TY - JOUR
T1 - Financial Hardship Among Nonelderly Adults With CKD in the United States
AU - Acquah, Isaac
AU - Valero-Elizondo, Javier
AU - Javed, Zulqarnain
AU - Ibrahim, Hassan N.
AU - Patel, Kershaw V.
AU - Ryoo Ali, Hyeon Ju
AU - Menser, Terri
AU - Khera, Rohan
AU - Cainzos-Achirica, Miguel
AU - Nasir, Khurram
N1 - Funding Information:
Dr Nasir is on the advisory board of Amgen, Novartis, Medicine Company, and his research is partly supported by the Jerold B. Katz Academy of Translational Research. The other authors declare that they have no relevant financial interests.
Publisher Copyright:
© 2021 National Kidney Foundation, Inc.
PY - 2021/11
Y1 - 2021/11
N2 - Rationale & Objective: The burden of financial hardship among individuals with chronic kidney disease (CKD) has not been extensively studied. Therefore, we describe the scope and determinants of financial hardship among a nationally representative sample of adults with CKD. Study Design: Cross-sectional. Setting & Participants: Nonelderly adults with CKD from the 2014-2018 National Health Interview Survey. Exposure: Sociodemographic and clinical characteristics. Outcome: Financial hardship based on medical bills and consequences of financial hardship (high financial distress, food insecurity, cost-related medication nonadherence, delayed/forgone care due to cost). Financial hardship was categorized into 3 levels: no financial hardship, financial hardship but able to pay bills, and unable to pay bills at all. Financial hardship was then modeled in 2 different ways: (1) any financial hardship (regardless of ability to pay) versus no financial hardship and (2) inability to pay bills versus no financial hardship and financial hardship but able to pay bills. Analytical Approach: Nationally representative estimates of financial hardship from medical bills were computed. Multivariable logistic regression models were used to examine the associations of sociodemographic and clinical factors with the outcomes of financial hardship based on medical bills. Results: A total 1,425 individuals, representing approximately 2.1 million Americans, reported a diagnosis of CKD within the past year, of whom 46.9% (95% CI, 43.7%-50.2%) reported experiencing financial hardship from medical bills; 20.9% (95% CI, 18.5%-23.6%) reported inability to pay medical bills at all. Lack of insurance was the strongest determinant of financial hardship in this population (odds ratio, 4.06 [95% CI, 2.18-7.56]). Limitations: Self-reported nature of CKD diagnosis. Conclusions: Approximately half the nonelderly US population with CKD experiences financial hardship from medical bills that is associated strongly with lack of insurance. Evidence-based clinical and policy interventions are needed to address these hardships.
AB - Rationale & Objective: The burden of financial hardship among individuals with chronic kidney disease (CKD) has not been extensively studied. Therefore, we describe the scope and determinants of financial hardship among a nationally representative sample of adults with CKD. Study Design: Cross-sectional. Setting & Participants: Nonelderly adults with CKD from the 2014-2018 National Health Interview Survey. Exposure: Sociodemographic and clinical characteristics. Outcome: Financial hardship based on medical bills and consequences of financial hardship (high financial distress, food insecurity, cost-related medication nonadherence, delayed/forgone care due to cost). Financial hardship was categorized into 3 levels: no financial hardship, financial hardship but able to pay bills, and unable to pay bills at all. Financial hardship was then modeled in 2 different ways: (1) any financial hardship (regardless of ability to pay) versus no financial hardship and (2) inability to pay bills versus no financial hardship and financial hardship but able to pay bills. Analytical Approach: Nationally representative estimates of financial hardship from medical bills were computed. Multivariable logistic regression models were used to examine the associations of sociodemographic and clinical factors with the outcomes of financial hardship based on medical bills. Results: A total 1,425 individuals, representing approximately 2.1 million Americans, reported a diagnosis of CKD within the past year, of whom 46.9% (95% CI, 43.7%-50.2%) reported experiencing financial hardship from medical bills; 20.9% (95% CI, 18.5%-23.6%) reported inability to pay medical bills at all. Lack of insurance was the strongest determinant of financial hardship in this population (odds ratio, 4.06 [95% CI, 2.18-7.56]). Limitations: Self-reported nature of CKD diagnosis. Conclusions: Approximately half the nonelderly US population with CKD experiences financial hardship from medical bills that is associated strongly with lack of insurance. Evidence-based clinical and policy interventions are needed to address these hardships.
KW - Chronic kidney disease (CKD)
KW - disparities
KW - economic burden
KW - financial distress
KW - financial hardship
KW - food insecurity
KW - forgone medical care
KW - health care costs
KW - health insurance
KW - medical bills
KW - non-elderly
KW - outcomes
KW - socioeconomic status
KW - Cross-Sectional Studies
KW - Humans
KW - Financial Stress
KW - Health Expenditures
KW - Medication Adherence
KW - United States/epidemiology
KW - Renal Insufficiency, Chronic/diagnosis
KW - Adult
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U2 - 10.1053/j.ajkd.2021.04.011
DO - 10.1053/j.ajkd.2021.04.011
M3 - Article
C2 - 34144103
AN - SCOPUS:85111569729
SN - 0272-6386
VL - 78
SP - 658
EP - 668
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -