Association of Medical Financial Hardship and Mortality Among Cancer Survivors in the United States

K. Robin Yabroff · Xuesong Han · Weishan Song · Jingxuan Zhao · Letícia Nogueira · Craig Evan Pollack +2 more

89 citations0/0 files storedJNCI Journal of the National Cancer Institute

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Economic and Financial Impacts of Cancer Cancer survivorship and care Global Cancer Incidence and Screening

Abstract

BACKGROUND: Cancer survivors frequently experience medical financial hardship in the United States. Little is known, however, about long-term health consequences. This study examines the associations of financial hardship and mortality in a large nationally representative sample of cancer survivors. METHODS: We identified cancer survivors aged 18-64 years (n = 14 917) and 65-79 years (n = 10 391) from the 1997-2014 National Health Interview Survey and its linked mortality files with vital status through December 31, 2015. Medical financial hardship was measured as problems affording care or delaying or forgoing any care because of cost in the past 12 months. Risk of mortality was estimated with separate weighted Cox proportional hazards models by age group with age as the timescale, controlling for the effects of sociodemographic characteristics. Health insurance coverage was added sequentially to multivariable models. RESULTS: Among cancer survivors aged 18-64 years and 65-79 years, 29.6% and 11.0%, respectively, reported financial hardship in the past 12 months. Survivors with hardship had higher adjusted mortality risk than their counterparts in both age groups: 18-64 years (hazard ratio [HR] = 1.17, 95% confidence interval [CI] = 1.04 to 1.30) and 65-79 years (HR = 1.14, 95% CI = 1.02 to 1.28). Further adjustment for health insurance reduced the magnitude of association of hardship and mortality among survivors aged 18-64 years (HR = 1.09, 95% CI = 0.97 to 1.24). Adjustment for supplemental Medicare coverage had little effect among survivors aged 65-79 years (HR = 1.15, 95% CI = 1.02 to 1.29). CONCLUSION: Medical financial hardship was associated with mortality risk among cancer survivors in the United States.

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2016Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer 2016Financial Hardships Experienced by Cancer Survivors: A Systematic Review 2008Association of Insurance with Cancer Care Utilization and Outcomes 2013Washington State Cancer Patients Found To Be At Greater Risk For Bankruptcy Than People Without A Cancer Diagnosis 2015Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors 2013Cost Sharing and Adherence to Tyrosine Kinase Inhibitors for Patients With Chronic Myeloid Leukemia 2016Association of Financial Strain With Symptom Burden and Quality of Life for Patients With Lung or Colorectal Cancer 2015Population-Based Assessment of Cancer Survivors' Financial Burden and Quality of Life: A Prospective Cohort Study

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