HEALTHCARE ACCESS, CHRONIC DISEASE BURDEN, AND DELAYED MEDICAL CARE AMONG U.S. ADULTS: A POPULATION-BASED ANALYSIS OF THE 2024 NATIONAL HEALTH INTERVIEW SURVEY
DOI:
https://doi.org/10.65327/hsn.v12i1.2481Keywords:
Healthcare access, Delayed medical care, Chronic disease burden, Health insurance, Medical financial hardshipAbstract
Cost-related delayed care is an important concern for access to healthcare in the United States, especially when financial hardship and poor insurance coverage are present, and when chronic disease is present. The study analyzed the relationship between delayed medical care and chronic disease burden, financial barriers, and health care access among all adults in the United States in 2024 based on the National Health Interview Survey Sample Adult data. A cross-sectional secondary analysis with complex survey weighting and design variables was performed. The influence of insurance coverage, usual source of care, problems paying medical bills, worry about medical bills, burden of chronic diseases, and sociodemographic factors on delayed medical care was assessed. The proportion of poor medical care was 8.58% (weighted). Delays in care were significantly higher among uninsured adults and those without a usual source of care. The strongest associations were with medical-bill problems and great concern about paying healthcare expenses. Lack of insurance, absence of a usual source of care, financial hardship, and increased chronic disease burden were associated with increased odds of delayed care in adjusted analyses. The lowest prevalence was among the oldest adults, those over the age of 65. These results suggest that financial and health-care-availability factors play a role in delaying medical care and support the need for measures that increase affordability and continuity of care as well as support adults with chronic conditions.
References
Azubuike, C. D., & Alawode, O. A. (2024). Delayed healthcare due to cost among adults with multimorbidity in the United States. Healthcare, 12(22), 2271. https://doi.org/10.3390/healthcare12222271
Baten, R. B. A., Noman, A., & Rahman, M. N. (2024). Affordable Care Act Medicaid expansion, access to health care, and financial behavior of the United States adults. Journal of Public Health Policy, 45(4), 740–756. https://doi.org/10.1057/s41271-024-00522-0
Becker, N. V., Scott, J. W., Moniz, M. H., Carlton, E. F., & Ayanian, J. Z. (2022). Association of chronic disease with patient financial outcomes among commercially insured adults. JAMA Internal Medicine, 182(10), 1044–1051. https://doi.org/10.1001/jamainternmed.2022.3687
Bernard, D. M., Selden, T. M., & Fang, Z. (2023). The joint distribution of high out-of-pocket burdens, medical debt, and financial barriers to needed care. Health Affairs, 42(11), 1517–1526. https://doi.org/10.1377/hlthaff.2023.00604
Casagrande, S. S., & Lawrence, J. M. (2025). Trends in delaying and forgoing medical care due to cost and the association with insurance status among US adults with diabetes, 2009–2023. BMJ Open Diabetes Research & Care, 13(6), e005446. https://doi.org/10.1136/bmjdrc-2025-005446
Choi, J., Castro, F., Swenor, B., & Varadaraj, V. (2025). Healthcare access by disability and race among United States adults: Behavioral Risk Factor Surveillance System 2019 to 2021. Disability and Health Journal, 18(4), 101908. https://doi.org/10.1016/j.dhjo.2025.101908
Datta, B. K., Coughlin, S. S., Moore, J. X., & Chen, J. (2024). Medical financial hardship in the Southern United States: The struggle continues across generations pre- and post-the Affordable Care Act. Research in Health Services & Regions, 3, 13. https://doi.org/10.1007/s43999-024-00049-7
Finneran, P., Toribio, M. P., Natarajan, P., & Honigberg, M. C. (2024). Delays in accessing healthcare across the gender spectrum in the All of Us Research Program. Journal of General Internal Medicine, 39(7), 1156–1163. https://doi.org/10.1007/s11606-023-08548-y
Ford, N. D., Slaughter, D., Dalton, A. F., Edwards, D., Ma, K., King, H., & Saydah, S. (2024). Health insurance and access to care in U.S. working-age adults experiencing Long COVID. American Journal of Preventive Medicine, 67(4), 530–539. https://doi.org/10.1016/j.amepre.2024.05.007
