Socioeconomic Factors Impact the Perception of Healthcare Experiences in Patients with Cirrhosis.

Abstract

Background: Suboptimal patient-provider relationship is a significant contributor to healthcare disparities. Minority populations report fewer favorable interactions, which may lead to poorer outcomes and engagement in care. Patients with chronic diseases are especially at risk.

Aims: We aimed to study perceptions of healthcare providers and experience among those with cirrhosis.

Methods: The nationally representative database, All of Us, was queried. The primary outcome was "favorable healthcare experiences," defined as whether providers asked for opinions, demonstrated respect, and were easy to understand. The secondary outcome was "unfavorable healthcare experiences," defined as whether patients felt they were treated with less courtesy, received poorer service, or not listened to. We compared the experience between income levels and other demographic variables. Multivariable logistic regression was adjusted for a priori covariates.

Results: 5753 patients with cirrhosis were included with a mean age of 58. The majority were male (51%), White (52%), and US-born (84%). On multivariable analysis, compared to those earning > $150 k annually, participants with $10-35 k and < $10 k reported significantly lower odds of finding providers easy to understand (OR 0.40 [0.17-0.96] and OR 0.37 [0.15-0.94], respectively) and higher odds of feeling they were treated with less courtesy (OR 3.10 [1.06-9.03] and OR 4.13 [1.30-13.1], respectively). After further controlling for education, participants with an annual income of $10-35 k and < $10 k still reported higher odds of feeling they received poorer service than others (OR 3.87 [1.09-13.71] and OR 5.01 [1.26-19.8], respectively). Compared to men, women felt that they were not listened to (OR 1.90 [1.37-2.63]).

Conclusion: Patients with cirrhosis from various backgrounds report significantly different experiences with providers. Notably, those with lower income endorsed more unfavorable interactions. We identified areas for interventions to strengthen the patient-provider relationship among patients with chronic liver disease.