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 cross-sectional study using the Medical Expenditure Panel Survey

Background Racial and ethnic minorities and those with low socioeconomic status are disproportionately affected by chronic kidney disease (CKD). The objective of this study was to evaluate the association between sociodemographic factors, access barriers, and healthcare costs among individuals with CKD and those at high risk due to type 2 diabetes mellitus (T2DM) or hypertension. Methods This was a cross-sectional analysis using data from the Medical Expenditure Panel Survey (MEPS) Household Component. The study included participants in MEPS between 2016 and 2020, were ≥ 18 years old at the time of survey completion and had either a diagnosis of CKD or kidney failure (CKD/KF cohort) or a diagnosis of T2DM or hypertension and no code for CKD or 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. 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 (CKD/KF, 596; high-risk, 33,655), with weighted sample sizes of 1,185,517 and 69,695,536, respectively. Adjusted annual healthcare costs were $25,042 ($19,578, $30,503; p < 0.01) 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 ($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 and being able to schedule care appointments were not associated with costs in either cohort. Conclusions People with CKD or KF are a vulnerable population with high healthcare costs and financial challenges in accessing appropriate medical care.