| Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, Gastroenterol Res and Elmer Press Inc |
| Journal website https://www.gastrores.org |
Original Article
Volume 14, Number 6, December 2021, pages 313-323
Ethnic Minorities and Low Socioeconomic Status Patients With Chronic Liver Disease Are at Greatest Risk of Being Uninsured
Figure
Tables
| No insurance | Private/commercial insurance | Medicare | Medicaid | P-value | |
|---|---|---|---|---|---|
| Data are shown as number (percentage) (95% confidence interval). Note: Please note that for some variables there may be missing data such that the total count across each variable may not add up to the total cohort. | |||||
| Total | 1,172 (19.0%) (17.2 - 21.0) | 2,710 (58.7%) (56.5 - 61.0) | 648 (9.6%) (8.6 - 10.7) | 737 (12.6%) (11.2 - 14.2) | - |
| Sex | |||||
| Female | 465 (16.40%) (14.66 - 18.30) | 1,254 (61.00%) (58.11 - 63.81) | 278 (9.19%) (7.90 - 10.67) | 355 (13.41%) (11.49 - 15.59) | < 0.01 |
| Male | 707 (21.15%) (18.63 - 23.91 | 1,456 (56.92%) (53.97 - 59.83) | 370 (9.91%) (8.50 - 11.52) | 382 (12.02%) (10.50 - 13.72) | |
| Race/ethnicity | |||||
| Non-Hispanic White | 331 (13.93%) (11.76 - 16.42) | 1,134 (64.77%) (61.93 - 67.51) | 250 (9.86%) (8.43 - 11.50) | 223 (11.44%) (9.71 - 13.43) | < 0.001 |
| African American | 193 (22.36%) (18.63 - 26.59) | 441 (47.30%) (43.10 - 51.55) | 120 (9.50%) (7.65 - 11.75) | 181 (20.83%) (17.15 - 25.07) | |
| Hispanic | 488 (33.51%) (29.79 - 37.44) | 709 (44.59%) (41.17 - 48.07) | 181 (7.83%) (6.48 - 9.43) | 249 (14.07%) (11.75 - 16.76) | |
| Asian | 104 (18.63%) (15.14 - 22.71) | 335 (59.22%) (53.78 - 64.44) | 69 (11.56%) (8.31 - 15.85) | 56 (10.60%) (7.08 - 15.58) | |
| Other | 56 (28.27%) (20.62 - 37.42) | 91 (50.42%) (39.84 - 60.96) | 28 (11.52%) (7.35 - 17.61) | 28 (9.79%) (6.56 - 14.37) | |
| Age groups | |||||
| 18 - 44 years | 634 (25.79%) (23.04 - 28.75) | 1,056 (55.94%) (52.90 - 58.94) | 71 (3.53%) (2.44 - 5.08) | 346 (14.74%) (12.75 - 16.97) | < 0.001 |
| 45 - 64 years | 435 (17.38%) (15.23 - 19.77) | 1,080 (63.80%) (60.88 - 66.62) | 147 (5.25%) (4.18 - 6.56) | 302 (13.57%) (11.88 - 15.46) | |
| 65 years and over | 103 (7.61%) (5.43 - 10.58) | 574 (54.48%) (50.22 - 58.68) | 430 (31.80%) (28.00 - 35.85) | 89 (6.11%) (4.21 - 8.80) | |
| Country of birth | |||||
| US born | 696 (16.19%) (14.36 - 18.20) | 1,949 (61.27%) (58.76 - 63.72) | 446 (9.77%) (8.58 - 11.11) | 518 (12.77%) (11.19 - 14.53) | < 0.001 |
| Non-US born | 473 (31.86%) (28.17 - 35.78) | 758 (47.26%) (43.62 - 50.93) | 202 (8.80%) (7.24 - 10.65) | 219 (12.09%) (9.97 - 14.57) | |
