Women and Younger Adults with Inflammatory Bowel Disease are at Greater Risk for Financial Toxicity from IBD.

Abstract

Financial toxicity, the combined objective burden and subjective distress that affects patients' medical care, is not well described in patients with IBD. We aimed to characterize financial toxicity in patients with IBD. We designed and administered a de-identified survey to patients with IBD. The primary outcome, financial toxicity, was defined as a score <22 on the COST-FACIT scale, a validated measure. We constructed multivariable logistic regression models to evaluate associations adjusting for age, sex, race, type of IBD, IBD medications, household income and education level. Respondents (n=669) had a median age of 49 years, were 62% female and 92% White. 52% were currently treated with advanced IBD-therapy and 58% reported IBD in remission/minimal activity. 53% were employed full-time. 61% had an annual household income ≥$100,000. 69% had private insurance and 31% had Medicare.21% reported trouble paying medical bills in the past year; 34% of working adults missed work in the past 7 days because of IBD. 39% experienced financial toxicity. Adjusting for confounders, adults <65 years were more likely to experience toxicity than older adults (aOR: 6.78, 95%CI: 2.60-17.65). Those with education less than a Bachelor's Degree (aOR: 2.73, 95%CI: 1.70-4.37), annual household income <$60,000 (aOR: 3.71, 95%CI: 2.14-6.42) and women were more likely to experience financial toxicity (aOR: 1.90; 95%CI: 1.28-2.81). Financial toxicity was prevalent among patients with IBD, particularly among younger adults, those with lower income and education and women. Enquiring about financial toxicity should be incorporated into IBD clinical practice.