Abstract 157: Assessment of Financial Hardship From Medical Bills Across the Spectrum of Diabetes Mellitus and Atherosclerotic Cardiovascular Disease Among Non-Elderly Adults in the United States

Abstract

Background: Diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD) both increase the risk for experiencing an adverse cardiac event and affected individuals often have large medical expenditures. While prior research has evaluated financial burden associated with acute cardiovascular events and comparative healthcare expenditures between DM and ASCVD, less is known about the expressed financial hardship and inability to pay medical bills for individuals with families on the basis of ASCVD and DM status. Methods: Using data from the National Information Survey between 2013 and 2017, we examined ASCVD/DM status, financial hardship from medical bills, and an inability to pay medical bills at all for a nationally representative sample of non-elderly adults in the United States between 18-64 years of age. Results: Our study population consisted of 121,672 individuals. Approximately 3.1% of the weighted population had ASCVD alone, 5.6% had diabetes alone, and 1.3% had both ASCVD and diabetes mellitus. Nearly 50% of individuals with both ASCVD and DM reported having financial hardship from medical bills (23% being unable to pay medical bills at all) as compared to 28% of those without ASCVD and DM reported financial hardship from medical bills (8% being unable to pay medical bills at all). Individuals having ASCVD concurrently with DM had higher odds of expressing inability to pay medical bills at all when compared to those with DM alone (OR 2.69, 95% CI [2.21, 3.28] vs OR 1.70, 95% CI [1.52, 1.91]) whereas it was not significant when compared to those with ASCVD alone (OR 1.97, 95% CI [1.72, 2.25]). Conclusion: Patients with ASCVD and concurrent DM have much higher risk of financial hardship from medical bills compared to individuals with neither ASCVD nor DM. These findings provide strong evidence for clinicians to address these co-morbidities concurrently, particularly among vulnerable populations with limited financial means, emphasizing the importance of primary and secondary prevention along with appropriate lifestyle and therapeutic management.