Association between access to care and direct healthcare costs in people with and at high-risk of chronic kidney disease in the United States: a pooled cross-sectional study using the Medical Expenditure Panel Survey

Abstract Background Racial and ethnic minorities and those with lower incomes are disproportionately affected by chronic kidney disease (CKD). The objectives of this study were to estimate the prevalence of access barriers in people at high risk of CKD due to type 2 diabetes mellitus (T2DM) and/or hypertension and in those with CKD, and evaluate the association between sociodemographic factors, access barriers, and healthcare costs among these populations. Methods This was a pooled cross-sectional analysis using data from the Medical Expenditure Panel Survey (MEPS) Household Component including participants in MEPS between 2016–2020, who were ≥ 18 years old at survey completion and had a diagnosis of CKD or kidney failure (CKD/KF cohort) or a diagnosis of T2DM and/or hypertension without CKD/KF (high-risk cohort). Access barriers included inability to pay medical bills, insurance coverage, having a usual source of care, type of usual care, and ability to schedule care when needed. The primary outcome was total annual healthcare costs (2022 US$). Multivariable regression models were estimated to assess the association of each access barrier on annual healthcare costs while controlling for other patient characteristics. Results The study population consisted of 34,251 participants across the five study years (weighted sample: CKD/KF, 1,185,517; high-risk, 69,695,536). Adjusted annual healthcare costs were $25,042 (95% CI, $19,578, $30,503) higher in the CKD/KF cohort compared to the high-risk cohort. Individuals reporting an inability to pay medical bills had significantly greater annual healthcare costs in the CKD/KF cohort ($22,701; $14,465, $30,937) and in the high-risk cohort ($7,452; $5,993, $8,910) compared to those without this barrier. Being uninsured (vs insured) was associated with significantly lower costs only in the CKD/KF cohort (-$39,660; -$64,872, -$14,447). Using a hospital clinic ($17,042; $1,495, $32,589) or ED ($43,009; $33,324, $52,695) as the usual source of care was associated with higher costs compared to a non-hospital setting in the CKD/KF cohort. Having a usual source of care (vs none) and being able to schedule care appointments (vs unable) were not associated with costs in either cohort. Conclusions People with CKD/KF are a vulnerable population with high healthcare costs and financial challenges in accessing appropriate medical care.