Food Insecurity, Housing Insecurity, and Transportation Barriers to Care Among Cancer Survivors With Medical Financial Hardship.

Abstract

Cancer survivors often experience financial hardship, negatively affecting quality of life, health care use, and survival. Health-related social needs (HRSNs)-such as food/housing insecurity and transportation barriers-are prevalent among survivors and may correlate with financial hardship. Research exploring associations between financial hardship and HRSNs is limited. This study quantifies these associations in a nationally representative US sample. We identified adult cancer survivors from the 2013 to 2018 National Health Interview Survey. Medical financial hardship was defined as (1) problems paying medical bills, (2) worry about medical bills, or (3) delaying/forgoing care because of cost. HRSNs were defined as (1) food insecurity, (2) housing insecurity, and (3) transportation barriers to care. Multivariable logistic regression models were used to assess associations between financial hardship and each HRSN, controlling for socioeconomic characteristics. Among 13,626 cancer survivors, 4,623 (34.2%) reported medical financial hardship. Survivors with financial hardship were significantly more likely to report any HRSN compared with those without hardship (53.1% <i>v</i> 8.7%, adjusted odds ratio [aOR], 6.99 [95% CI, 6.06 to 8.07]). This association persisted across household income levels (interaction <i>P</i> = .58). Specifically, survivors with financial hardship were more likely to experience food insecurity (21.9% <i>v</i> 2.2%, aOR, 5.49 [95% CI, 4.38 to 6.87]), housing insecurity (44.6% <i>v</i> 6.4%, aOR, 7.14 [95% CI, 6.1 to 8.35]), and transportation barriers to care (6.6% <i>v</i> 1.1%, aOR, 3.1 [95% CI, 2.27 to 4.22]), than survivors without hardship. Medical financial hardship among cancer survivors is strongly associated with HRSNs, such as food, housing, and transportation insecurity, across income levels. These findings highlight the importance of systematic screening of financial hardship and HRSNs, along with providing comprehensive socioeconomic support to address the needs of all cancer survivors, regardless of their household income.