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Kim D, Manikat R, Wijarnpreecha K, Ahmed A. Financial hardship and cost-related nonadherence to medication in patients with liver disease in the United States. Aliment Pharmacol Ther 2024. [PMID: 38864288 DOI: 10.1111/apt.18122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/05/2024] [Accepted: 06/04/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Economic hardship associated with chronic liver disease (CLD) may delay timely access to healthcare. AIM 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. METHODS 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. RESULTS 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. CONCLUSIONS Financial hardship from medical bills and cost-related nonadherence to medication can negatively impact individuals with CLD and need further evaluation.
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Affiliation(s)
- Donghee Kim
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Richie Manikat
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
| | - Karn Wijarnpreecha
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Banner University Medical Center, Phoenix, Arizona, USA
| | - Aijaz Ahmed
- Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California, USA
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Ufere NN, Serper M, Kaplan A, Horick N, Indriolo T, Li L, Satapathy N, Donlan J, Castano Jimenez JC, Lago-Hernandez C, Lieber S, Gonzalez C, Keegan E, Schoener K, Bethea E, Dageforde LA, Yeh H, El-Jawahri A, Park ER, Vodkin I, Schonfeld E, Nipp R, Desai A, Lai JC. Financial burden following adult liver transplantation is common and associated with adverse recipient outcomes. Liver Transpl 2024:01445473-990000000-00333. [PMID: 38353602 DOI: 10.1097/lvt.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024]
Abstract
The financial impact of liver transplantation has been underexplored. We aimed to identify associations between high financial burden (≥10% annual income spent on out-of-pocket medical costs) and work productivity, financial distress (coping behaviors in response to the financial burden), and financial toxicity (health-related quality of life, HRQOL) among adult recipients of liver transplant. Between June 2021 and May 2022, we surveyed 207 adult recipients of liver transplant across 5 US transplant centers. Financial burden and distress were measured by 25 items adapted from national surveys of cancer survivors. Participants also completed the Work Productivity and Activity Impairment and EQ-5D-5L HRQOL questionnaires. In total, 23% of recipients reported high financial burden which was significantly associated with higher daily activity impairment (32.9% vs. 23.3%, p =0.048). In adjusted analyses, the high financial burden was significantly and independently associated with delayed or foregone medical care (adjusted odds ratio, 3.95; 95% CI, 1.85-8.42) and being unable to afford basic necessities (adjusted odds ratio, 5.12; 95% CI: 1.61-16.37). Recipients experiencing high financial burden had significantly lower self-reported HRQOL as measured by the EQ-5D-5L compared to recipients with low financial burden (67.8 vs. 76.1, p =0.008) and an age-matched and sex-matched US general population (67.8 vs. 79.1, p <0.001). In this multicenter cohort study, nearly 1 in 4 adult recipients of liver transplant experienced a high financial burden, which was significantly associated with delayed or foregone medical care and lower self-reported HRQOL. These findings underscore the need to evaluate and address the financial burden in this population before and after transplantation.
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Affiliation(s)
- Nneka N Ufere
- Department of Medicine, Gastrointestinal Division, Liver Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Marina Serper
- Department of Medicine, Division of Gastroenterology & Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Alyson Kaplan
- Department of Medicine, Tufts Abdominal Transplant Institute, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Nora Horick
- Department of Statistics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Teresa Indriolo
- Department of Medicine, Gastrointestinal Division, Liver Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lucinda Li
- Department of Medicine, Gastrointestinal Division, Liver Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nishant Satapathy
- University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA
| | - John Donlan
- Harvard Medical School, Boston, Massachusetts, USA
| | - Janeth C Castano Jimenez
- Department of Medicine, Division of Gastroenterology & Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Carlos Lago-Hernandez
- Department of Medicine, Division of Hospital Medicine, University of California San Diego, La Jolla, California, USA
| | - Sarah Lieber
- Department of Medicine, Division of Digestive and Liver Diseases, University of Texas Southwestern (UTSW) Medical Center, Dallas, Texas, USA
| | - Carolina Gonzalez
- Department of Social Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Eileen Keegan
- Department of Social Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kimberly Schoener
- Department of Social Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Emily Bethea
- Department of Medicine, Gastrointestinal Division, Liver Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leigh-Anne Dageforde
- Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Heidi Yeh
- Department of Surgery, Division of Transplantation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Areej El-Jawahri
- Department of Medicine, Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elyse R Park
- Department of Psychiatry, Mongan Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Irine Vodkin
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California, San Diego, California, USA
| | - Emily Schonfeld
- Department of Medicine, Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, New York, USA
| | - Ryan Nipp
- Department of Medicine, University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, Oklahoma, USA
| | - Archita Desai
- Department of Medicine, Division of Gastroenterology & Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jennifer C Lai
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Francisco, San Francisco, California, USA
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Zhang Y, Pu J, Xie R. From liver to heart: Enhancing the understanding of cardiovascular outcomes in the UK biobank. J Hepatol 2024; 80:e23-e24. [PMID: 37813241 DOI: 10.1016/j.jhep.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 09/01/2023] [Indexed: 10/11/2023]
Affiliation(s)
- Ya Zhang
- The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China Hengyang 421002, China; Department of Hepatobiliary Surgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, 533000, China
| | - Jian Pu
- Department of Hepatobiliary Surgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, 533000, China.
