Are survivors who report cancer-related financial problems more likely to forgo or delay medical care?
Are survivors who report cancer-related financial problems more likely to forgo or delay medical care?
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DOI：
10.1002/cncr.28262
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发表时间：
2013-10-15
期刊：
影响因子：
6.2
通讯作者：
Rowland JH
中科院分区：
文献类型：
--
作者：
Kent EE;Forsythe LP;Yabroff KR;Weaver KE;de Moor JS;Rodriguez JL;Rowland JH
癌症及其治疗造成的经济问题会严重影响幸存者及其家属，并对寻求医疗保健造成障碍。作者从具有全国代表性的2010年全国健康访谈调查中确定了成年诊断的癌症幸存者（n = 1556）。使用多变量逻辑回归分析，作者报告了与感知癌症相关的财务问题相关的社会人口统计学、临床和治疗相关因素，以及财务问题与因成本而放弃或推迟医疗保健之间的关联。采用预测边际法调整百分比。31.8%（95%可信区间，29.3%-34.5%）的幸存者报告了癌症相关的财务问题。与幸存者癌症相关的财务问题显著相关的因素包括诊断时年龄较小，少数种族/民族，化疗或放疗史，复发或多发性癌症，以及诊断时间较短。在调整协变量后，报告经济问题的受访者比没有经济问题的受访者更有可能报告延迟（18.3%对7.4%）或放弃整体医疗保健（13.8%对5.0%）、处方药（14.2%对7.6%）、牙科保健（19.8%对8.3%）、眼镜（13.9%对5.8%）和精神保健（3.9%对1.6%）（均P< 0.05）。癌症相关的财务问题不仅不成比例地出现在年轻、少数群体的幸存者中，并且有更高的治疗负担，而且还可能导致幸存者放弃或延迟癌症后的医疗护理。
Financial problems caused by cancer and its treatment can substantially affect survivors and their families and create barriers to seeking health care. The authors identified cancer survivors diagnosed as adults (n = 1556) from the nationally representative 2010 National Health Interview Survey. Using multivariable logistic regression analyses, the authors report sociodemographic, clinical, and treatment-related factors associated with perceived cancer-related financial problems and the association between financial problems and forgoing or delaying health care because of cost. Adjusted percentages using the predictive marginals method are presented. Cancer-related financial problems were reported by 31.8% (95% confidence interval, 29.3%–34.5%) of survivors. Factors found to be significantly associated with cancer-related financial problems in survivors included younger age at diagnosis, minority race/ethnicity, history of chemotherapy or radiation treatment, recurrence or multiple cancers, and shorter time from diagnosis. After adjustment for covariates, respondents who reported financial problems were more likely to report delaying (18.3% vs 7.4%) or forgoing overall medical care (13.8% vs 5.0%), prescription medications (14.2% vs 7.6%), dental care (19.8% vs 8.3%), eyeglasses (13.9% vs 5.8%), and mental health care (3.9% vs 1.6%) than their counterparts without financial problems (all P<.05). Cancer-related financial problems are not only disproportionately represented in survivors who are younger, members of a minority group, and have a higher treatment burden, but may also contribute to survivors forgoing or delaying medical care after cancer.