Rural-urban differences in financial burden among cancer survivors

an analysis of a nationally representative survey

Whitney E. Zahnd, Melinda Davis, Jason S. Rotter, Robin C. Vanderpool, Cynthia Perry, Jackilen (Jackie) Shannon, Linda K. Ko, Stephanie B. Wheeler, Cassie L. Odahowski, Paige E. Farris, Jan M. Eberth

Research output: Contribution to journalArticle

Abstract

Purpose: Rural cancer survivors may disproportionately experience financial problems due to their cancer because of greater travel costs, higher uninsured/underinsured rates, and other factors compared to their urban counterparts. Our objective was to examine rural-urban differences in reported financial problems due to cancer using a nationally representative survey. Methods: We used data from three iterations of the National Cancer Institute’s Health Information and National Trends Survey (2012, 2014, and 2017) to identify participants who had a previous or current cancer diagnosis. Our outcome of interest was self-reported financial problems associated with cancer diagnosis and treatment. Rural-urban status was defined using 2003 Rural-Urban Continuum Codes. We calculated weighted percentages and Wald chi-square statistics to assess rural-urban differences in demographic and cancer characteristics. In multivariable logistic regression models, we examined the association between rural-urban status and other factors and financial problems, reporting the corresponding adjusted predicted probabilities. Findings: Our sample included 1359 cancer survivors. Rural cancer survivors were more likely to be married, retired, and live in the Midwest or South. Over half (50.5%) of rural cancer survivors reported financial problems due to cancer compared to 38.8% of urban survivors (p = 0.02). This difference was attenuated in multivariable models, 49.3 and 38.7% in rural and urban survivors, respectively (p = 0.06). Conclusions: A higher proportion of rural survivors reported financial problems associated with their cancer diagnosis and treatment compared to urban survivors. Future research should aim to elucidate these disparities and interventions should be tested to address the cancer-related financial problems experienced by rural survivors.

Original languageEnglish (US)
JournalSupportive Care in Cancer
DOIs
StateAccepted/In press - Jan 1 2019

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Survivors
Neoplasms
Surveys and Questionnaires
Logistic Models
National Cancer Institute (U.S.)
National Institutes of Health (U.S.)
Demography
Costs and Cost Analysis

Keywords

  • Cancer survivorship
  • Financial toxicity
  • Health disparities
  • Rural health
  • Survey research

ASJC Scopus subject areas

  • Oncology

Cite this

Rural-urban differences in financial burden among cancer survivors : an analysis of a nationally representative survey. / Zahnd, Whitney E.; Davis, Melinda; Rotter, Jason S.; Vanderpool, Robin C.; Perry, Cynthia; Shannon, Jackilen (Jackie); Ko, Linda K.; Wheeler, Stephanie B.; Odahowski, Cassie L.; Farris, Paige E.; Eberth, Jan M.

In: Supportive Care in Cancer, 01.01.2019.

Research output: Contribution to journalArticle

Zahnd, Whitney E. ; Davis, Melinda ; Rotter, Jason S. ; Vanderpool, Robin C. ; Perry, Cynthia ; Shannon, Jackilen (Jackie) ; Ko, Linda K. ; Wheeler, Stephanie B. ; Odahowski, Cassie L. ; Farris, Paige E. ; Eberth, Jan M. / Rural-urban differences in financial burden among cancer survivors : an analysis of a nationally representative survey. In: Supportive Care in Cancer. 2019.
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abstract = "Purpose: Rural cancer survivors may disproportionately experience financial problems due to their cancer because of greater travel costs, higher uninsured/underinsured rates, and other factors compared to their urban counterparts. Our objective was to examine rural-urban differences in reported financial problems due to cancer using a nationally representative survey. Methods: We used data from three iterations of the National Cancer Institute’s Health Information and National Trends Survey (2012, 2014, and 2017) to identify participants who had a previous or current cancer diagnosis. Our outcome of interest was self-reported financial problems associated with cancer diagnosis and treatment. Rural-urban status was defined using 2003 Rural-Urban Continuum Codes. We calculated weighted percentages and Wald chi-square statistics to assess rural-urban differences in demographic and cancer characteristics. In multivariable logistic regression models, we examined the association between rural-urban status and other factors and financial problems, reporting the corresponding adjusted predicted probabilities. Findings: Our sample included 1359 cancer survivors. Rural cancer survivors were more likely to be married, retired, and live in the Midwest or South. Over half (50.5{\%}) of rural cancer survivors reported financial problems due to cancer compared to 38.8{\%} of urban survivors (p = 0.02). This difference was attenuated in multivariable models, 49.3 and 38.7{\%} in rural and urban survivors, respectively (p = 0.06). Conclusions: A higher proportion of rural survivors reported financial problems associated with their cancer diagnosis and treatment compared to urban survivors. Future research should aim to elucidate these disparities and interventions should be tested to address the cancer-related financial problems experienced by rural survivors.",
keywords = "Cancer survivorship, Financial toxicity, Health disparities, Rural health, Survey research",
author = "Zahnd, {Whitney E.} and Melinda Davis and Rotter, {Jason S.} and Vanderpool, {Robin C.} and Cynthia Perry and Shannon, {Jackilen (Jackie)} and Ko, {Linda K.} and Wheeler, {Stephanie B.} and Odahowski, {Cassie L.} and Farris, {Paige E.} and Eberth, {Jan M.}",
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T2 - an analysis of a nationally representative survey

