People with chronic liver disease can be classified into four distinct risk groups, study finds

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

The results, published on November 20 in PLOS ONEhighlight the need for interventions to reduce potentially avoidable hospitalizations among those most at risk with chronic liver disease (CLD).

Previous research has shown that people with CLD need more hospital care on average than those with other chronic illnesses.

About 4 million adults in the United States 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 senior author of the study. .

“We need to remove barriers to community health care, particularly for people who have difficulty obtaining care, as a potential approach to reducing recurrent hospital use among adults with chronic liver disease in the United States “Wong said.

Researchers used National Health Survey data from 2011 to 2017 to determine a nationally representative sample of people who reported experiencing barriers in the survey. The time period was chosen to report respondents’ health care experiences after the enactment of the Affordable Care Act.

They assessed risk groups based on sociodemographic, health, and insurance characteristics to identify salient characteristics of people in each group and measure their likelihood of needing recurrent care.

Overall, the experiences of just over 5,000 people were included in the sample, which represented approximately 4.7 million U.S. adults with CLD. They were asked 13 questions, such as whether a doctor’s office or clinic would not accept them as new patients, whether they could not afford to see a specialist or obtain prescription medications, or whether they had to delay treatment due to lack of transportation.

Based on the results, researchers classified 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 who were older, had the lowest proportion of fair or poor barriers. health and fewer economic and social limitations; “unaffordability of health care” (10.7%); “delays in care” (6.5%) and “inability to establish care” (4.8%).

The unaffordability group had the largest number of uninsured people, those in the care delay group were mostly insured, and those unable to establish care included most adults under 65, women, the unemployed or people living in poverty.

Compared to those with minimal barriers to care, people unable to obtain care were 85% more likely to need recurring hospital care. Additionally, women 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 analysis from which causal inferences cannot be drawn. Other limitations include researchers’ inability to capture respondents’ CLD severity and lack of detail on health insurance plans and more recent experiences with barriers to health care.

However, “our findings can be leveraged in future prioritization efforts aimed at reducing avoidable recurrent acute care among the most vulnerable people with CLD, particularly those who frequently face organizational barriers to entry into care.” health,” write the researchers.

Co-authors of the study are Catherine Crespi, Beth Glenn, Dr. Steven Han, James Macinko and Roshan Bastani of UCLA.