Abstract 2: Financial Toxicity From Out-of-pocket Annual Health Expenditures in Low-income Adults With Atherosclerotic Cardiovascular Disease in the United States

Abstract

Background: Health insurance is effective in preventing financial hardship from unexpected major healthcare events. However, to determine whether vulnerable patients are adequately protected from longitudinal health care costs, it is also essential to assess the financial impact of cumulative out of-pocket (OOP) healthcare expenses for common chronic conditions like ASCVD, particularly for low-income families. Methods: Using the Medical Expenditure Panel Survey (2006-2015), we assessed the annual inflation-adjusted OOP expenses, inclusive of insurance premiums, for all patients with ASCVD (coronary, cerebral, or peripheral vascular disease). We assessed these expenses at a family-level, i.e. for families with ≥1 members with ASCVD, and compared against annual family incomes. Low-income families were defined by an income <200% of the federal poverty limit. OOP expenses of >20% and >40% of family income defined high, and catastrophic health expenses, respectively. Survey methods were used to obtain national estimates. Results: We identified 22521 adults (≥18y) with ASCVD, represented in 20600 families in MEPS. They correspond to an annual estimated 23 million or 9.9% of US adults, and 21 million or 15% of all US families. Of these, 39% were low-income. The median annual family OOP expenses were $2450 (IQR 725, 5343), and income was $39765 (IQR 19080, 77635). Overall, OOP expenses represented a median 6.4% (IQR: 1.3, 19.1) of income in low-income, and 5.5% (IQR 2.6, 10.4) in mid/high income families. Low-income families had over 3-fold and 9-fold higher odds than mid/high income families of expenses of >20% of income (24.1% vs 8.1%, OR 3.6 [3.2, 4.1]), and >40% of income (11.2% vs 1.4%, OR 9.2 [7.5, 11.2]) (Fig A). While more low-income families gained insurance coverage (90% in 2006 to 93% in 2015), those with insurance had higher rates of OOP expenses than those without insurance (Fig B/C) or any mid/high income insurance subgroups. Conclusion: 1 in 4 low-income families with a member with ASCVD experience a high financial burden, and 1 in 10 experience a catastrophic healthcare expense, even with insurance coverage. Underinsurance of low-income families has improved minimally. To alleviate economic disparities, policy interventions must extend focus to improving the quality of coverage for low-income families.