Grafova Irina B, Devine Katie A, Hudson Shawna V, O'Malley Denalee, Paddock Lisa E, Bandera Elisa V, Llanos Adana A M, Fong Angela J, Evens Andrew M, Manne Sharon
Edward J. Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA.
Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
J Cancer Surviv. 2024 Dec 11. doi: 10.1007/s11764-024-01730-z.
To examine how household income and county income inequality are linked to financial hardship among cancer survivors.
Cancer survivors (n = 864) identified through the New Jersey State Cancer Registry were surveyed from August 2018 to January 2022. Local area income inequality was reflected by the Gini index a measure of income inequality at the county level. Multivariable logistic regression analyses were performed, and the average marginal effect (AME) was calculated.
Compared to survivors residing in households with income of $90,000 or more (higher income), those with household incomes between $50,000 and $89,999 (middle income) had a significantly higher risk of ever being unable to cover their share of the cost of cancer-related medical care (AME = .104, p = .001), higher risk of foregoing care in the past 12 months because of cost, including dental care (AME = .124, p < .001), eye care (AME = .082, p = .005), and mental health care or counseling (AME = .067, p = .002). An increase in the Gini index from the 25th to 75th percentile was associated with an increased risk of unmet needs in paying for follow-up care or medications related to cancer (AME = .021, p = .014) and an increased risk of foregoing doctor visits (AME = .017, p = .02) and eye care (AME = .03, p = .002) because of cost in the past 12 months.
Local area income inequality was associated with certain aspects of cancer survivors' experience of financial hardship.
It is important to consider refining and extending financial navigation programs to survivors residing in areas with high income inequality.
研究家庭收入和县域收入不平等与癌症幸存者经济困难之间的联系。
2018年8月至2022年1月，对通过新泽西州癌症登记处识别出的癌症幸存者（n = 864）进行了调查。地区收入不平等用基尼指数反映，该指数衡量县级层面的收入不平等情况。进行了多变量逻辑回归分析，并计算了平均边际效应（AME）。
与收入9万美元及以上家庭（高收入）的幸存者相比，收入在5万美元至89,999美元之间（中等收入）的幸存者，曾经无法承担癌症相关医疗费用份额的风险显著更高（AME = 0.104，p = 0.001），过去12个月因费用而放弃治疗的风险更高，包括牙科护理（AME = 0.124，p < 0.001）、眼科护理（AME = 0.082，p = 0.005）以及心理健康护理或咨询（AME = 0.067，p = 0.002）。基尼指数从第25百分位数增加到第75百分位数，与支付癌症后续护理或药物费用方面未满足需求的风险增加相关（AME = 0.021，p = 0.014），以及过去12个月因费用而放弃看医生（AME = 0.017，p = 0.02）和眼科护理（AME = 0.03，p = 0.002）的风险增加相关。
地区收入不平等与癌症幸存者经济困难经历的某些方面相关。
考虑完善并扩展针对居住在高收入不平等地区幸存者的财务指导计划非常重要。
