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

Cassie L. Odahowski, Whitney E. Zahnd, Anja Zgodic, Jean S. Edward, Lauren N. Hill, Melinda M. Davis, Cynthia K. Perry, Jackilen Shannon, Stephanie B. Wheeler, Robin C. Vanderpool, Jan M. Eberth

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

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.

Original languageEnglish
Article number105881
JournalPreventive Medicine
Volume129
DOIs
StatePublished - Dec 2019

Bibliographical note

Funding Information:
This publication was supported, in part, by the Cancer Prevention and Control Research Network , funded by the Centers for Disease Control and Prevention and the National Cancer Institute (3 U48 DP005000-01S2, University of South Carolina PI: Friedman, Authors: Zahnd, Eberth, Zgodic, Odahowski; 3 U48 DP005006-01S3, Oregon Health & Science University PI: Shannon and Winters-Stone, Authors: Perry, Shannon, Davis; 3 U48 DP005014-01S2, University of Kentucky PI: Vanderpool, Author: Vanderpool, Edward; 3 U48 DP005017-01S8, University of North Carolina PI: Wheeler, Author: Wheeler). This study was also supported, in part, by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement [ 5 U1CRH30539 ; Eberth, Zahnd, Odahowski, Zgodic]. Melinda Davis was supported by an NCI K07 award ( 1K07CA211971-01A1 ). The information, conclusions, and opinions expressed in this brief are those of the authors and no endorsement by FORHP, HRSA, NCI, CDC, or HHS is intended or should be inferred. Funders were not involved in the design, data collection, analysis, data interpretation, or submission of this manuscript. Appendix A

Funding Information:
This publication was supported, in part, by the Cancer Prevention and Control Research Network, funded by the Centers for Disease Control and Prevention and the National Cancer Institute (3 U48 DP005000-01S2, University of South Carolina PI: Friedman, Authors: Zahnd, Eberth, Zgodic, Odahowski; 3 U48 DP005006-01S3, Oregon Health & Science University PI: Shannon and Winters-Stone, Authors: Perry, Shannon, Davis; 3 U48 DP005014-01S2, University of Kentucky PI: Vanderpool, Author: Vanderpool, Edward; 3 U48 DP005017-01S8, University of North Carolina PI: Wheeler, Author: Wheeler). This study was also supported, in part, by the Federal Office of Rural Health Policy (FORHP), Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services (HHS) under cooperative agreement [5 U1CRH30539; Eberth, Zahnd, Odahowski, Zgodic]. Melinda Davis was supported by an NCI K07 award (1K07CA211971-01A1). The information, conclusions, and opinions expressed in this brief are those of the authors and no endorsement by FORHP, HRSA, NCI, CDC, or HHS is intended or should be inferred. Funders were not involved in the design, data collection, analysis, data interpretation, or submission of this manuscript. Publication of this supplement was supported by the Cancer Prevention and Control Network (CPCRN), University of North Carolina at Chapel Hill and the following co-funders: Case Western Reserve University, Oregon Health & Science University, University of South Carolina, University of Iowa, University of Kentucky, University of Pennsylvania and University of Washington.

Publisher Copyright:
© 2019

Keywords

  • Cost of illness
  • Health expenditures
  • Health surveys
  • Neoplasms
  • Psychological
  • Rural health
  • Stress
  • Survivors

ASJC Scopus subject areas

  • Epidemiology
  • Public Health, Environmental and Occupational Health

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