Journal article
Financial hardship among rural cancer survivors: An analysis of the Medical Expenditure Panel Survey
Preventive medicine, Vol.129, pp.105881-105881
12/2019
DOI: 10.1016/j.ypmed.2019.105881
PMCID: PMC7190004
PMID: 31727380
Abstract
Some cancer survivors report spending 20% of their annual income on medical care. Undue financial burden that patients face related to the cost of care is referred to as financial hardship, which may be more prevalent among rural cancer survivors. This study examined contrasts in financial hardship among 1419 rural and urban cancer survivors using the 2011 Medical Expenditure Panel Survey supplement – The Effects of Cancer and Its Treatment on Finances. We combined four questions, creating a measure of material financial hardship, and examined one question on financial worry. We conducted multivariable logistic regression analyses, which produced odds ratios (OR) for factors associated with financial hardship and worry, and then generated average adjusted predicted probabilities. We focused on rural and urban differences classified by metropolitan statistical area (MSA) designation, controlling for age, education, race, marital status, health insurance, family income, and time since last cancer treatment. More rural cancer survivors reported financial hardship than urban survivors (23.9% versus 17.1%). However, our adjusted models revealed no significant impact of survivors' MSA designation on financial hardship or worry. Average adjusted predicted probabilities of financial hardship were 18.6% for urban survivors (Confidence Interval [CI]: 11.9%–27.5%) and 24.2% for rural survivors (CI: 15.0%–36.2%). For financial worry, average adjusted predicted probabilities were 19.9% for urban survivors (CI: 12.0%–31.0%) and 18.8% for rural survivors (CI: 12.1%–28.0%). Improving patient-provider communication through decision aids and/or patient navigators may be helpful to reduce financial hardship and worry regardless of rural-urban status.
•We examined rural-urban differences in financial hardship among cancer survivors using nationally representative data.•Rural (vs. urban) cancer survivors were more likely to report financial hardship, but this was explained by other factors.•Cancer survivors ≥65 years were less likely to report financial hardship and worry.•Non-white race and lower educational attainment were associated with greater financial hardship and worry, respectively.•Navigation services and decision support tools may help mitigate financial hardship and worry in cancer survivors.
Details
- Title: Subtitle
- Financial hardship among rural cancer survivors: An analysis of the Medical Expenditure Panel Survey
- Creators
- Cassie L Odahowski - Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, United States of AmericaWhitney E Zahnd - Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, United States of AmericaAnja Zgodic - Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, United States of AmericaJean S Edward - College of Nursing, University of Kentucky, United States of AmericaLauren N Hill - Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, United States of AmericaMelinda M Davis - Oregon Health & Science UniversityCynthia K Perry - School of Nursing, Oregon Health & Sciences University, United States of AmericaJackilen Shannon - OHSU-PSU School of Public Health, Oregon Health & Sciences University, United States of AmericaStephanie B Wheeler - Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, United States of AmericaRobin C Vanderpool - Department of Health, Behavior & Society, College of Public Health, University of Kentucky, United States of AmericaJan M Eberth - Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, United States of America
- Resource Type
- Journal article
- Publication Details
- Preventive medicine, Vol.129, pp.105881-105881
- DOI
- 10.1016/j.ypmed.2019.105881
- PMID
- 31727380
- PMCID
- PMC7190004
- NLM abbreviation
- Prev Med
- ISSN
- 0091-7435
- eISSN
- 1096-0260
- Publisher
- Elsevier Inc
- Grant note
- name: Cancer Prevention and Control Research Network; DOI: 10.13039/100000030, name: Centers for Disease Control and Prevention; DOI: 10.13039/100000054, name: National Cancer Institute; DOI: 10.13039/100010001, name: Federal Office of Rural Health Policy; DOI: 10.13039/100000102, name: Health Resources and Services Administration; DOI: 10.13039/100000016, name: U.S. Department of Health and Human Services, award: 5 U1CRH30539; name: NCI K07, award: 1K07CA211971-01A1; name: Cancer Prevention and Control Network; DOI: 10.13039/100007890, name: University of North Carolina at Chapel Hill; DOI: 10.13039/100008136, name: Case Western Reserve University; DOI: 10.13039/100006668, name: Oregon Health & Science University; DOI: 10.13039/100008899, name: University of South Carolina; DOI: 10.13039/100008893, name: University of Iowa; DOI: 10.13039/100007472, name: University of Kentucky; name: University of Pennsylvania and University of Washington
- Language
- English
- Date published
- 12/2019
- Academic Unit
- Health Management and Policy
- Record Identifier
- 9984214687702771
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