Ethnic Minorities and Low Socioeconomic Status Patients With Chronic Liver Disease Are at Greatest Risk of Being Uninsured

Abstract

Background Chronic liver disease (CLD) predominantly affects ethnic minorities and socially vulnerable populations, who have high prevalence of risk factors (e.g., suboptimal insurance coverage) predisposing to healthcare disparities. We evaluate prevalence and predictors of uninsured status among CLD adults, and secondarily, how this affects documented immunity or vaccination for hepatitis A virus (HAV) and hepatitis B virus (HBV). Methods Using 2011 - 2018 National Health and Nutrition Examination Survey data, self-reported insurance status was determined among adults with CLD. Prevalence of uninsured status was stratified by patient characteristics and evaluated using multivariable logistic regression models. Prevalence of self-reported completion of vaccination as well as laboratory value-based documented immunity to HAV and HBV was stratified by insurance status. Results Overall, 19.0% of adults with CLD reported having no insurance, which was highest among individuals of Hispanic ethnicity (33.5%), less than high school education (33.7%), and below poverty status (35.3%). On multivariable analyses, significantly lower odds of having any insurance coverage was observed in men, Hispanics, and individuals with lower education and lower household income. Prevalence of documented immunity or vaccination for HAV was low across all insurance categories, ranging from 46.5% to 54.0%. Prevalence of documented immunity or vaccination for HBV was similarly low across all insurance categories, ranging from 24.3% to 40.8%. Conclusion Prevalence of uninsured status among CLD was more than twice the US adult population, and lack of insurance particularly impacted Hispanics and individuals with low education and low household income. Low prevalence of documented immunity or vaccination for HAV and HBV across all insurance categories is concerning.

Increasing prevalence of cirrhosis among insured adults in the United States, 2012–2018

“…Fourth, the data source of this study is limited to commercially and Medicare Advantage insured patients. Though, these findings may not apply to uninsured or Medicaid insured patients, approximately 70% of the US population are enrolled in commercial or Medicare Advantage insurance and captures an important proportion of the US population [ 76 ]. Data on large cohorts of patients with cirrhosis are limited since large, national data repositories of these patients currently do not exist.…”

Epidemiologic and socioeconomic factors impacting hepatitis B virus and related hepatocellular carcinoma

“…While Hepatitis B viral load is considered one of the strongest predictors of HCC risk and can be managed with anti-viral medications, unfortunately, even in low-risk regions such as United States, roughly 3% of people currently living with chronic HBV are on treatment[ 14 , 21 ]. Several studies have shown the impact of socioeconomic status (SES) on health outcomes in cancer with populations of lower SES and less wealthy nations having significantly lower survival rates[ 32 , 59 - 61 ]. One retrospective analysis of European nations found nearly 20% variation in all-cancer relative survival between the least wealthy and most wealthy nations[ 61 ].…”