| | - Ruijie Xie
- The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China Hengyang 421002, China; Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 581, 69120 Heidelberg, Germany.
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Ufere NN, Lago-Hernandez C, Alejandro-Soto A, Walker T, Li L, Schoener K, Keegan E, Gonzalez C, Bethea E, Singh S, El-Jawahri A, Nephew L, Jones P, Serper M. Health care-related transportation insecurity is associated with adverse health outcomes among adults with chronic liver disease. Hepatol Commun 2024; 8:e0358. [PMID: 38206200 PMCID: PMC10786597 DOI: 10.1097/hc9.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/07/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Health care-related transportation insecurity (delayed or forgone medical care due to transportation barriers) is being increasingly recognized as a social risk factor affecting health outcomes. We estimated the national burden and adverse outcomes of health care-related transportation insecurity among US adults with chronic liver disease (CLD). METHODS Using the U.S. National Health Interview Survey from 2014 to 2018, we identified adults with self-reported CLD. We used complex weighted survey analysis to obtain national estimates of health care-related transportation insecurity. We examined the associations between health care-related transportation insecurity and health care-related financial insecurity, food insecurity, self-reported health status, work productivity, health care use, and mortality. RESULTS Of the 3643 (representing 5.2 million) US adults with CLD, 267 [representing 307,628 (6%; 95% CI: 5%-7%)] reported health care-related transportation insecurity. Adults with CLD experiencing health care-related transportation insecurity had 3.5 times higher odds of cost-related medication nonadherence [aOR, 3.5; (2.4-5.0)], 3.5 times higher odds of food insecurity [aOR, 3.5; (2.4-5.3)], 2.5 times higher odds of worsening self-reported health status over the past year [aOR, 2.5; (1.7-3.7)], 3.1 times higher odds of being unable to work due to poor health over the past year [aOR, 3.1; (2.0-4.9)], and 1.7 times higher odds of being in a higher-risk category group for number of hospitalizations annually [aOR, 1.7; (1.2-2.5)]. Health care-related transportation insecurity was independently associated with mortality after controlling for age, income, insurance status, comorbidity burden, financial insecurity, and food insecurity [aHR, 1.7; (1.4-2.0)]. CONCLUSIONS Health care-related transportation insecurity is a critical social risk factor that is associated with health care-related financial insecurity, food insecurity, poorer self-reported health status and work productivity, and increased health care use and mortality among US adults with CLD. Efforts to screen for and reduce health care-related transportation insecurity are warranted.
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Affiliation(s)
- Nneka N. Ufere
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos Lago-Hernandez
- Department of Medicine, Division of Hospital Medicine, University of California San Diego, La Jolla, California, USA
| | - Alysa Alejandro-Soto
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tiana Walker
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lucinda Li
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Schoener
- Department of Social Services, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eileen Keegan
- Department of Social Services, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Gonzalez
- Department of Social Services, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Bethea
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Siddharth Singh
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Nephew
- Division of Gastroenterology & Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Patricia Jones
- Department of Medicine, Division of Digestive Health and Liver Services, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marina Serper
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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