Financial Hardship Among US Adults with Inflammatory Bowel Disease: A National Analysis.

BACKGROUND: Inflammatory bowel disease (IBD) affects >3 million Americans and often requires expensive care spanning decades. Using national data, we evaluated the association between IBD and patient financial hardship, subgroups most affected, and changes over time. METHODS: Using the 2015-16 and 2023-24 National Health Interview Survey, we matched adults with IBD to non-IBD controls on age, sex, race, geographic region, income, insurance status, and employment using coarsened exact matching. Multivariable logistic regression was used to evaluate the association between IBD and 8 measures of financial hardship, and changes in hardship over time. RESULTS: 35.2% of IBD patients reported financial hardship in the past year, versus (vs) 25.4% of matched controls (odds ratio [OR] 1.71, 95% confidence interval [CI]: 1.50-1.96). 12.7% of IBD patients delayed care due to cost, vs 7.6% of controls (OR 1.95, 95% CI: 1.63-2.32). Finally, 15.5% of IBD patients reported cost-related medication nonadherence, vs 8.2% of controls (OR 2.22, 95% CI: 1.87-2.64). Age <65, living in the South, lower income, and being uninsured were associated with higher odds of financial hardship. From 2015-16 to 2023-24, IBD patients reporting problems paying medical bills declined 5.1 percentage points (pp, 95% CI: -9.8 to -0.4) and cost-related medication nonadherence declined 5.6pp (95% CI: -9.9 to -1.3), but other financial hardship measures remained unchanged. CONCLUSION: Each year, 1 in 3 Americans with IBD experience financial hardship and 1 in 6 skip medications due to cost - far more than in peers without IBD. Research is needed to identify interventions to reduce financial hardship in IBD.