Abstract 30: Association of Cardiovascular Risk Factor Profile with Financial Hardship from Medical Bills and Other Cost-Related Barriers to Care Among US Non-Elderly Adults: The National Health Information Survey 2013-2017

Abstract

Background: Atherosclerotic cardiovascular disease (ASCVD) remains a nation-wide crisis. Optimal cardiovascular risk factor (CRF) profile has been associated with lower mortality and morbidity, as well as lower healthcare expenditure and resource utilization. In this study, we examined the association of optimal CRF profile to financial hardship and other cost-related barriers to care, both with and without ASCVD. Methods: We used a nationally representative sample of non-elderly adults aged between 18-64 years from the National Health Interview Survey (2013-2017). We assessed atherosclerotic cardiovascular disease (ASCVD) status, CRF profile, financial hardship from medical bills, unable to pay bill at all, cost-related medication non-adherence, forgone/delayed care, and perceived financial distress from self-reported questionnaire. Results: A total of 119,388 individuals were included in the study. Individuals with ASCVD had financial hardship and inability to pay bills at 45% and 19%, respectively, significantly higher than those without ASCVD and optimal CRF profile at 24% and 6%, respectively. Similarly, the prevalence of other cost-related barriers to care was significantly higher among ASCVD (>2-fold) compared to non-ASCVD with optimal CRF profile. Individuals without ASCVD and optimal CRF profile among low/poor income and uninsured had higher prevalence of all the outcomes when compared to ASCVD among high income and insured. Individuals without ASCVD and optimal CRF profile had lowest odds of financial hardship (OR 0.44, 95% CI 0.41, 0.48), inability paying bills (OR 0.30, 95% CI 0.26, 0.34), cost-related medication non-adherence (OR 0.42, 95% CI 0.38, 0.48), foregone/delayed care (OR 0.41, 95% CI 0.37, 0.45), and high financial distress (OR 0.52, 95% CI 0.47, 0.58) (Table). There were no significant differences in these outcomes when comparing individuals without ASCVD and poor CRF profile to those with ASCVD. Conclusion: Optimal CRF profile is strongly associated with lower prevalence of financial hardship and other cost-related barriers to care. Upfront investment of preventive health programs, especially among vulnerable populations, may improve overall health and decrease financial hardship.