Financial Hardship Among Nonelderly Adults With CKD in the United States.

Abstract

RATIONALE OBJECTIVE\nThe burden of financial hardship among individuals with CKD has not been extensively studied. Therefore, we aimed to describe the scope and determinants of financial hardship among a nationally representative sample of adults with CKD.\n\n\nSTUDY DESIGN\nCross-sectional.\n\n\nSETTING\n& Participants: Non-elderly adults with CKD from the 2014-2018 National Health Interview Survey.\n\n\nEXPOSURE\nSociodemographic and clinical characteristics.\n\n\nOUTCOMES\nFinancial hardship based on medical bills and consequences of financial hardship (high financial distress, food insecurity, cost-related medication non-adherence, 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 two different ways: a) any financial hardship (regardless of ability to pay) vs no financial hardship and b) inability to pay bills vs no financial hardship and financial hardship but able to pay bills.\n\n\nANALYTIC APPROACH\nNationally 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.\n\n\nRESULTS\nA 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 (OR=4.06 [95% CI, 2.18-7.56]).\n\n\nLIMITATIONS\nSelf-reported nature of CKD diagnosis.\n\n\nCONCLUSION\nApproximately half of the non-elderly 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.