Approximately 21.9% of U.S. adults with chronic liver disease may experience health care barriers, with those unable to establish care showing an 85% higher likelihood of recurrent acute care use, according to a recent study.

In the study, published in PLoS ONE, population-based study identified four distinct risk groups among U.S. adults with chronic liver disease (CLD), revealing significant associations between health care barriers and recurrent acute care use. Using data from the 2011 to 2017 National Health Interview Survey, investigators analyzed responses from 5,062 adults, representing an estimated 4.7 million participants with CLD.

Latent class analysis revealed four groups: minimal barriers (78.1%), unaffordability (10.7%), care delays (6.5%), and inability to establish care (4.8%). Participants in the unaffordability group had the highest uninsured rate (38.9%), whereas the care delays group was predominantly insured (93.1%) but experienced barriers such as delayed appointments (90.1%). The inability-to-establish-care group reported the highest prevalence of unemployment (70.6%), poverty (35.3%), and functional limitations (84.6%).

The likelihood of recurrent acute care use was highest in the inability-to-establish-care group (adjusted odds ratio [OR] = 1.85, 95% confidence interval [CI] = 1.23–2.79), followed by the care delays group (adjusted OR = 1.50, 95% CI = 1.07–2.11) and the unaffordability group (adjusted OR = 1.48, 95% CI = 1.11–1.97). Publicly insured participants within these groups demonstrated the greatest risk of recurrent acute care utilization.

The study's limitations included its cross-sectional design, which precluded causal inferences, and the inability to determine the causes or severity of CLD. Additionally, the study lacked detailed insurance plan information, used data from a period that did not reflect more recent health care barriers, and was limited to community-dwelling participants aware of their CLD diagnosis, excluding institutionalized or undiagnosed populations.

Addressing health care barriers, particularly organizational challenges in accessing care, may help reduce recurrent acute care use. Interventions to improve provider availability for public insurance plans and reduce unaffordability could help reduce disparities in this population. The study highlighted the need to prioritize subgroups with significant health care barriers to improve outcomes for participants with CLD.

Full disclosures can be found in the published study.