The relationship of race/ethnicity and age with medical financial hardship for cancer survivors in the United States.
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PURPOSE: The present study examined the association between race/ethnicity and medical financial hardship between cancer survivors aged 18-64 years who were diagnosed when they were adolescents or young adults (AYAs, aged 15-39 years old) and non-AYAs (aged 40-64 years old). METHODS: We used data from the 2013-2018 National Health Interview Survey (NHIS) to identify AYA cancer survivors who were defined as receiving a cancer diagnosis between 15 and 39 years old and non-AYA cancer survivors who were defined as receiving a cancer diagnosis between 40 and 64 years old. Medical financial hardship was defined by 3 hardship domains: material (e.g., difficulty paying off medical bills), psychological (e.g., worry about medical costs), and behavioral (e.g., not receiving/postponing care because of cost). RESULTS: There were 2162 AYA cancer survivors (mean age = 32 years) and 3393 non-AYA cancer survivors (mean age = 51 years). AYA cancer survivors were more likely than non-AYA cancer survivors to experience all 3 hardship domains (30% vs. 20%, P < 0.01). Hispanic AYA and non-AYA cancer survivors had increased odds for experiencing any psychological hardship compared to White counterparts (P < 0.05). Black non-AYA cancer survivors had increased odds for experiencing any material hardship (P < 0.05). CONCLUSION: Race/ethnicity was associated with some domains of medical financial hardship for Black and Hispanic cancer survivors. AYA cancer survivors also experienced more domains of medical financial hardship compared to non-AYA cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Direct practice and policy-level interventions are needed to address financial disparities among cancer survivors. Future research should examine disaggregated racial data.