Medical Financial Hardship Intensity and Financial Sacrifice Associated with Cancer in the United States
Medical Financial Hardship Intensity and Financial Sacrifice Associated with Cancer in the United States
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DOI：
10.1158/1055-9965.epi-19-0460
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发表时间：
2020-02-01
影响因子：
3.8
通讯作者：
Yabroff, K. Robin
中科院分区：
文献类型：
--
作者：
Han, Xuesong;Zhao, Jingxuan;Yabroff, K. Robin
背景资料：随着癌症护理成本的上升，这项研究的目的是估计的患病率，以及与之相关的因素，医疗经济困难的强度和经济牺牲，由于癌症在UnitedStates.Methods：我们确定了963癌症幸存者从2016年医疗支出小组调查-癌症的经验。由于癌症造成的医疗经济困难是以物质（例如，申请破产），心理（例如，担心支付账单和财务），和行为（例如，由于成本而延迟或放弃护理）领域。非医疗财务牺牲包括支出和储蓄使用的变化。多变量Logistic模型被用来确定与困难强度和牺牲分层的年龄组（18-64或65岁以上）。结果：在癌症幸存者年龄18至64岁，53.6%，28.4%，和11.4%的报告至少有一个，两个，或所有三个领域的困难，分别。在65岁以上的幸存者中，相应的百分比分别为42.0%、12.7%和4.0%。此外，18至64岁的幸存者（54.2%）比65岁以上的幸存者（38.4%; P < 0.001）更常见于癌症造成的经济损失。在多变量分析中，与艰苦程度显著相关的因素包括低收入和教育程度、种族/少数民族、共同患病、缺乏私人保险、长期就业变化和最近的癌症治疗。大多数也显着相关的财务sacrification.Conclusions：医疗财政困难和经济牺牲是巨大的癌症幸存者在美国，特别是年轻的survivor.Impact：努力减轻经济困难的癌症幸存者是必要的，特别是那些在高风险。
Background: With rising costs of cancer care, this study aims to estimate the prevalence of, and factors associated with, medical financial hardship intensity and financial sacrifices due to cancer in the United States.Methods: We identified 963 cancer survivors from the 2016 Medical Expenditures Panel Survey - Experiences with Cancer. Medical financial hardship due to cancer was measured in material (e.g., filed for bankruptcy), psychological (e.g., worry about paying bills and finances), and behavioral (e.g., delaying or forgoing care due to cost) domains. Nonmedical financial sacrifices included changes in spending and use of savings. Multivariable logistic models were used to identify characteristics associated with hardship intensity and sacrifices stratified by age group (18-64 or 65+ years).Results: Among cancer survivors ages 18 to 64 years, 53.6%, 28.4%, and 11.4% reported at least one, two, or all three domains of hardship, respectively. Among survivors ages 65+ years, corresponding percentages were 42.0%, 12.7%, and 4.0%, respectively. Moreover, financial sacrifices due to cancer were more common in survivors ages 18 to 64 years (54.2%) than in survivors 65+ years (38.4%; P < 0.001). Factors significantly associated with hardship intensity in multivariable analyses included low income and educational attainment, racial/ethnic minority, comorbidity, lack of private insurance coverage, extended employment change, and recent cancer treatment. Most were also significantly associated with financial sacrifices.Conclusions: Medical financial hardship and financial sacrifices are substantial among cancer survivors in the United States, particularly for younger survivors.Impact: Efforts to mitigate financial hardship for cancer survivors are warranted, especially for those at high risk.