{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:15:35Z","timestamp":1788498935945,"version":"build-2803163510"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:00:00Z","timestamp":1788480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>U.S. evidence combining healthcare expenditure, utilization and patient-reported burden in gastroesophageal reflux disease (GERD) within one nationally representative framework is limited. Because survey condition records capture only medically attended disease, we quantified the burden of a treated, event-linked reflux condition record.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      We pooled the 2018\u20132023 Medical Expenditure Panel Survey Household Component. Since 2018 a condition enters the MEPS Medical Conditions File only when linked to a medical event or prescribed-medicine purchase, so the exposure is a treated (event-linked) ICD-10-CM K21 record, not symptom-defined GERD. Pooled variance used the AHRQ HC-036 file, with person weights divided by six. Primary outcomes were annual all-cause total expenditure (2023 USD) and high-cost status (top weighted decile); secondary outcomes were out-of-pocket expenditure, utilization and patient-reported burden. Expenditure was modelled by survey-weighted quasi-Poisson (adjusted mean ratio) and linear regression (adjusted mean difference);\n                      <jats:italic>P<\/jats:italic>\n                      values were Benjamini\u2013Hochberg corrected.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The sample comprised 117,962 person-years (62,494 persons), including 8,725 (5,292 persons) with a treated K21 record. The weighted proportion carrying such a record was stable at 6.4%\u20136.7%, far below symptom-based U.S. prevalence estimates of about 20%\u201330%. Fully adjusted models gave an adjusted mean ratio for total expenditure of 1.39 (95% CI: 1.32\u20131.46), a mean difference of $5,481 ($4,596\u2013$6,367), and associations with out-of-pocket expenditure ($388; $233\u2013$542), high-cost status (odds ratio [OR] 1.70; 1.58\u20131.84), emergency department use (OR: 1.54; 1.43\u20131.66), inpatient use (OR: 1.38; 1.27\u20131.50), office-based (OR: 3.58; 3.00\u20134.27) and outpatient visits (OR: 1.81; 1.68\u20131.94), all FDR-corrected\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.0001. Prescription use is reported descriptively only, as a filled prescription can itself generate the record. Patient-reported burden was consistently worse. Adults with both a treated record and depressive symptoms had the highest burden (expenditure difference $11,274, $8,059\u2013$14,489; high-cost OR: 2.70, 2.15\u20133.39), with no significant interaction.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Adults with a treated, event-linked reflux record incur substantially higher all-cause expenditure and utilization and report worse physical, psychological and functional health. Because identification requires healthcare contact, these estimates describe the burden borne by adults receiving care for reflux disease, not the causal effect of GERD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1933050","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:25:17Z","timestamp":1788495917000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Healthcare burden of treated gastroesophageal reflux disease among U.S. adults, 2018\u20132023: a pooled cross-sectional analysis of the medical expenditure panel survey"],"prefix":"10.3389","volume":"13","author":[{"given":"Mureaihemaitijiang","family":"Mutalifu","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, The First Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, Xinjiang Uygur Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wubulikasimu","family":"Mijiti","sequence":"additional","affiliation":[{"name":"Department of Hepatic Laparoscopic Surgery, The First Affiliated Hospital of Xinjiang Medical University","place":["Urumqi, Xinjiang Uygur Autonomous Region, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1900","DOI":"10.1111\/j.1572-0241.2006.00630.x","article-title":"The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus","volume":"101","author":"Vakil","year":"2006","journal-title":"Am J Gastroenterol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"27","DOI":"10.14309\/ajg.0000000000001538","article-title":"ACG clinical guideline for the diagnosis and management of gastroesophageal reflux disease","volume":"117","author":"Katz","year":"2022","journal-title":"Am J Gastroenterol"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2536","DOI":"10.1001\/jama.2020.21360","article-title":"Gastroesophageal reflux disease: a review","volume":"324","author":"Maret-Ouda","year":"2020","journal-title":"JAMA"},{"key":"B4","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1136\/gutjnl-2016-313589","article-title":"Global prevalence of, and risk factors for, gastro-oesophageal reflux symptoms: a meta-analysis","volume":"67","author":"Eusebi","year":"2018","journal-title":"Gut"},{"key":"B5","doi-asserted-by":"publisher","first-page":"5814","DOI":"10.1038\/s41598-020-62795-1","article-title":"Global prevalence and risk factors of gastro-oesophageal reflux disease (GORD): systematic review with meta-analysis","volume":"10","author":"Nirwan","year":"2020","journal-title":"Sci Rep"},{"key":"B6","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1136\/gutjnl-2012-304269","article-title":"Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review","volume":"63","author":"El-Serag","year":"2014","journal-title":"Gut"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.1053\/j.gastro.2019.12.014","article-title":"Prevalence of gastroesophageal reflux disease and proton pump inhibitor-refractory symptoms","volume":"158","author":"Delshad","year":"2020","journal-title":"Gastroenterology"},{"key":"B8","volume-title":"Medical Expenditure Panel Survey (MEPS): Download Data