ASPO Abstracts
Financial Hardship among Rural Cancer Survivors in the U.S.
Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2019
Abstract Body:
Purpose: This study examined geographic differences in financial hardship among cancer survivors.Methods: We used data from the 2011 Medical Expenditure Panel Survey supplement — The Effects of Cancer and Its Treatment on Finances — to investigate rural-urban differences in the financial experience of 1,492 cancer survivors. Urban and rural designations were assigned using metropolitan statistical areas from the Office of Management and Budget with micropolitan areas defined as rural and metropolitan areas as urban. We combined four survey questions to create a measure of overall material financial hardship: borrowed money/in debt, filed bankruptcy, made other financial sacrifices, unable to cover medical costs. We used multivariable logistic regression to produce predicted probabilities and odds ratios for patient factors associated with overall material financial hardship, controlling for age, education, race, marital status, health insurance, and time since last cancer treatment.Preliminary Results: A higher proportion of rural cancer survivors reported material financial hardship than urban survivors (23.9% vs. 17.1%). Among rural survivors, non-white race (OR=3.21) and time since last cancer treatment (1-4 years: OR=12.99; 5+ years: OR=7.49) were associated with increased odds of material financial hardship. Also among rural survivors, those under age 65 and uninsured had lower odds of material financial hardship (OR=0.16) compared to those under age 65 and with private insurance. Among urban cancer survivors, only insurance type was associated with material financial hardship for those under age 65. Urban survivors under age 65 with public insurance (OR=2.89) and the uninsured under 65 years (OR=5.13) had higher odds of material hardship when compared to urban survivors under age 65 on private insurance. Conclusions: Rural cancer survivors experienced higher rates of material financial hardship compared to those living in urban areas. Although insurance type was an important factor for both groups, race and time since treatment were also significant among rural cancer survivors. Future clinically-based interventions should aim to address the financial burden among minority and uninsured rural cancer survivors.
Keywords: rural, cancer survivorship, financial distress