Healthcare burden of treated gastroesophageal reflux disease among U.S. adults, 2018-2023: a pooled cross-sectional analysis of the medical expenditure panel survey.

BACKGROUND: 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. METHODS: We pooled the 2018-2023 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); P values were Benjamini-Hochberg corrected. RESULTS: 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%-6.7%, far below symptom-based U.S. prevalence estimates of about 20%-30%. Fully adjusted models gave an adjusted mean ratio for total expenditure of 1.39 (95% CI: 1.32-1.46), a mean difference of $5,481 ($4,596-$6,367), and associations with out-of-pocket expenditure ($388; $233-$542), high-cost status (odds ratio [OR] 1.70; 1.58-1.84), emergency department use (OR: 1.54; 1.43-1.66), inpatient use (OR: 1.38; 1.27-1.50), office-based (OR: 3.58; 3.00-4.27) and outpatient visits (OR: 1.81; 1.68-1.94), all FDR-corrected P < 0.0001. 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-$14,489; high-cost OR: 2.70, 2.15-3.39), with no significant interaction. CONCLUSIONS: 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.