{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T09:16:00Z","timestamp":1784279760032,"version":"3.55.0"},"reference-count":15,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T00:00:00Z","timestamp":1718150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Economic hardship associated with chronic liver disease (CLD) may delay timely access to healthcare.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To estimate the national burden of financial hardship across the spectrum of CLD in the United States (US) during the coronavirus disease 2019 (COVID\u201019) pandemic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A cross\u2010sectional analysis was performed using the 2020\u20132021 US National Health Interview Survey database. The questionnaire defined financial hardship from medical bills and cost\u2010related nonadherence to medications in patients with CLD. We used weighted survey analysis to obtain the national estimates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>While 6.9% (95% confidence interval [CI]: 6.7%\u20137.2%) out of 60,689 US adults (weighted sample: 251 million) reported financial hardship and inability to pay medical bills; 10.6% (95% CI: 8.3%\u201313.4%), 18.2% (95% CI: 14.5%\u201322.6%), 22.6% (95% CI: 11.0%\u201341.0%) with hepatitis, CLD\/cirrhosis, and liver cancer experienced an inability to pay their medical bills due to financial hardship, respectively. 19.8% (95% CI: 15.9%\u201324.5%) and 23.3% (95% CI: 12.5%\u201339.3%) with CLD\/cirrhosis and liver cancer, respectively experienced cost\u2010related nonadherence to medications, compared to a tenth of US adults (10.7%, 95% CI: 10.3%\u201311.2%). CLD\/cirrhosis demonstrated an independent association with financial hardship from medical bills and cost\u2010related nonadherence to medications. Overall, these disparities were more pronounced in individuals aged &lt;65\u2009years old. In addition, over 40% of individuals with CLD\/cirrhosis reported difficulties accessing medical care during the COVID\u201019 pandemic. CLD\/cirrhosis showed an independent association with difficulties accessing medical care due to COVID\u201019.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Financial hardship from medical bills and cost\u2010related nonadherence to medication can negatively impact individuals with CLD and need further evaluation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.18122","type":"journal-article","created":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T09:29:56Z","timestamp":1718184596000},"page":"492-502","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Financial hardship and cost\u2010related nonadherence to medication in patients with liver disease in the United States"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1919-6800","authenticated-orcid":false,"given":"Donghee","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7348-8081","authenticated-orcid":false,"given":"Richie","family":"Manikat","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6232-6343","authenticated-orcid":false,"given":"Karn","family":"Wijarnpreecha","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine University of Arizona College of Medicine  Phoenix Arizona USA"},{"name":"Division of Gastroenterology and Hepatology, Department of Internal Medicine Banner University Medical Center  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3609-8586","authenticated-orcid":false,"given":"Aijaz","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology Stanford University School of Medicine  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,12]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.07.008"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(19)30349-8"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15381"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14135"},{"key":"e_1_2_11_6_1","unstructured":"WHO.WHO Coronavirus (COVID\u201019) Dashboard. [cited 2023 Feb 1]https:\/\/covid19.who.int\/"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.05.045"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.31835"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.119.041974"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc21-1757"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.26514"},{"key":"e_1_2_11_12_1","unstructured":"Centers for Disease Control and Prevention NHIS Data Questionnaires and Related Documentation. [cited 2023 Feb 1]. Available from:https:\/\/www.cdc.gov\/nchs\/nhis\/data\u2010questionnaires\u2010documentation.htm"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2023.03.020"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30489"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2022.11.038"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v14.i11.1940"}],"container-title":["Alimentary Pharmacology &amp; Therapeutics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apt.18122","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,7,23]],"date-time":"2024-07-23T06:00:44Z","timestamp":1721714444000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apt.18122"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,12]]},"references-count":15,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1111\/apt.18122"],"URL":"https:\/\/doi.org\/10.1111\/apt.18122","archive":["Portico"],"relation":{},"ISSN":["0269-2813","1365-2036"],"issn-type":[{"value":"0269-2813","type":"print"},{"value":"1365-2036","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,12]]},"assertion":[{"value":"2024-04-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}