Abstract

Background: The relative prevalence of health care barriers for patients with CLD vs. those with non-CLD chronic diseases and the cumulative effect of these barriers on recurrent acute care use remains unknown. We aimed to assess the number of health care barriers and their association with acute care use by CLD vs. chronic obstructive pulmonary disease (COPD) and/or cardiovascular disease (CVD).

Methods: We performed a pooled cross-sectional study using data from the National Health Interview Survey from 2011 to 2017 and applied weight adjustments to yield nationally representative estimates. In-person surveys provided self-reports on sociodemographic, health, and health care characteristics. Health care barriers (from organizational, financial, transportation domains) were measured as a count of all reported barriers (ranging from 0 to 13). Acute care use was defined as ≥2 hospitalizations and/or emergency department visits in the past year. We performed descriptive statistics (χ², Wald test), multivariable regression analyses (negative binomial, logistic regression), and estimated predicted probabilities from these models.

Results: The sample included 47,037 adults (5,062 CLD vs. 41,975 COPD/CVD) which provided weighted estimates for 43,264,685 persons (4,742,444 CLD vs. 38,522,241 COPD/CVD). The CLD group was younger (median age 55 vs. 62 years), had more Hispanics (17.5% vs. 8.6%), fair/poor health (41.4% vs. 33.3%), less than high school education (7.2% vs. 6.5%), poverty (20.1 vs. 15.3%), material hardship (29.5% vs. 21.5%), and public insurance (23.6% vs. 15.7%) than the COPD/CVD group (p<.001). The prevalence of health care barriers for CLD was 1.29 times greater compared to COPD/CVD after adjusting for age, sex, region, and year (incident rate ratio 1.29, 95% CI 1.22-1.37, p<.001). Adjusted odds of acute care use were 1.36 (95% CI 1.23-1.50, p<.001) times greater for CLD vs. COPD/CVD. Probability of acute care use increased with greater health care barriers (0.19-0.81 for CLD, 0.15-0.76 for COPD/CVD) and the differences between CLD and COPD/CVD were consistent across the distribution (Figure).

Conclusion: Our findings from a national sample representative of over 43 million US adults revealed that those with CLD (vs. other common chronic conditions COPD/CVD) have a higher prevalence of health care barriers, which was in turn associated with increased probability of acute care use. These disparities in health care accessibility and utilization are attributable to both characteristics of US adults with CLD and their ability to access appropriate and timely medical care.