| Comorbidities | |||||
| Diabetes | 223 (15.06%) (12.60 - 17.90) | 616 (53.88%) (49.78 - 57.93) | 276 (18.04%) (15.22 - 21.25) | 177 (13.02%) (10.51 - 16.02) | < 0.001 |
| Metabolic syndrome | 585 (17.48%) (15.45 - 19.72) | 1,458 (58.17%) (55.40 - 60.89) | 432 (11.54%) (10.11 - 13.15) | 395 (12.80%) (11.06 - 14.78) | < 0.001 |
| Hypertension | 545 (16.49%) (14.50 - 18.70) | 1,457 (57.67%) (54.91 - 60.38) | 483 (12.64%) (11.18 - 14.26) | 414 (13.20%) (11.27 - 15.40) | < 0.001 |
| Dyslipidemia | 1,061 (19.0%) (17.07 - 21.10) | 2,464 (58.50%) (56.14 - 60.83) | 601 (9.76%) (8.69 - 10.95) | 670 (12.74%) (11.21 - 14.45) | |
| Presence of advanced fibrosis | 168 (17.50%) (14.32 - 21.22) | 398 (57.10%) (52.52 - 61.57) | 116 (11.64%) (9.16 - 14.69) | 108 (13.75%) (10.76 - 17.42) | 0.3 |
| Education level | |||||
| Lower than high school education | 416 (33.68%) (29.87 - 37.71) | 433 (37.77%) (33.79 - 41.92) | 213 (12.76%) (10.01 - 16.13) | 201 (15.79%) (13.39 - 18.53) | < 0.001 |
| High school graduation/some college | 591 (18.92%) (16.61 - 21.48) | 1,427 (59.54%) (56.72 - 62.30) | 318 (8.60%) (7.50 - 9.85) | 385 (12.94%) (11.02 - 15.12) | |
| College graduation or higher | 126 (10.25%) (7.79 - 13.38) | 783 (70.58%) (66.18 - 74.63) | 113 (10.13%) (7.47 - 13.60) | 109 (9.03%) (7.05 - 11.51) | |
| Poverty status | |||||
| Above poverty | 654 (15.68%) (14.03 - 17.48) | 2,170 (64.77%) (62.41 - 67.05) | 424 (9.33%) (8.18 - 10.64) | 394 (10.22%) (8.81 - 11.82) | < 0.001 |
| At or below poverty | 393 (35.28%) (30.83 - 39.99) | 315 (28.35%) (23.83 - 33.36) | 149 (10.24%) (8.53 - 12.23) | 269 (26.13%) (22.76 - 29.82) | |
| Year | |||||
| 2011 - 2012 | 373 (23.29%) (19.95 - 27.00) | 668 (61.93%) (57.08 - 66.55) | 174 (9.08%) (7.11 - 11.53) | 123 (5.70%) (3.81 - 8.44) | < 0.001 |
| 2013 - 2014 | 345 (20.36%) (17.11 - 24.05) | 777 (63.77%) (58.50 - 68.73) | 172 (9.38%) (8.04 - 10.91) | 122 (6.49%) (4.71 - 8.87) | |
| 2015 - 2016 | 248 (16.77%) (13.59 - 20.51) | 705 (51.16%) (48.32 - 54.00) | 106 (7.49%) (5.96 - 9.38) | 317 (24.58%) (20.96 - 28.61) | |
| 2017 - 2018 | 206 (15.58%) (11.20 - 21.27) | 560 (58.56%) (53.84 - 63.12) | 196 (12.87%) (10.11 - 16.23) | 175 (13.00%) (9.99 - 16.74) | |
| Variables | Univariate | Multivariate | ||||
|---|---|---|---|---|---|---|
| OR | 95% CI | P-value | OR | 95% CI | P-value | |
| OR: odds ratio; CI: confidence interval. | ||||||
| Female | 1.00 | Reference | - | 1.00 | Reference | - |
| Male | 0.73 | 0.62 - 0.86 | < 0.001 | 0.75 | 0.63 - 0.90 | < 0.01 |
