Decomposing racial differences in financial hardship among older cancer survivors.

Abstract

6598 Background: Despite Medicare coverage, financial hardship is a prevalent issue among older cancer survivors, particularly among those belonging to a racial/ethnic minority. Sociodemographic, clinical, and area-level factors may mediate this relationship; however, no studies have assessed the extent to which these factors contribute to disparities. Methods: Surveys assessing financial hardship after cancer were completed by 721 patients age 65y+ of Black or white race completing primary cancer treatment for breast, prostate, colorectal, prostate cancer or lymphoma at University of Alabama at Birmingham between 2000 and 2019. Financial hardship included material, psychological, and behavioral domains. Material hardship included ever 1) borrowing money/going into debt, 2) filed for bankruptcy, 3) worried about paying large medical bills, and 4) made any other financial sacrifices due to cancer. Psychological hardship was measured by asking if participants were ever worried about paying large medical bills related to cancer, its treatment or effects of treatment. Behavioral hardship was measured by asking if participants were unable or delayed in obtaining medical care, tests, treatments or prescriptions in the last 6 months. Non-linear Blinder-Oaxaca effect decomposition methods evaluated the extent to which individual-level sociodemographic, clinical, and area-level factors contributed to racial disparities in financial hardship. Results: Median age at survey was 78 (IQR = 73-82), majority were female (53%) and non-Hispanic White (84%). The most common cancers were breast (34%) and prostate (27%), followed by lung (17%), lymphoma (9%) and colorectal (14%). Ninety percent were diagnosed at an early stage and median time from diagnosis to survey was 8y (IQR = 5-12). There were no significant clinical differences between Black and white patients. Overall, 22% reported any financial hardship; 14% material, 3% behavioral, and 14% psychological. Black, compared to White participants reported significantly (p < 0.001) higher rates of overall (39% v 18%), material (29% v 11%), and psychological (27% v 11%) financial hardship. Notably, Black patients had higher rates of being unable to cover cancer-related costs (23% v 7%), worrying about paying large medical bills (27% v 11%), and having to borrow money or go into debt (9% v 3%). Overall, the observed characteristics explained 81% of racial differences in financial hardship among cancer survivors, primarily by differences in income (24%), cancer diagnosis and stage (22%), and area deprivation (15%). Conclusions: These results identify primary contributors to racial disparities in financial hardship among older cancer survivors, which can be used to develop interventions aimed at eliminating inferior healthcare outcomes experienced by certain racial groups, inform policy, and allocate resources to those at greatest risk for financial hardship.