Background & Aims

We estimated the prevalence of social determinants of health (SDH, food insecurity and social support) in adults with inflammatory bowel diseases (IBD) in the United States and evaluated associations with financial toxicity and healthcare use.

Methods

In the National Health Interview Survey 2015, we identified adults with IBD and estimated the prevalence of food insecurity and/or lack of social support. We evaluated associations with financial toxicity (financial hardship due to medical bills, personal and health-related financial distress, cost-related medication nonadherence, healthcare affordability) and emergency department use.

Results

Of estimated 3.1 million adults with IBD in the US, 42% or estimated 1,277,215 patients with IBD reported at least one negative SDH, with 12% reporting both food insecurity and lack of social support. On multivariable analysis adjusting for age, sex, race, family income and comorbidities, patients with food insecurity were significantly more likely to experience financial hardship due to medical bills (odds ratio [OR], 3.31; 95% CI, 1.48-7.39), financial distress (OR, 6.92; 95% CI, 2.28–21.0) and cost-related medication non-adherence (OR, 8.07; 95% CI, 3.16–20.6). Similarly, patients with inadequate social support were significantly more likely to experience financial hardship due to medical bills (OR, 2.98; 95% CI, 1.56–5.67), financial distress (OR, 3.05; 95% CI, 1.64–5.67) and cost-related medication non-adherence (OR, 2.71; 95% CI, 1.10–6.66). Food insecurity and/or lack of social support was not associated with increased risk of emergency department use.

Conclusions

In an analysis of data from the National Health Interview Survey 2015, we found that 1 in 8 patients with IBD have food insecurity and lack social support, which is associated with higher financial toxicity. Patients with IBD should be assessed for SDH to tailor healthcare delivery and improve population health.

中文翻译：

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食物不安全和社会支持对炎症性肠病患者的财务毒性和医疗保健使用的患病率和影响

背景与目标

我们估计了美国炎症性肠病 (IBD) 成人中健康的社会决定因素（SDH、食品不安全和社会支持）的流行率，并评估了与财务毒性和医疗保健使用的关联。

方法

在 2015 年全国健康访谈调查中，我们确定了患有 IBD 的成年人，并估计了粮食不安全和/或缺乏社会支持的普遍程度。我们评估了与财务毒性（由于医疗费用、个人和健康相关的财务困境、与成本相关的药物不依从性、医疗保健负担能力）和急诊科使用相关的财务问题。

结果

在美国估计有 310 万 IBD 成人中，42% 或估计有 1,277,215 名 IBD 患者报告至少有一次 SDH 阴性，其中 12% 报告粮食不安全和缺乏社会支持。在对年龄、性别、种族、家庭收入和合并症进行调整的多变量分析中，粮食不安全的患者因医疗费用而遭受经济困难的可能性显着增加（优势比 [OR]，3.31；95% CI，1.48-7.39），财务困境（OR，6.92；95% CI，2.28-21.0）和与成本相关的药物不依从性（OR，8.07；95% CI，3.16-20.6）。同样，社会支持不足的患者更有可能因医疗费用（OR，2.98；95% CI，1.56-5.67）、财务困境（OR，3.05；95% CI，1.64-5.67）和成本而经历财务困难相关药物不依从性（OR，2.71；95% CI，1.10–6.66）。

结论

在对 2015 年全国健康访谈调查数据的分析中，我们发现每 8 名 IBD 患者中就有 1 名存在粮食不安全和缺乏社会支持，这与较高的经济毒性有关。应评估 IBD 患者的 SDH 以定制医疗保健服务并改善人群健康。