| Non-Hispanic White | 1.00 | Reference | - | 1.00 | Reference | - |
| Black/African American | 0.57 | 0.42 - 0.77 | < 0.001 | 0.78 | 0.58 - 1.05 | 0.10 |
| Hispanic | 0.33 | 0.25 - 0.42 | < 0.001 | 0.67 | 0.52 - 0.86 | < 0.01 |
| Asian | 0.69 | 0.52 - 0.93 | 0.017 | 1.04 | 0.69 - 1.55 | 0.86 |
| Other race | 0.40 | 0.26 - 0.60 | < 0.001 | 0.50 | 0.32 - 0.80 | < 0.01 |
| Age 18 - 44 | 1.00 | Reference | - | 1.00 | Reference | - |
| Age 45 - 64 | 1.62 | 1.34 - 1.99 | < 0.001 | 1.48 | 1.18 - 1.86 | < 0.01 |
| Age 65 and over | 4.00 | 2.82 - 5.68 | < 0.001 | 3.51 | 2.29 - 5.40 | < 0.001 |
| US born | 1.00 | Reference | - | 1.00 | Reference | - |
| Non-US born | 0.41 | 0.33 - 0.50 | < 0.001 | 0.68 | 0.54 - 0.86 | < 0.01 |
| Lower than high school education | 1.00 | Reference | - | 1.00 | Reference | - |
| High school graduation/some college | 2.20 | 1.76 - 2.75 | < 0.001 | 1.76 | 1.39 - 2.23 | <0.001 |
| College graduation or higher | 4.39 | 3.13 - 6.16 | < 0.001 | 3.06 | 2.09 - 4.47 | < 0.001 |
| Above poverty | 1.00 | Reference | - | 1.00 | Reference | - |
| At or below poverty | 0.36 | 0.29 - 0.44 | < 0.001 | 0.57 | 0.47 - 0.69 | < 0.001 |
| No insurance | Private/commercial insurance | Medicare | Medicaid | P-value | |
|---|---|---|---|---|---|
| Data are shown as number (percentage) (95% confidence interval). Note: Please note that for some variables there may be missing data such that the total count across each variable may not add up to the total cohort. | |||||
| Total | 742 (58.5%) (54.0 - 62.8) | 1,462 (46.5%) (43.8 - 49.3) | 376 (50.4%) (45.2 - 55.6) | 435 (50.7%) (44.3 - 57.0) | < 0.001 |
| Sex | |||||
| Female | 303 (61.05%) (55.10 - 66.69) | 675 (45.48%) (41.90 - 49.10) | 168 (52.91%) (44.76 - 60.91) | 206 (50.67%) (43.73 - 57.57) | < 0.001 |
| Male | 439 (56.86%) (51.66 - 61.92) | 786 (47.43%) (43.58 - 51.32) | 208 (48.53%) (41.33 - 55.79) | 229 (50.65%) (41.75 - 59.52) | < 0.05 |
| Race/ethnicity | |||||
| Non-Hispanic White | 127 (39.30%) (32.93 - 46.06) | 397 (36.44%) (33.39 - 39.60) | 93 (39.52%) (32.92 - 46.52) | 80 (34.47%) (25.88 - 44.21) | 0.64 |
| African American | 90 (50.77%) (43.40 - 58.14) | 213 (55.24%) (50.28 - 60.20) | 61 (56.44%) (47.09 - 65.79) | 92 (57.17%) (50.73 - 63.61) | 0.20 |
| Hispanic | 422 (87.56%) (83.16 - 90.94) | 537 (76.41%) (72.22 - 80.14) | 149 (80.70%) (68.83 - 88.79) | 207 (88.10%) (82.85 - 91.90) | < 0.001 |
| Asian | 80 (84.49%) (77.29 - 91.69) | 258 (82.60%) (78.39 - 86.81) | 60 (92.82%) (86.50 - 99.14) | 48 (93.80%) (87.18 - 100) | 0.055 |
