Financial hardship among rural cancer survivors: An analysis of the Medical Expenditure Panel Survey

PREVENTIVE MEDICINE

卷:129

Article

Odahowski, Cassie L.^1,2  Zahnd, Whitney E.^1,3  Zgodic, Anja^1,2  Edward, Jean S.⁴  Hill, Lauren N.²  Davis, Melinda M.^5,6  Perry, Cynthia K.⁷  Shannon, Jackilen⁶  Wheeler, Stephanie B.⁸  Vanderpool, Robin C.⁹  Eberth, Jan M.^1,2 

[1] Univ South Carolina, Rural & Minor Hlth Res Ctr, Arnold Sch Publ Hlth, Columbia, SC 29208 USA

[2] Univ South Carolina, Arnold Sch Publ Hlth, Dept Epidemiol & Biostat, Columbia, SC 29208 USA

[3] Univ South Carolina, Arnold Sch Publ Hlth, Dept Hlth Serv Policy & Management, Columbia, SC 29208 USA

[4] Univ Kentucky, Coll Nursing, Lexington, KY 40506 USA

[5] Univ Kentucky, Coll Publ Hlth, Dept Hlth Behav & Soc, Lexington, KY 40506 USA

[6] Oregon Hlth & Sci Univ, Sch Med, Dept Family Med, Oregon Rural Practice Based Res Network, Portland, OR 97201 USA

[7] Oregon Hlth & Sci Univ, Sch Publ Hlth, OHSU PSU, Portland, OR 97201 USA

[8] Oregon Hlth & Sci Univ, Sch Nursing, Portland, OR 97201 USA

[9] Univ N Carolina, Gillings Sch Global Publ Hlth, Dept Hlth Policy & Managemen4, Chapel Hill, NC 27515 USA

关键词: Health expenditures;    Cost of illness;    Rural health;    Neoplasms;    Health surveys;    Stress;    Psychological;    Survivors;   

DOI  :  10.1016/j.ypmed.2019.105881

来源: Elsevier

【 摘 要 】

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.

【 授权许可】

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