Over 4 million US adults with chronic liver disease can be grouped into unique risk groups based on barriers to care

People with chronic liver disease can be categorized into four distinct risk groups based on the different barriers they face in obtaining outpatient care, barriers that increase their odds of requiring hospitalization, a new UCLA study finds.

The findings, to be published November 20 in the peer-reviewed PLOS ONE, point to the need for interventions aimed at reducing possibly avoidable hospitalizations among the highest-risk people with chronic liver disease (CLD). Previous research has found that people with CLD on average need more hospital-based care than those with other chronic diseases.

About 4 million adults in the US have CLD, said Dr. Carrie Wong, assistant professor of medicine in the division of digestive diseases at the David Geffen School of Medicine at UCLA and the study’s lead author.

“We need to address community-based health care barriers, particularly for persons who struggle to establish care, as a potential approach to reduce recurrent hospital use among adults with chronic liver disease in the US,” Wong said.

The researchers used National Health Interview Survey data from 2011 to 2017 to tease out a nationally representative sample of people that self-reported their encounters with barriers in the survey. The timeframe was chosen to capture respondents’ health care experiences after the Affordable Care Act was enacted. They evaluated the risk groups by sociodemographic, health and insurance characteristics to identify salient features of people in each group and to measure their likelihood of needing recurrent care.

Overall the experiences of just over 5000 people were included in the sample which represented about 4.7 million US adults with CLD. They were asked 13 questions such as whether a doctor’s office or clinic did not accept them as a new patient, if they were unable to afford a specialist or obtain prescription medications, or had to delay care due to a lack of transportation.

Based on the results, the researchers categorized people with CLD into four unique risk groups based on the types of barriers they faced: “minimal barriers,” a group comprising 78.1% of the sample and were older, had the lowest proportion with fair or poor health, and fewer economic and social limitations;   “health care unaffordability” (10.7%); “care delays” (6.5%), and “inability to establish care” (4.8%).

The unaffordability group had the most uninsured people, those in the care delay group were mostly insured, and people who were unable to establish care included the most adults under age 65, females, the unemployed, or lived in poverty.

Compared with those with minimal barriers to care, people who were unable to establish care were 85% more likely to need recurrent hospital-based care. In addition, females as well as people with health-related physical limitations were particularly unable to establish care.

The researchers note that the study is a pooled-cross sectional look from which causal inferences cannot be drawn. Other limitations include the researchers’ inability to capture the respondents’ severity of CLD and lack of details about health insurance plans and more recent experiences with health care barriers.

However, “our results can be leveraged in future prioritization efforts that aim to reduce avoidable recurrent acute care among the most vulnerable persons with CLD, particularly those who frequently face organizational barriers at entry to health care,” the researchers write.

Study co-authors are Catherine Crespi, Beth Glenn, Dr. Steven Han, James Macinko, and Roshan Bastani of UCLA.