Cancer and asset inheritance at the end of life in the United States.

Abstract

225 Background: The cost of medical care in the United States is among the highest in the world and has risen in recent decades with trends toward greater cost-sharing from payors and higher out-of-pocket costs for individuals diagnosed with cancer. It is unclear if high healthcare expenses can also have a significant impact on the accumulation of wealth across generations, as families struggle to pay for medical care and may not have the financial resources to pass as inheritance or bequests. In this study, we investigated trends in asset inheritance following the death of a primary household member from cancer. Methods: We conducted a retrospective analysis of deaths among respondents in the Health and Retirement Study (HRS) through 2014. The HRS is a nationally representative, biennial and longitudinal survey of adults 50 and older and their spouses collected since 1992. We compared remaining estate size and familial bequests among those who died from cancer versus other causes of death using post-mortem interviews with next-of-kin proxy respondents. Results: Our sample included 10,196 deaths (mean age 78y) including 2752 cancer-related deaths (27.0%). Compared to those that died from non-cancer causes, those dying from cancer had higher OOP costs for doctor visits ($1244 vs $785; p < 0.05), and more often had not paid medical expenses (16.2% vs 9.7%; p < 0.05). Similar trends were noted for individuals that had a lifetime diagnosis of cancer. Higher rates of will completion were seen in patients with a history of cancer as well (p < 0.01). While higher homeownership at death was noted in this group compared to those without a history of cancer, those dying from cancer were less likely to sell their home or pass it as inheritance to a child, grandchild, or spouse. Unmarried/unpartnered respondents dying from cancer were also more likely to have reduced estate assets. Conclusions: We noted a striking loss of inheritance transfer resulting in reduced accumulation of generational wealth following death from cancer, or from a history of cancer in a household in the United States. These represent troubling findings and should inform an urgent need to prioritize policy-level solutions to reduce cost burden of receiving required care.