Medical financial hardship reported by Native Hawaiian and Pacific Islander cancer survivors compared with non‐Hispanic whites

Abstract

Although medical financial hardship (MFH) resulting from sequelae of cancer and treatment has been reported in other racial/ethnic populations, little is known about MFH among Native Hawaiian and Pacific Islander (NHPI) cancer survivors. One hundred fifty adult NHPI cancer survivors were identified from the 2014 NHPI National Health Interview Survey (NHIS). Cancer survivors were those with a history of cancer (excluding nonmelanoma/unknown type of skin cancer). MFH was defined by 3 domains: 1) material (problem paying or unable to pay medical bills); 2) psychological (worrying about paying medical bills); and 3) behavioral (delaying or forgoing medical care for financial reasons). For comparison, 2098 non-Hispanic white (NHW) cancer survivors were identified from the 2014 NHIS. Logistic regressions were used to identify sociodemographic and health factors associated with experiencing MFH. Stratified analysis by age (<65 vs ≥65years) and sensitivity analysis using propensity score-matched NHPI and NHW cancer survivors were conducted. Nationally representative estimates were generated using survey weights. Among elderly cancer survivors, more NHPIs reported any MFH (59% vs 32%; P=.001), psychological MFH (36% vs 22%; P=.040), and behavioral MFH (27% vs 9%; P=.004) than NHWs. Among survivors aged <65years, NHPIs reported less MFH (46% vs. 65%; P=.034). Even after propensity score matching, these patterns persisted. Female NHPIs and NHPIs with a college degree were significantly more likely to report MFH, especially material and psychological MFH. A significantly higher proportion of elderly NHPI cancer survivors reported MFH, and this difference persisted even after propensity score matching, which warrants further investigation.