Zhao Jingxuan, Han Xuesong, Zheng Zhiyuan, Banegas Matthew P, Ekwueme Donatus U, Yabroff K Robin
Surveillance and Health Services Research Program, American Cancer Society, Atlanta, GA.
The Center for Health Research, Kaiser Permanente, Portland, OR.
JNCI Cancer Spectr. 2019 Oct 21;3(4):pkz061. doi: 10.1093/jncics/pkz061. eCollection 2019 Dec.
Little is known about the association between health insurance literacy and financial hardship among cancer survivors. Using the 2016 Medical Expenditure Panel Survey Experiences with Cancer self-administered questionnaire, we evaluated the associations between health insurance literacy and medical financial hardship and nonmedical financial sacrifices among adult cancer survivors in the United States. Of the survivors, 18.9% aged 18-64 years and 14.6% aged 65 years and older reported health insurance literacy problems. In both age groups (18-64 and ≥65 years), from multivariable logistic regressions, survivors with health insurance literacy problems were more likely to report any material (adjusted odds ratio [AOR] = 3.02, 95% confidence interval [CI] = 1.53 to 5.96; AOR = 3.33, 95% CI = 1.69 to 6.57, respectively) or psychological (AOR = 5.53, 95% CI = 2.35 to 13.01; AOR = 8.79, 95% CI = 4.55 to 16.97, respectively) hardship, as well as all types of nonmedical financial sacrifices than those without these problems. Future longitudinal studies are warranted to test causality and assess whether improving health insurance literacy can mitigate financial hardship.
关于癌症幸存者的健康保险素养与经济困难之间的关联，目前所知甚少。我们使用2016年医疗支出小组调查癌症经历自填问卷，评估了美国成年癌症幸存者的健康保险素养与医疗经济困难以及非医疗财务牺牲之间的关联。在这些幸存者中，18.9%的18至64岁者以及14.6%的65岁及以上者报告有健康保险素养问题。在两个年龄组（18至64岁和≥65岁）中，多变量逻辑回归显示，有健康保险素养问题的幸存者比没有这些问题的幸存者更有可能报告任何物质方面（调整后的优势比[AOR]=3.02，95%置信区间[CI]=1.53至5.96；AOR=3.33，95%CI=1.69至6.57）或心理方面（AOR=5.53，95%CI=2.35至13.01；AOR=8.79，95%CI=4.55至16.97）的困难，以及所有类型的非医疗财务牺牲。未来有必要进行纵向研究以检验因果关系，并评估提高健康保险素养是否能减轻经济困难。
