Association of Neighborhood Deprivation Index With Success in Cancer Care Crowdfunding.
Association of Neighborhood Deprivation Index With Success in Cancer Care Crowdfunding.
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DOI：
10.1001/jamanetworkopen.2020.26946
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发表时间：
2020-12-01
影响因子：
13.8
通讯作者：
Tatonetti NP
中科院分区：
文献类型：
--
作者：
Silver ER;Truong HQ;Ostvar S;Hur C;Tatonetti NP
癌症护理在线众筹与美国癌症护理环境中现有的社会经济健康差异有何关联？在这项针对 144 061 项癌症众筹活动的横断面研究中，位于美国社会经济地位较高县的众筹活动筹集的资金明显多于社会经济地位较低县的众筹活动。使用竞选叙述将受益人描绘成值得捐赠的众筹者比没有这种描绘的众筹者筹集的资金要多得多，而且这些描绘的使用在社会经济阶层中分布不均。这些发现表明，众筹对人际财富获取和数字自我营销熟练程度的依赖可能会给那些拥有现有社会经济优势的人带来不成比例的好处。这项横断面研究探讨了较高的县级社会经济地位以及活动描述中受益人价值文本指标的存在（与不存在）是否与癌症众筹筹集的金额相关。癌症护理造成的经济毒性构成了重大的公共健康问题，导致一些患者转向在线众筹。然而，这种做法可能会给那些拥有人际财富和数字媒体素养的人带来特权，从而加剧现有的社会经济癌症差异。检验以下假设：较高的县级社会经济地位以及活动描述中受益人价值文本指标的存在（与不存在）与癌症众筹筹集的金额相关。这项横断面分析研究了 2010 年至 2019 年期间进行的美国癌症众筹活动以及美国社区调查（2013-2017 年）的数据。数据分析于2019年12月至2020年3月进行。活动地点的邻里剥夺指数和表明受益人价值的活动文本特征。筹集的资金数额。这项研究分析了 144 061 美国癌症众筹活动。邻里贫困程度较高的县的活动筹集的资金少于邻里贫困程度较低的县的活动（–26.07%；95% CI，–27.46% 至 –24.65%；P < .001）。当提供合法化详细信息时，活动筹集了更多资金，包括有关癌症类型的临床详细信息（9.58%；95% CI，8.00%至11.18%；P<0.001）和治疗类型（6.58%；95% CI，5.44%至7.79%；P<0.001）以及财务详细信息，例如保险状况（1.39%；95% CI，0.20% 至 2.63%；P = .02）和自付费用（7.36%；95% CI，6.18% 至 8.55%；P < .001）。当受益人被描述为热情（13.80%；95% CI，12.30%至15.26%；P<0.001）、勇敢（15.40%；95% CI，14.11%至16.65%；P<0.001）或自力更生（5.23%；P<0.001）时，活动筹集到的资金更多。 95% CI，3.77% 至 6.72%；P < .001）。这些研究结果表明，癌症众筹的成功可能会让那些社会经济地位较高的地区以及那些具有将受益人描绘成有价值的网络素养的人受益匪浅。通过奖励那些具有现有社会经济优势的人，癌症众筹可能会延续癌症护理方面的社会经济差异。研究结果还强调了癌症护理造成的经济毒性的普遍性。
How is online crowdfunding for cancer care associated with existing socioeconomic health disparities in the US cancer care setting? In this cross-sectional study of 144 061 cancer crowdfunding campaigns, those located in US counties with high socioeconomic status raised significantly more than campaigns in lower–socioeconomic status counties. Crowdfunders who used campaign narratives to portray beneficiaries as worthy of donations raised significantly more than those without such portrayals, and the use of these portrayals was unequally distributed across socioeconomic strata. These findings suggest that crowdfunding’s reliance on access to interpersonal wealth and proficiency in digital self-marketing may disproportionately benefit those with existing socioeconomic advantage. This cross-sectional study examines whether higher county-level socioeconomic status and the presence (vs absence) of text indicators of beneficiary worth in campaign descriptions are associated with the amount raised from cancer crowdfunding. Financial toxicity resulting from cancer care poses a substantial public health concern, leading some patients to turn to online crowdfunding. However, the practice may exacerbate existing socioeconomic cancer disparities by privileging those with access to interpersonal wealth and digital media literacy. To test the hypotheses that higher county-level socioeconomic status and the presence (vs absence) of text indicators of beneficiary worth in campaign descriptions are associated with amount raised from cancer crowdfunding. This cross-sectional analysis examined US cancer crowdfunding campaigns conducted between 2010 and 2019 and data from the American Community Survey (2013-2017). Data analysis was performed from December 2019 to March 2020. Neighborhood deprivation index of campaign location and campaign text features indicating the beneficiary’s worth. Amount of money raised. This study analyzed 144 061 US cancer crowdfunding campaigns. Campaigns in counties with higher neighborhood deprivation raised less (–26.07%; 95% CI, –27.46% to –24.65%; P < .001) than those in counties with less neighborhood deprivation. Campaigns raised more funds when legitimizing details were provided, including clinical details about the cancer type (9.58%; 95% CI, 8.00% to 11.18%; P < .001) and treatment type (6.58%; 95% CI, 5.44% to 7.79%; P < .001) and financial details, such as insurance status (1.39%; 95% CI, 0.20% to 2.63%; P = .02) and out-of-pocket costs (7.36%; 95% CI, 6.18% to 8.55%; P < .001). Campaigns raised more money when beneficiaries were described as warm (13.80%; 95% CI, 12.30% to 15.26%; P < .001), brave (15.40%; 95% CI, 14.11% to 16.65%; P < .001), or self-reliant (5.23%; 95% CI, 3.77% to 6.72%; P < .001). These findings suggest that cancer crowdfunding success ay disproportionately benefit those in high–socioeconomic status areas and those with the internet literacy necessary to portray beneficiaries as worthy. By rewarding those with existing socioeconomic advantage, cancer crowdfunding may perpetuate socioeconomic disparities in cancer care access. The findings also underscore the widespread nature of financial toxicity resulting from cancer care.
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