Financial Hardship Among Nonelderly Adults With CKD in the United States

Isaac Acquah, Javier Valero-Elizondo, Zulqarnain Javed, Hassan N. Ibrahim, Kershaw V. Patel, Hyeon Ju Ryoo Ali, Terri Menser, Rohan Khera, Miguel Cainzos-Achirica, Khurram Nasir

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Rationale & Objective: The burden of financial hardship among individuals with chronic kidney disease (CKD) has not been extensively studied. Therefore, we describe the scope and determinants of financial hardship among a nationally representative sample of adults with CKD. Study Design: Cross-sectional. Setting & Participants: Nonelderly adults with CKD from the 2014-2018 National Health Interview Survey. Exposure: Sociodemographic and clinical characteristics. Outcome: Financial hardship based on medical bills and consequences of financial hardship (high financial distress, food insecurity, cost-related medication nonadherence, delayed/forgone care due to cost). Financial hardship was categorized into 3 levels: no financial hardship, financial hardship but able to pay bills, and unable to pay bills at all. Financial hardship was then modeled in 2 different ways: (1) any financial hardship (regardless of ability to pay) versus no financial hardship and (2) inability to pay bills versus no financial hardship and financial hardship but able to pay bills. Analytical Approach: Nationally representative estimates of financial hardship from medical bills were computed. Multivariable logistic regression models were used to examine the associations of sociodemographic and clinical factors with the outcomes of financial hardship based on medical bills. Results: A total 1,425 individuals, representing approximately 2.1 million Americans, reported a diagnosis of CKD within the past year, of whom 46.9% (95% CI, 43.7%-50.2%) reported experiencing financial hardship from medical bills; 20.9% (95% CI, 18.5%-23.6%) reported inability to pay medical bills at all. Lack of insurance was the strongest determinant of financial hardship in this population (odds ratio, 4.06 [95% CI, 2.18-7.56]). Limitations: Self-reported nature of CKD diagnosis. Conclusions: Approximately half the nonelderly US population with CKD experiences financial hardship from medical bills that is associated strongly with lack of insurance. Evidence-based clinical and policy interventions are needed to address these hardships.

Original languageEnglish (US)
Pages (from-to)658-668
Number of pages11
JournalAmerican Journal of Kidney Diseases
Issue number5
StatePublished - Nov 2021


  • Chronic kidney disease (CKD)
  • disparities
  • economic burden
  • financial distress
  • financial hardship
  • food insecurity
  • forgone medical care
  • health care costs
  • health insurance
  • medical bills
  • non-elderly
  • outcomes
  • socioeconomic status
  • Cross-Sectional Studies
  • Humans
  • Financial Stress
  • Health Expenditures
  • Medication Adherence
  • United States/epidemiology
  • Renal Insufficiency, Chronic/diagnosis
  • Adult

ASJC Scopus subject areas

  • Nephrology


Dive into the research topics of 'Financial Hardship Among Nonelderly Adults With CKD in the United States'. Together they form a unique fingerprint.

Cite this