Wong Carrie R, Crespi Catherine M, Glenn Beth, May Folasade P, Han Steven-Huy B, Bastani Roshan, Macinko James A
Vatche and Tamar Manoukian Division of Digestive Diseases, Department of Medicine, University of California, Los Angeles, Los Angeles, California.
Kaiser Permanente Center for Health Equity, University of California, Los Angeles, Los Angeles, California.
Gastro Hep Adv. 2024 May 17;3(6):796-808. doi: 10.1016/j.gastha.2024.05.004. eCollection 2024.
The extent of healthcare barriers and its association with acute care use among adults with chronic liver disease (CLD) relative to other chronic conditions remains understudied. We compared the probability of barriers and recurrent acute care use among persons with CLD and persons with chronic obstructive pulmonary disease (COPD) and/or cardiovascular disease (CVD).
We assembled a population-based, cross-sectional study using pooled self-reported National Health Interview Survey data (2011-2017) among community-dwelling persons. Probability of barriers by disease group (CLD vs COPD/CVD) was assessed using hurdle negative binomial regression.
The sample included 47,037 adults (5062 with CLD, 41,975 with COPD/CVD). The CLD group was younger (median age 55 vs 62 years) and included more Hispanics (17.5% vs 8.6%) and persons with poverty (20.1% vs 15.3%) than the COPD/CVD group. More respondents with CLD vs COPD/CVD reported barriers (44.7% vs 34.4%), including unaffordability (27.5% vs 18.8%), transportation-related (6.1% vs 4.1%), and organizational barriers at entry to (17.6% vs 13.0%) and within healthcare (19.5% vs 14.2%). While adults with CLD were more likely to experience at least 1 barrier (adjusted incident rate ratio, 1.12 [1.01-1.24], = .03), they were not associated with more (1.05 [1.00-2.71], = .06). Probability of recurrent acute care use was associated with more healthcare barriers.
Findings from this nationally representative sample of over 43 million US adults reveal that persons with CLD have increased probability of healthcare barriers, likely related to their higher prevalence of socioeconomic vulnerabilities compared to persons with COPD/CVD. CLD warrants attention as a priority condition in public policies that direct resources towards high-risk populations.
相对于其他慢性疾病，慢性肝病（CLD）成人患者的医疗保健障碍程度及其与急性护理使用的关联仍未得到充分研究。我们比较了CLD患者与慢性阻塞性肺疾病（COPD）和/或心血管疾病（CVD）患者面临障碍和反复使用急性护理的可能性。
我们利用全国健康访谈调查（2011 - 2017年）汇总的自我报告数据，对社区居住人群进行了一项基于人群的横断面研究。使用障碍负二项回归评估疾病组（CLD与COPD/CVD）面临障碍的可能性。
样本包括47,037名成年人（5062名CLD患者，41,975名COPD/CVD患者）。与COPD/CVD组相比，CLD组更年轻（中位年龄55岁对62岁），西班牙裔比例更高（17.5%对8.6%），贫困人群比例更高（20.1%对15.3%）。与COPD/CVD患者相比，更多CLD患者报告了障碍（44.7%对34.4%），包括费用负担不起（27.5%对18.8%）、交通相关障碍（6.1%对4.1%）以及就医时（17.6%对13.0%）和医疗过程中的组织障碍（19.5%对14.2%）。虽然CLD成人患者更有可能至少经历一种障碍（调整后的发病率比为1.12[1.01 - 1.24]，P = 0.03），但他们与更多障碍并无关联（1.05[1.00 - 2.71]，P = 0.06）。反复使用急性护理的可能性与更多的医疗保健障碍相关。
来自这个具有全国代表性的超过4300万美国成年人样本的研究结果表明，与COPD/CVD患者相比，CLD患者面临医疗保健障碍的可能性增加，这可能与其社会经济脆弱性患病率较高有关。在将资源导向高危人群的公共政策中，CLD应作为优先关注的疾病。