AU - Zahnd, Whitney E.

AU - Davis, Melinda

AU - Rotter, Jason S.

AU - Vanderpool, Robin C.

AU - Perry, Cynthia

AU - Shannon, Jackilen (Jackie)

AU - Ko, Linda K.

AU - Wheeler, Stephanie B.

AU - Odahowski, Cassie L.

AU - Farris, Paige E.

AU - Eberth, Jan M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: Rural cancer survivors may disproportionately experience financial problems due to their cancer because of greater travel costs, higher uninsured/underinsured rates, and other factors compared to their urban counterparts. Our objective was to examine rural-urban differences in reported financial problems due to cancer using a nationally representative survey. Methods: We used data from three iterations of the National Cancer Institute’s Health Information and National Trends Survey (2012, 2014, and 2017) to identify participants who had a previous or current cancer diagnosis. Our outcome of interest was self-reported financial problems associated with cancer diagnosis and treatment. Rural-urban status was defined using 2003 Rural-Urban Continuum Codes. We calculated weighted percentages and Wald chi-square statistics to assess rural-urban differences in demographic and cancer characteristics. In multivariable logistic regression models, we examined the association between rural-urban status and other factors and financial problems, reporting the corresponding adjusted predicted probabilities. Findings: Our sample included 1359 cancer survivors. Rural cancer survivors were more likely to be married, retired, and live in the Midwest or South. Over half (50.5%) of rural cancer survivors reported financial problems due to cancer compared to 38.8% of urban survivors (p = 0.02). This difference was attenuated in multivariable models, 49.3 and 38.7% in rural and urban survivors, respectively (p = 0.06). Conclusions: A higher proportion of rural survivors reported financial problems associated with their cancer diagnosis and treatment compared to urban survivors. Future research should aim to elucidate these disparities and interventions should be tested to address the cancer-related financial problems experienced by rural survivors.

AB - Purpose: Rural cancer survivors may disproportionately experience financial problems due to their cancer because of greater travel costs, higher uninsured/underinsured rates, and other factors compared to their urban counterparts. Our objective was to examine rural-urban differences in reported financial problems due to cancer using a nationally representative survey. Methods: We used data from three iterations of the National Cancer Institute’s Health Information and National Trends Survey (2012, 2014, and 2017) to identify participants who had a previous or current cancer diagnosis. Our outcome of interest was self-reported financial problems associated with cancer diagnosis and treatment. Rural-urban status was defined using 2003 Rural-Urban Continuum Codes. We calculated weighted percentages and Wald chi-square statistics to assess rural-urban differences in demographic and cancer characteristics. In multivariable logistic regression models, we examined the association between rural-urban status and other factors and financial problems, reporting the corresponding adjusted predicted probabilities. Findings: Our sample included 1359 cancer survivors. Rural cancer survivors were more likely to be married, retired, and live in the Midwest or South. Over half (50.5%) of rural cancer survivors reported financial problems due to cancer compared to 38.8% of urban survivors (p = 0.02). This difference was attenuated in multivariable models, 49.3 and 38.7% in rural and urban survivors, respectively (p = 0.06). Conclusions: A higher proportion of rural survivors reported financial problems associated with their cancer diagnosis and treatment compared to urban survivors. Future research should aim to elucidate these disparities and interventions should be tested to address the cancer-related financial problems experienced by rural survivors.

KW - Cancer survivorship

KW - Financial toxicity

KW - Health disparities

KW - Rural health

KW - Survey research

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