Associations of cancer history, food insecurity, and nonmedical financial worry and mortality risk in the US.

Abstract

6537 Background: Cancer survivors often face substantial out-of-pocket medical costs, which can adversely affect their financial well-being. Cutting expenses on food and housing to save money are common coping strategies. However, little is known about the extent to which food insecurities and non-medical financial worries affect mortality risk after consideration of medical financial hardship. Methods: The 2013-2018 National Health Interview Survey (NHIS) and the NHIS linked mortality files with vital status through December 31, 2019 were used to identify cancer survivors (ages 18-64: n=5,110; ages 65-79: n=4,949) and individuals without a cancer history (ages 18-64: n=115,643; ages 65-79: n=24,785). Medical financial hardship included 3 domains: material, psychological, and behavioral. Food insecurity (e.g., worry about food running out) and non-medical financial worries (e.g., paying for monthly bills and housing) were separately summarized and categorized as severe, moderate, and minor/none levels. Using age as the time scale, associations of cancer history, food insecurity and non-medical financial worry and mortality risk were examined with weighted Cox proportional hazards models. Adjusted models included medical financial hardship, sex, educational attainment, marital status, health insurance, comorbid conditions, and survey year. All estimates accounted for complex survey design. Results: In our sample, about 13.8% (ages 18-64) and 7.9% (ages 65-79) reported moderate to severe levels of food insecurity, respectively; 32.1% (ages 18-64) and 19.2% (ages 65-79) reported moderate to severe levels of non-medical financial worries, respectively. In adjusted analyses, cancer survivors had increased mortality risk. After controlling for medical financial hardship, food insecurity was associated with higher mortality risk in both age groups, following a dose-response relationship (Table); Non-medical financial worry was associated with higher mortality risk in the 65-79 age group (Table). Conclusions: Standardized and comprehensive assessment of financial hardship and other social needs, such food insecurity, is essential to identify and mitigate adverse economic impacts of cancer. [Table: see text]