Files","year":"2026"},{"key":"B9","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/s0002-9343(97)00354-9","article-title":"The impact of gastroesophageal reflux disease on health-related quality of life","volume":"104","author":"Revicki","year":"1998","journal-title":"Am J Med"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1487","DOI":"10.1111\/j.1572-0241.2003.07531.x","article-title":"Nighttime heartburn is an under-appreciated clinical problem that impacts sleep and daytime function: the results of a Gallup survey conducted on behalf of the American Gastroenterological Association","volume":"98","author":"Shaker","year":"2003","journal-title":"Am J Gastroenterol"},{"key":"B11","doi-asserted-by":"publisher","first-page":"621","DOI":"10.1053\/j.gastro.2021.10.017","article-title":"Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: update 2021","volume":"162","author":"Peery","year":"2022","journal-title":"Gastroenterology"},{"key":"B12","doi-asserted-by":"publisher","first-page":"6594","DOI":"10.1038\/s41598-024-57101-2","article-title":"Analyzing the correlation between gastroesophageal reflux disease and anxiety and depression based on ordered logistic regression","volume":"14","author":"Li","year":"2024","journal-title":"Sci Rep"},{"key":"B13","doi-asserted-by":"publisher","first-page":"e0153","DOI":"10.1097\/MD.0000000000010153","article-title":"Comorbid risks of psychological disorders and gastroesophageal reflux disorder using the national health insurance service-national sample cohort: a STROBE-compliant article","volume":"97","author":"Lee","year":"2018","journal-title":"Medicine (Baltimore)"},{"key":"B14","volume-title":"MEPS HC-207: 2018 Medical Conditions File (Documentation and Codebook)","year":"2020"},{"key":"B15","volume-title":"Medical Expenditure Panel Survey (MEPS): Survey Background","year":"2026"},{"key":"B16","volume-title":"MEPS HC-036: 1996-2023 Pooled Linkage Variance Estimation File","year":"2025"},{"key":"B17","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"Von Elm","year":"2007","journal-title":"Lancet"},{"key":"B18","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1136\/gutjnl-2023-330616","article-title":"Updates to the modern diagnosis of GERD: Lyon consensus 2.0","volume":"73","author":"Gyawali","year":"2024","journal-title":"Gut"},{"key":"B19","volume-title":"Consumer Price Index (CPI) Supplemental Files","year":"2026"},{"key":"B20","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1017\/s0033291702006074","article-title":"Short screening scales to monitor population prevalences and trends in non-specific psychological distress","volume":"32","author":"Kessler","year":"2002","journal-title":"Psychol Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1097\/01.MLR.0000093487.78664.3C","article-title":"The patient health questionnaire-2: validity of a two-item depression screener","volume":"41","author":"Kroenke","year":"2003","journal-title":"Med Care"},{"key":"B22","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1007\/s11136-008-9418-2","article-title":"Updated U.S. Population standard for the veterans RAND 12-item health survey (VR-12)","volume":"18","author":"Selim","year":"2009","journal-title":"Qual Life Res"},{"key":"B23","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1111\/j.2517-6161.1995.tb02031.x","article-title":"Controlling the false discovery rate: a practical and powerful approach to multiple testing","volume":"57","author":"Benjamini","year":"1995","journal-title":"J R Stat Soc Ser B"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v009.i08","article-title":"Analysis of complex survey samples","volume":"9","author":"Lumley","year":"2004","journal-title":"J Stat Softw"},{"key":"B25","doi-asserted-by":"publisher","first-page":"953","DOI":"10.1016\/j.cgh.2009.04.005","article-title":"Effects of gastroesophageal reflux disease on sleep and outcomes","volume":"7","author":"Mody","year":"2009","journal-title":"Clin Gastroenterol Hepatol"},{"key":"B26","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1080\/00365521.2016.1224383","article-title":"Associations among gastroesophageal reflux disease, psychological stress, and sleep disturbances in Japanese adults","volume":"52","author":"Okuyama","year":"2017","journal-title":"Scand J Gastroenterol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1351","DOI":"10.1186\/s12913-024-11781-8","article-title":"Diagnosis and treatment of patients with gastroesophageal reflux disease\u2014a systematic review of cost-effectiveness and economic burden","volume":"24","author":"Maresova","year":"2024","journal-title":"BMC Health Serv Res"},{"key":"B28","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.14309\/ajg.0000000000002411","article-title":"Association between anxiety\/depression and gastroesophageal reflux: a systematic review and meta-analysis","volume":"118","author":"Zamani","year":"2023","journal-title":"Am J Gastroenterol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"534","DOI":"10.1016\/j.ejim.2015.05.005","article-title":"Risk of psychiatric disorders following gastroesophageal reflux disease: a nationwide population-based cohort study","volume":"26","author":"You","year":"2015","journal-title":"Eur J Intern Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1186\/s12876-021-01717-5","article-title":"Study on the relationship of depression, anxiety, lifestyle and eating habits with the severity of reflux esophagitis","volume":"21","author":"Wang","year":"2021","journal-title":"BMC Gastroenterol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1933050\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:25:19Z","timestamp":1788495919000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2026.1933050\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,4]]},"references-count":30,"alternative-id":["10.3389\/fmed.2026.1933050"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2026.1933050","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,4]]},"article-number":"1933050"}}