Giannouchos, T. V., Brooks, J. M., Andreyeva, E., & Ukert, B. (2022). Frequency and factors associated with foregone and delayed medical care due to COVID-19 among nonelderly US adults from August to December 2020. Journal of Evaluation in Clinical Practice, 28(1), 33–42. https://doi.org/10.1111/jep.13645
Gulati, I., Kilian, C., Buckley, C., Mulia, N., & Probst, C. (2025). Socioeconomic disparities in healthcare access and implications for all-cause mortality among US adults: A 2000–2019 record linkage study. American Journal of Epidemiology, 194(2), 432–440. https://doi.org/10.1093/aje/kwae202
Karpman, M., Zuckerman, S., & Morriss, S. (2023). Health care access and affordability among US adults aged 18 to 64 years with self-reported post-COVID-19 condition. JAMA Network Open, 6(4), e237455. https://doi.org/10.1001/jamanetworkopen.2023.7455
Kazi, D. S., Beckman, J. A., Benjamin, R. M., Firestone, G., Johnson, J. C., McClellan, M. B., Meltzer, N., Oxrider, A., Rosen, S. E., Scott, B. L., Volpp, K. G., & Warner, J. J. (2026). Health care affordability in the United States, from crisis to action: A Presidential Advisory from the American Heart Association. Circulation, 153(22), e1369–e1389. https://doi.org/10.1161/CIR.0000000000001442
Kim, D., Manikat, R., Wijarnpreecha, K., & Ahmed, A. (2024). Financial hardship and cost-related nonadherence to medication in patients with liver disease in the United States. Alimentary Pharmacology & Therapeutics, 60(4), 492–502. https://doi.org/10.1111/apt.18122
Marinacci, L. X., Bartlett, V., Zheng, Z., Mein, S., & Wadhera, R. K. (2023). Health care access and cardiovascular risk factor management among working-age US adults during the pandemic. Circulation: Cardiovascular Quality and Outcomes, 16(12), e010516. https://doi.org/10.1161/CIRCOUTCOMES.123.010516
McWilliams, J. M., & Dusetzina, S. B. (2024). Affordability of health care in the United States—Old problems awaiting a new administration. New England Journal of Medicine, 391(15), 1372–1374. https://doi.org/10.1056/NEJMp2410638
Moon, K. J., Becker, N. V., Miller, K. E. M., & Ettman, C. K. (2026). Medical debt and deferred care for physical health, mental health, and dental needs among U.S. adults. Journal of General Internal Medicine, 41(11), 3133–3141. https://doi.org/10.1007/s11606-026-10215-x
Mszar, R., Hagan, K., Lahan, S., & Parekh, T. (2024). Cost and non-cost factors associated with delays in receiving medical care in adults with atherosclerotic cardiovascular disease. Journal of the Royal College of Physicians of Edinburgh, 54(2), 127–132. https://doi.org/10.1177/14782715241256693
Park, K. E., Saluja, S., & Kaplan, C. M. (2023). Alleviating financial hardships associated with high-deductible health plans for adults with chronic conditions through health savings accounts. Journal of General Internal Medicine, 38(7), 1593–1598. https://doi.org/10.1007/s11606-022-07985-5
Ratnapradipa, K. L., Jadhav, S., Kabayundo, J., Wang, H., & Smith, L. C. (2023). Factors associated with delaying medical care: Cross-sectional study of Nebraska adults. BMC Health Services Research, 23, 118. https://doi.org/10.1186/s12913-023-09140-0
Roberts, E. T., Ruggiero, D. A., Stefanescu, A., Patel, S., Hames, A. G., & Tipirneni, R. (2024). Racial and ethnic disparities in satisfaction with healthcare access and affordability in Medicare Advantage vs. Traditional Medicare. Journal of General Internal Medicine, 39(12), 2368–2371. https://doi.org/10.1007/s11606-024-08892-7
Shah, R. M., Arun, A. S., Lu, Y., Dhruva, S. S., Wadhera, R. K., & Krumholz, H. M. (2026). Health care affordability by atherosclerotic cardiovascular disease status: A JACC data report on trends in the United States, 2019–2024. Journal of the American College of Cardiology, 87(9), 1145–1148. https://doi.org/10.1016/j.jacc.2025.12.042
Shashikumar, S. A., Zheng, Z., Joynt Maddox, K. E., & Wadhera, R. K. (2024). Financial burden of health care in the privately insured US population. JAMA Internal Medicine, 184(7), 843–845. https://doi.org/10.1001/jamainternmed.2024.1464
Wen, X., Qiu, H., Yu, B., Bi, J., Gu, X., Zhang, Y., & Wang, S. (2024). Cost-related medication nonadherence in adults with COPD in the United States 2013–2020. BMC Public Health, 24, 864. https://doi.org/10.1186/s12889-024-18333-z
Yaver, M. (2024). Rationing by inconvenience: How insurance denials induce administrative burdens. Journal of Health Politics, Policy and Law, 49(4), 539–565. https://doi.org/10.1215/03616878-11186111
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