American Cancer Society, Atlanta, GA
Margaret Katana Ogongo , Jingxuan Zhao , Zhiyuan Zheng , Xuesong Han , Robin Yabroff
Background: Medical financial hardship (MFH) in cancer survivors is well-documented. Little is known about how disability impacts healthcare needs and costs in cancer survivorship. We examined associations of disability and MFH among survivors in the US. Methods: We identified cancer survivors ≥18 years with (n=2,795) and without (n=12,263) a disability from the National Health Interview Survey 2019 to 2022. The Washington Group Short Set, a validated six-item measure intended to describe the functional status of adults (e.g. disability in seeing, hearing, or walking) was used to identify those with disabilities. MFH was categorized into three domains: 1) material (e.g. problems paying medical bills), 2) psychological (e.g. worrying about medical bills), and 3) behavioral (e.g. delaying/forgoing care due to cost). Adjusted logistic regressions were used to examine associations of disability and MFH among cancer survivors. Results: Cancer survivors with a disability were more likely to experience any MFH (57.2% vs. 47.0%, p<0.05) or any individual domain (Material: 26.4% vs. 13.3%, p<0.05; Psychological: 50.5% vs. 43.0%, p<0.05; Behavioral: 23.2% vs. 12.9%, p<0.05) compared with those without a disability. In addition, survivors with a disability were more likely to report experiencing multiple domains of MFH (29.1% vs. 15.9%; p<0.05). Conclusions: Cancer survivors with a disability face higher risks of MFH. Our findings can inform interventions alleviating MFH in this especially vulnerable population.
Cancer Survivors with a Disability n = 2,795 | Cancer Survivors without a Disability n = 12,263 | ||
---|---|---|---|
AME (95% CI) | AME (95% CI) | ||
Any material financial hardship | 26.4 (24.7, 28.0) | 13.3 (12.5, 14.2) | |
Any psychological financial hardship | 50.5 (49.1, 52.0) | 43.0 (42.0, 44.0) | |
Any behavioral financial hardship | 23.2 (21.7, 24.7) | 12.9 (12.0, 13.7) | |
Any MFH | 57.2 (55.8, 58.6) | 47.0 (46.0, 48.0) | |
1 domain of MFH | 57.2 (55.8, 58.6) | 47.0 (46.0, 48.0) | |
2+ domains of MFH | 29.1 (27.5, 30.6) | 15.0 (14.1, 15.8) |
Note: In adjusted analyses, covariates included age, sex, race/ethnicity, marital status, education, family income as % of Federal Poverty Level, insurance, year, and survey design; AME=Average Marginal Effect; CI = Confidence Interval.
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