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

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.

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.

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.

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.