| Other | 23 (39.39%) (21.63 - 60.47) | 56 (69.75%) (56.85 - 80.15) | 13 (48.46%) (25.55 - 72.04) | 8 (29.89%) (12.65 - 55.66) | < 0.05 |
| Age groups | |||||
| 18 - 44 years | 395 (62.82%) (56.90 - 68.38) | 592 (55.03%) (50.50 - 59.47) | 32 (43.80%) (33.07 - 55.14) | 206 (57.05%) (48.42 - 65.28) | < 0.05 |
| 45 - 64 years | 268 (49.81%) (43.12 - 56.50) | 557 (38.44%) (34.59 - 42.44) | 80 (50.09%) (37.21 - 62.95) | 172 (41.81%) (35.24 - 48.69) | < 0.05 |
| 65 years and over | 79 (66.79%) (53.28 - 78.01) | 312 (47.25%) (41.57 - 53.01) | 264 (52.04%) (45.94 - 58.08) | 57 (58.76%) (37.36 - 77.30) | 0.07 |
| Country of birth | |||||
| US born | 313 (43.31%) (38.85 - 47.87) | 832 (40.26%) (37.56 - 43.03) | 198 (42.35%) (36.87 - 48.02) | 243 (41.73%) (34.75 - 49.06) | 0.65 |
| Non-US born | 426 (92.37%) (86.20 - 95.91) | 627 (82.56%) (77.75 - 86.50) | 178 (91.72%) (83.03 - 96.17) | 192 (95.12%) (90.00 - 97.67) | <0.01 |
| Comorbidities | |||||
| Diabetes | 138 (49.69%) (41.28 - 58.12) | 348 (47.15%) (42.08 - 52.27) | 178 (58.63%) (49.50 - 67.21) | 106 (45.85%) (35.91 - 56.13) | 0.11 |
| Metabolic syndrome | 366 (55.40%) (49.64 - 61.01) | 802 (45.67%) (42.29 - 49.09) | 256 (50.67%) (43.35 - 57.96) | 218 (45.36%) (36.95 - 54.04) | < 0.05 |
| Hypertension | 325 (52.24%) (45.59 - 58.82) | 782 (46.29%) (43.24 - 49.36) | 279 (49.07%) (42.74 - 55.43) | 221 (44.19%) (35.32 - 55.43) | 0.32 |
| Dyslipidemia | 705 (57.33%) (52.79 - 61.74) | 1,393 (45.69%) (42.99 - 48.41) | 366 (49.91%) (44.57 - 55.26) | 414 (44.22%) (43.06 - 55.39) | < 0.001 |
| Presence of advanced fibrosis | 81 (84.76%) (77.57 - 91.95) | 142 (50.84%) (44.98 - 56.70) | 52 (54.86%) (44.85 - 64.87) | 42 (53.44%) (42.44 - 64.44) | < 0.001 |
| Education level | |||||
| Lower than high school education | 322 (78.94%) (72.80 - 84.00) | 314 (63.76%) (55.07 - 71.64) | 158 (70.58%) (58.21 - 80.51) | 145 (67.21%) (57.79 - 75.43) | < 0.05 |
| High school graduation/some college | 317 (48.80%) (41.59 - 56.06) | 680 (41.39%) (38.32 - 44.52) | 153 (44.38%) (36.75 - 52.28) | 203 (46.92%) (38.86 - 55.15) | 0.19 |
| College graduation or higher | 74 (50.32%) (37.31 - 63.29) | 425 (48.81%) (43.70 - 53.95) | 62 (44.73%) (33.58 - 56.42) | 57 (39.22%) (25.02 - 55.51) | 0.55 |
| Poverty status | |||||
| Above poverty | 388 (53.32%) (48.33 - 58.25) | 1,120 (44.25%) (41.29 - 47.25) | 231 (47.32%) (40.95 - 53.77) | 214 (44.12%) (35.92 - 52.65) | < 0.05 |
| At or below poverty | 259 (67.79%) (60.91 - 73.98) | 206 (68.41%) (58.68 - 76.75) | 91 (59.41%) (50.03 - 68.15) | 168 (57.25%) (48.84 - 65.25) | 0.07 |
| Year | |||||
