Distinct risk groups with different healthcare barriers and acute care use exist in the U.S. population with chronic liver disease

Background: The relationship between community-based healthcare barriers and risk of recurrent hospital-based care among persons with chronic liver disease (CLD) is understudied. We aimed to uncover distinct groups among adults in the United States with CLD based on healthcare barriers and risk-stratify recurrent acute care use by group. Methods: Using National Health Interview Survey (2011 to 2017) data, we performed latent class analysis (LCA) to uncover groups experiencing distinct sets of healthcare barriers. We assessed sociodemographic and health characteristics and probabilities of recurrent acute care use by group. Results: The sample included 5,062 (estimated 4.7 million) adults with CLD (median [range] age 55 [18–85]). LCA modeling differentiated 4 groups: minimal barriers (group 1) (n = 3,953; 78.1%), unaffordability (group 2) (n = 540; 10.7%), care delays (group 3) (n = 328; 6.5%), and inability to establish care (group 4) (n = 240; 4.8%). Group 2 had the most uninsured persons (n = 210; 38.9%), whereas group 3 was mostly insured (n = 305; 93.1%). Group 4 included the most adults under 65 years old (n = 220; 91.7%), females (n = 156; 65.1%), and persons with unemployment (n = 169; 70.6%) and poverty (n = 85; 35.3%). Compared to group 1, the likelihood of recurrent acute care use was highest for group 4 (aOR, 1.85; 95% CI, 1.23–2.79 followed by group 3 (aOR, 1.50; 95% CI, 1.07–2.11) and group 2 (aOR, 1.48; 95% CI, 1.11–1.97). Conclusion: US adults with CLD can be categorized into 4 distinct groups based on healthcare barriers, which are associated with different probabilities of recurrent acute care use. Findings from this study are important for future interventions to reduce potentially avoidable hospital-based care among the highest-risk persons with CLD.