肝脏疾病带来重大的发病率和死亡率，可能导致经济困难（即医疗保健经济负担和可及性问题），但长期的国家级数据有限。我们利用2004至2018年的国家健康采访调查，根据患病和其他与死亡有关的慢性病情况对成年人进行分类，并与国家死亡指数相关的数据进行。我们估计了报告医疗保健经济负担和可及性问题的成年人的年龄调整比例。通过多变量 logistic 回归和 Cox 回归，分别评估了肝脏疾病与经济困难以及经济困难与全因死亡率之间的关联。在肝脏疾病（N=19,407）、无肝脏疾病（N=996,352）、癌症史（N=37,225）、肺气肿（N=7,937）和冠状动脉疾病（N=21,510）的成年人中，按年龄调整的医疗服务和药物经济负担问题的比例分别为：医疗服务：29.9%（95%CI：29.7-30.1%）对 18.1%（18.0-18.3%）；26.5%（26.3-26.7%）；42.2%（42.1-42.4%）；31.6%（31.5-31.8%）；药物：15.5%（15.4-15.6%）对8.2%（8.1-8.3%）；14.8%（14.7-14.9%）；26.1%（26.0-26.2%）；20.6%（20.5-20.7%）。在多变量分析中，肝脏疾病（与无肝脏疾病、癌症史、肺气肿、冠状动脉疾病相比）与无法负担医疗服务[aOR：1.84（1.77-1.92）；1.32（1.25-1.40）；0.91（0.84-0.98）；1.11（1.04-1.19）]和药物[aOR：1.92（1.82-2.03）；1.24（1.14-1.33）；0.81（0.74-0.90）；0.94（0.86-1.02）]、医疗护理延迟[aOR：1.77（1.69-1.87）；1.14（1.06-1.22）；0.88（0.79-0.97）；1.05（0.97-1.14）]以及未接受必要的医疗服务 [aOR：1.86（1.76-1.96）；1.16（1.07-1.26）；0.89（0.80-0.99）；1.06（0.96-1.16）] 相关联。在肝脏疾病患者中，经济困难（与未经济困难者相比）与全因死亡率升高[aHR：1.24（1.01-1.53）]有相关性。肝病成年人面临着比未患肝病、罹患癌症史的成年人更严重的经济困难。肝病成年人的经济困难与全因死亡风险增加有关。应优先考虑改善这一人群中医疗保健的经济负担。Copyright © 2023 European Association for the Study of the Liver 。Elsevier B.V. 版权所有。

Liver disease carries substantial morbidity and mortality, likely incurring financial distress (ie, healthcare affordability and accessibility issues), though long-term national-level data are limited.Using the National Health Interview Survey from 2004-2018, we categorized adults based on report of liver disease and other chronic conditions linked to mortality data from the National Death Index. We estimated age-adjusted proportions of adults reporting healthcare affordability and accessibility issues. Multivariable logistic regression and Cox regression assessed the association of liver disease with financial distress and financial distress with all-cause mortality, respectively.Among adults with liver disease (N=19,407) vs without liver disease (N=996,352); vs cancer history (N=37,225); vs emphysema (N=7,937); vs coronary artery disease (N=21,510), the age-adjusted proportion reporting healthcare affordability issues for medical services was: 29.9% (95%CI: 29.7-30.1%) vs 18.1%(18.0-18.3%); 26.5%(26.3-26.7%); 42.2%(42.1-42.4%); 31.6%(31.5-31.8%) and for medications: 15.5%(15.4-15.6%) vs 8.2%(8.1-8.3%); 14.8%(14.7-14.9%); 26.1%(26.0-26.2%); 20.6%(20.5-20.7%). In multivariable analysis, liver disease (vs without liver disease; vs cancer history; vs emphysema; vs coronary artery disease) was associated with inability to afford medical services [aOR: 1.84(1.77-1.92); 1.32(1.25-1.40); 0.91(0.84-0.98); 1.11(1.04-1.19)] and medications [aOR: 1.92(1.82-2.03); 1.24(1.14-1.33); 0.81(0.74-0.90); 0.94(0.86-1.02)], delays in medical care [aOR: 1.77(1.69-1.87); 1.14(1.06-1.22); 0.88(0.79-0.97); 1.05(0.97-1.14)], and not receiving needed medical care [aOR: 1.86(1.76-1.96); 1.16(1.07-1.26); 0.89(0.80-0.99); 1.06(0.96-1.16)]. In multivariable analysis, among adults with liver disease, financial distress (vs. without financial distress) was associated with increased all-cause mortality [aHR: 1.24(1.01-1.53)].Adults with liver disease face greater financial distress than adults without liver disease, adults with cancer history. Financial distress is associated with increased risk of all-cause mortality among adults with liver disease. Interventions to improve healthcare affordability should be prioritized in this population.Copyright © 2023 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.