Cost concerns lead older, rural survivors of cancer to avoid health care

Abstract

When compared with their urban counterparts, older survivors of cancer residing in rural areas are more likely to skip medical and dental care because of cost concerns, according to new research. In a study published in Cancer Epidemiology, Biomarkers & Prevention, data indicated that rural survivors who were aged 65 years or older were approximately 66% more likely to forgo medical care and were 54% more likely to avoid dental care than those in urban areas, due to cost.1 Nynikka Palmer, DrPH, MPH, a postdoctoral fellow in the department of social sciences and health policy at the Wake Forest School of Medicine in Winston-Salem, North Carolina, says this study is the first population-based research to examine whether survivors of cancer residing in rural and urban areas were equally likely to avoid medical care because of cost. She and her colleagues found a disparity between older survivors, despite the fact that Medicare coverage is nearly universal. At the same time, no disparity was found in younger survivors. These findings indicate that health insurance may not be the main factor affecting access to health care. Cancer survivors often require regular follow-up care and may be at risk of other health conditions such as diabetes and heart disease, Dr. Palmer says, adding that providers should be made aware of this disparity between rural and urban survivors so they can help provide resources and support. Older survivors residing in rural areas may have trouble traveling to see a provider, which could lead to more expense and lost wages. They may also have less social support if younger family members have moved away. Dr. Palmer and her colleagues analyzed 7804 cancer survivors who participated in the National Health Interview Surveys conducted by the National Center for Health Statistics of the Centers for Disease Control and Prevention between 2006 and 2010. The participants included 1642 individuals from rural areas and 6162 individuals from urban areas. Approximately 49% of the survivors were aged 18 years to 64 years and primarily received coverage through their employers, whereas some had no health insurance. The other 51% of respondents were aged 65 years or older, and most were covered by Medicare and supplemental Medicaid or private insurance. Researchers examined 3 outcomes: if the participants delayed or did not get medical care because of cost; if they could not afford prescription medicine; and if they could not afford dental care.