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

C. L. Odahowski, W. E. Zahnd, A. Zgodic, J. S. Edward, L. N. Hill, M. M. Davis, C. K. Perry, J. Shannon, S. B. Wheeler, R. C. Vanderpool, J. M. Eberth

Research output: Contribution to journalArticle

1 Citation (Scopus)

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 (US)
Article number105881
JournalPreventive medicine
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Health Expenditures
Survivors
Neoplasms
Confidence Intervals
Patient Navigation
Surveys and Questionnaires
Decision Support Techniques
Marital Status
Health Insurance
Logistic Models
Odds Ratio
Communication
Regression Analysis
Education
Costs and Cost Analysis
Therapeutics

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

Cite this

Odahowski, C. L., Zahnd, W. E., Zgodic, A., Edward, J. S., Hill, L. N., Davis, M. M., ... Eberth, J. M. (Accepted/In press). Financial hardship among rural cancer survivors: An analysis of the Medical Expenditure Panel Survey. Preventive medicine, [105881]. https://doi.org/10.1016/j.ypmed.2019.105881

Financial hardship among rural cancer survivors : An analysis of the Medical Expenditure Panel Survey. / Odahowski, C. L.; Zahnd, W. E.; Zgodic, A.; Edward, J. S.; Hill, L. N.; Davis, M. M.; Perry, C. K.; Shannon, J.; Wheeler, S. B.; Vanderpool, R. C.; Eberth, J. M.

In: Preventive medicine, 01.01.2019.

Research output: Contribution to journalArticle

Odahowski, CL, Zahnd, WE, Zgodic, A, Edward, JS, Hill, LN, Davis, MM, Perry, CK, Shannon, J, Wheeler, SB, Vanderpool, RC & Eberth, JM 2019, 'Financial hardship among rural cancer survivors: An analysis of the Medical Expenditure Panel Survey', Preventive medicine. https://doi.org/10.1016/j.ypmed.2019.105881
Odahowski, C. L. ; Zahnd, W. E. ; Zgodic, A. ; Edward, J. S. ; Hill, L. N. ; Davis, M. M. ; Perry, C. K. ; Shannon, J. ; Wheeler, S. B. ; Vanderpool, R. C. ; Eberth, J. M. / Financial hardship among rural cancer survivors : An analysis of the Medical Expenditure Panel Survey. In: Preventive medicine. 2019.
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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.",
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