 40% of individuals with CLD/cirrhosis reported difficulties accessing medical care during the COVID-19 pandemic. CLD/cirrhosis showed an independent association with difficulties accessing medical care due to COVID-19.
Financial hardship from medical bills and cost-related nonadherence to medication can negatively impact individuals with CLD and need further evaluation.
与慢性肝病（CLD）相关的经济困难可能会延迟及时获得医疗保健的机会。
估计在 2019 冠状病毒病（COVID-19）大流行期间，美国（US）CLD 谱范围内经济困难的国家负担。
使用 2020-2021 年美国国家健康访谈调查数据库进行横断面分析。该问卷从 CLD 患者的医疗账单和与成本相关的药物不依从性方面定义了经济困难。我们使用加权调查分析获得了全国估计数。
在 60689 名美国成年人中（加权样本：2.51 亿），有 6.9%（95%置信区间[CI]：6.7%-7.2%）报告经济困难和无力支付医疗账单；10.6%（95%CI：8.3%-13.4%）、18.2%（95%CI：14.5%-22.6%）、22.6%（95%CI：11.0%-41.0%）患有肝炎、CLD/肝硬化和肝癌，因经济困难无法支付医疗费用。分别有 19.8%（95%CI：15.9%-24.5%）和 23.3%（95%CI：12.5%-39.3%）患有 CLD/肝硬化和肝癌的患者出现药物相关费用不依从，而美国成年人中只有十分之一（10.7%，95%CI：10.3%-11.2%）。CLD/肝硬化与医疗账单相关的经济困难和药物相关费用不依从均有独立关联。总体而言，这些差异在年龄<65 岁的人群中更为明显。此外，超过 40%的 CLD/肝硬化患者在 COVID-19 大流行期间表示难以获得医疗服务。CLD/肝硬化与因 COVID-19 而难以获得医疗服务有独立关联。
医疗账单相关的经济困难和药物相关费用不依从可能会对 CLD 患者产生负面影响，需要进一步评估。
