Financial Hardship, Healthcare Utilization, and Health Among U.S. Cancer Survivors.

Abstract

This study examined associations of both medical and nonmedical financial hardships with healthcare utilization and self-rated health among cancer survivors. The National Health Interview Survey (2013-2017) was used to identify cancer survivors (aged 18-64 years: n=4,939; aged ≥65 years: n=6,972). A total of 4 levels of medical financial hardship intensities were created with measures from material, psychological, and behavioral domains. A total of 5 levels of nonmedical financial hardship intensities were created with measures in food insecurity and worry about other economic needs (e.g., housing expenses). Generalized ordinal logistic regression examined associations between medical and nonmedical financial hardship intensities and emergency department visits, use of preventive services and cancer screenings, and self-rated health. All analyses were performed in 2019. In adjusted analyses, cancer survivors with higher medical financial hardship intensity (Level 4 vs Level 1; aged 18-64 years: 42% vs 26.2%, p<0.001; aged ≥65 years: 37.6% vs 24.3%, p=0.001) and higher nonmedical financial hardship intensity (Level 5 vs Level 1; aged 18-64 years: 37.2% vs 27.9%, p=0.011) had more emergency department visits. Moreover, cancer survivors with higher medical financial hardship intensity had lower influenza vaccine (Level 4 vs Level 1; aged 18-64 years: 45.6% vs 52.5%, p=0.036; aged ≥65 years: 64.6% vs 75.6%, p=0.008) and lower breast cancer screening levels (Level 4 vs Level 1; 46.8% vs 61.2%, p=0.001). Similar patterns were found between higher financial hardship intensities and worse self-rated health. Higher medical and nonmedical financial hardships are independently associated with more emergency department visits, lower receipt of some preventive services, and worse self-rated health in cancer survivors. With growing healthcare costs, unmet medical and nonmedical financial needs may worsen health disparities among cancer survivors.