| 2011 - 2012 | 248 (62.61%) (54.07 - 70.44) | 349 (46.54%) (41.75 - 51.39) | 110 (67.05%) (55.32 - 76.98) | 70 (59.64%) (48.03 - 70.27) | < 0.001 |
| 2013 - 2014 | 221 (63.97%) (54.87 - 72.18) | 400 (41.94%) (37.19 - 46.86) | 104 (52.07%) (43.07 - 60.94) | 74 (59.95%) (50.43 - 68.77) | < 0.001 |
| 2015 - 2016 | 151 (49.82%) (43.06 - 56.59) | 410 (48.32%) (40.46 - 56.26) | 57 (42.20%) (29.06 - 56.54) | 182 (44.35%) (33.42 - 55.86) | 0.64 |
| 2017 - 2018 | 122 (54.68%) (42.14 - 66.66) | 302 (50.34%) (44.95 - 55.72) | 105 (41.56%) (31.58 - 52.28) | 109 (55.28%) (45.77 - 64.42) | 0.25 |
| No insurance | Private/commercial insurance | Medicare | Medicaid | P-value | |
|---|---|---|---|---|---|
| Data are shown as number (percentage) (95% confidence interval). Note: Please note that for some variables there may be missing data such that the total count across each variable may not add up to the total cohort. | |||||
| Total | 407 (40.84%) (36.39 - 45.44) | 984 (39.61%) (37.24 - 42.03) | 153 (24.27%) (20.11 - 28.98) | 271 (39.64%) (35.16 - 44.30) | < 0.001 |
| Sex | |||||
| Female | 181 (49.64%) (43.42 - 55.87) | 485 (42.07%) (38.88 - 45.34) | 64 (23.62%) (18.38 - 29.79) | 147 (47.92%) (40.97 - 54.95) | < 0.001 |
| Male | 226 (35.29%) (29.91 - 41.07) | 499 (37.54%) (33.79 - 41.43) | 89 (24.76%) (18.92 - 31.69) | 124 (32.19%) (26.62 - 38.32) | < 0.05 |
| Race/ethnicity | |||||
| Non-Hispanic White | 127 (43.68%) (36.67 - 50.96) | 366 (36.47%) (33.36 - 39.70) | 46 (20.80%) (15.57 - 27.22) | 85 (36.24%) (29.93 - 43.05) | < 0.001 |
| African American | 74 (48.99%) (41.02 - 56.96) | 174 (51.89%) (47.44 - 56.34) | 30 (33.81%) (23.98 - 43.64) | 67 (46.99%) (38.81 - 55.17) | <0.01 |
| Hispanic | 144 (33.05%) (26.65 - 40.14) | 248 (41.91%) (37.51 - 46.44) | 38 (24.53%) (17.63 - 33.05) | 86 (43.19%) (35.85 - 50.84) | < 0.01 |
| Asian | 43 (68.84%) (57.31 - 80.37) | 151 (56.53%) (50.59 - 62.47) | 33 (60.74%) (47.71 - 73.76) | 21 (51.26%) (35.96 - 66.56) | < 0.05 |
| Other | 19 (36%) (21.45 - 53.67) | 45 (55.26%) (42.44 - 67.43) | 6 (23.95%) (8.30 - 52.26) | 12 (40.68%) (20.37 - 64.78) | 0.09 |
| Age groups | |||||
| 18 - 44 years | 280 (50.36%) (44.59 - 56.12) | 554 (57.98%) (53.77 - 62.07) | 30 (42.17%) (32.24 - 52.77) | 180 (57.45%) (49.90 - 64.67) | < 0.05 |
| 45 - 64 years | 109 (30.79%) (23.05 - 39.79) | 320 (29.89%) (26.73 - 33.24) | 38 (24.06%) (16.61 - 33.50) | 75 (23.29%) (17.31 - 30.58) | 0.31 |
| 65 years and over | 18 (5.68%) (8.48 - 31.48) | 110 (2.27%) (16.93 - 26.01) | 85 (2.46%) (15.27 - 25.10) | 16 (4.13%) (11.39 - 28.00) | 0.84 |
