Financial hardship associated health care utilization among cancer survivors in the United States.

Abstract

133 Background: A cancer diagnosis is associated with medical financial hardship in the U.S. However, little is known about health consequences associated with financial hardship. This study examines associations between medical and non-medical financial hardship on healthcare utilization among cancer survivors. Methods: We used the National Health Interview Survey (2013-2017) to identify cancer survivors (18-64 years: n = 5200; 65+ years: n = 7326). Medical financial hardship included material (e.g., problems paying medical bills), psychological (e.g., worry about medical bills), and behavioral (e.g., forgoing care due to cost) domains, and non-medical financial hardship included food hardship and worry for other financial needs (e.g. retirement, monthly bills, standard of living, and housing costs). We compared cancer survivors by intensities of medical and non-medical financial hardships in: 1) emergency department (ED) visits; 2) preventive services use (receipt of influenza vaccine, and blood pressure/cholesterol screenings); and 3) cervical/breast/colorectal cancer screenings among eligible cancer survivors. We used generalized ordinal logistic regressions, controlling for demographic characteristics, time since diagnosis, number of cancer diagnoses, insurance, income, and comorbidities. Results: Across age groups, both higher medical and non-medical hardship intensities were associated with higher ED visits and lower use of preventive services. Compared to cancer survivors with lowest intensity, higher percentages of ED visits were observed among those with highest medical hardship intensity (ages 18-64: 42% vs 26.2%; ages 65+: 37.2% vs 27.9%, all p < .01) and highest non-medical hardship intensity (ages 18-64: 37.6% vs 24.3%, p = .01). Moreover, compared to lowest intensity, highest medical hardship intensity was associated with lower influenza vaccination (ages 18-64: 45.6% vs 52.5%; ages 65+: 64.6% vs 75.6%, p < .05) and breast cancer screening (54.4% vs 65.9%, p < .05). Conclusions: Cancer survivors with higher medical and non-medical financial hardships have more ED visits and medical financial hardship was also associated with less use of preventive services and some cancer screening.