| Country of birth | |||||
| US born | 282 (46.09%) (40.73 - 51.55) | 723 (39.55%) (36.70 - 42.49) | 99 (23.39%) (18.78 - 28.73) | 203 (39.75%) (34.69 - 45.03) | < 0.001 |
| Non-US born | 124 (28.27%) (22.77 - 34.49) | 261 (40.06%) (35.12 - 45.22) | 54 (29.19%) (22.64 - 36.72) | 68 (39.06%) (31.25 - 47.47) | < 0.01 |
| Comorbidities | |||||
| Diabetes | 66 (33.34%) (24.13 - 44.03) | 193 (32.61%) (27.16 - 38.58) | 51 (17.80%) (11.94 - 25.71) | 56 (29.39%) (22.30 - 37.64) | < 0.05 |
| Metabolic syndrome | 181 (34.23%) (28.34 - 40.66) | 472 (33.40%) (29.72 - 37.30) | 91 (20.80%) (16.29 - 26.18) | 132 (36.91%) (29.77 - 44.80) | < 0.01 |
| Hypertension | 174 (34.53%) (29.31 - 40.15) | 476 (36.18%) (32.36 - 40.19) | 103 (21.13%) (16.52 - 26.62) | 120 (32.90%) (26.42 - 40.12) | < 0.01 |
| Dyslipidemia | 366 (38.73%) (34.37 - 43.28) | 896 (38.01%) (35.58 - 40.49) | 141 (22.85%) (18.69 - 27.63) | 251 (37.89%) (33.45 - 42.54) | < 0.001 |
| Presence of advanced fibrosis | 58 (68.51%) (58.64 - 78.38) | 129 (49.79%) (43.70 - 55.88) | 27 (27.45%) (18.61 - 36.29) | 32 (42.85%) (31.65 - 54.05) | < 0.01 |
| Education level | |||||
| Lower than high school education | 107 (32.08%) (25.83 - 39.05) | 101 (28.86%) (22.48 - 36.21) | 37 (21.31%) (13.69 - 31.62) | 49 (30.31%) (22.26 - 39.78) | 0.35 |
| High school graduation/some college | 223 (41.53%) (35.87 - 47.43) | 496 (36.71%) (33.73 - 39.79) | 75 (22.28%) (16.53 - 29.34) | 152 (39.71%) (31.89 - 48.09) | < 0.01 |
| College graduation or higher | 51 (49.57%) (37.06 - 62.14) | 341 (46.61%) (42.21 - 51.06) | 39 (30.24%) (20.44 - 42.23) | 37 (40.57%) (30.86 - 51.07) | 0.06 |
| Poverty status | |||||
| Above poverty | 229 (42.03%) (36.48 - 47.79) | 791 (39.08%) (36.34 - 41.89) | 105 (24.11%) (19.63 - 29.25) | 141 (38.22%) (32.45 - 44.34) | < 0.001 |
| At or below poverty | 152 (44.22%) (37.30 - 51.36) | 115 (45.87%) (38.12 - 53.82) | 31 (23.77%) (17.49 - 31.44) | 108 (41.10%) (33.78 - 48.85) | < 0.01 |
| Year | |||||
| 2011 - 2012 | 146 (43.33%) (33.99 - 53.17) | 236 (37.26%) (33.46 - 41.23) | 40 (20.73%) (13.99 - 29.61) | 49 (44.22%) (30.83 - 58.50) | < 0.05 |
| 2013 - 2014 | 141 (46.82%) (39.52 - 54.26) | 318 (41.89%) (37.07 - 46.87) | 51 (26.61%) (19.46 - 35.23) | 54 (50.25%) (39.74 - 60.74) | < 0.05 |
| 2015 - 2016 | 74 (39.25%) (29.81 - 49.56) | 248 (38.93%) (33.80 - 44.32) | 36 (40.92%) (30.74 - 51.95) | 112 (36.14%) (29.18 - 43.73) | 0.84 |
| 2017 - 2018 | 46 (29.30%) (19.67 - 41.23) | 182 (40.25%) (34.16 - 46.66) | 26 (13.64%) (6.38 - 26.81) | 56 (39.48%) (30.92 - 48.73) | < 0.01 |