Waters Austin R, Wheeler Stephanie B, Fine Jeremey, Cheung Christabel K, Tan Kelly R, Rosenstein Donald L, Roberson Mya L, Kent Erin E
Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
J Natl Cancer Inst. 2025 May 1;117(5):997-1007. doi: 10.1093/jnci/djae350.
Lesbian, gay, bisexual, transgender, queer, or another nonheterosexual or cisgender identity (LGBTQ+) cancer survivors experience high financial hardship. However, structural drivers of inequities do not impact all LGBTQ+ individuals equally. Using All of Us data, we conducted an intersectional analysis of behavioral financial hardship among LGBTQ+ cancer survivors.
LGBTQ+ inequities in behavioral financial hardship (ie, cost-related foregone care, delayed care, and medication alterations) and non-cost-related delayed care were estimated using All of Us data. Multivariable logit models were used to generate predicted probabilities, average marginal effects, and 95% confidence intervals. Models were then used to estimate inequities when disaggregating LGBTQ+ status and combing LGBTQ+ status with age, race, ethnicity, and treatment status.
This analysis included N = 36 217 cancer survivors (6.6%, n = 2399 LGBTQ+). In multivariable models, LGBTQ+ identity was associated with higher probabilities of and significant average marginal effects for all types of behavioral financial hardship (foregone care 31.1% vs 19.4%; delayed care 22.6% vs 15.6%; medication alterations 19.2% vs 11.9%) and non-cost delayed care (14.3% vs 7.2%). Within the disaggregated analysis, cisgender bisexual and another/multiple orientation women and gender minority survivors had the highest predicted probabilities of all outcomes. In intersectional analyses, survivors who were aged 18-39 and LGBTQ+, Black and LGBTQ+, or Hispanic/Latine and LGBTQ+ had the highest predicted probabilities of all outcomes.
LGBTQ+ cancer survivors experience significantly more behavioral financial hardship and non-cost-related delayed care than non-LGBTQ+ cancer survivors. Interventions at the individual, system, and policy level are needed to address LGBTQ+ inequities in financial hardship.
女同性恋、男同性恋、双性恋、跨性别者、酷儿或其他非异性恋或顺性别身份（LGBTQ+）的癌症幸存者面临着严重的经济困难。然而，不平等的结构性驱动因素对所有LGBTQ+个体的影响并不相同。利用“我们所有人”项目的数据，我们对LGBTQ+癌症幸存者行为性经济困难进行了交叉分析。
利用“我们所有人”项目的数据估计LGBTQ+在行为性经济困难（即与费用相关的放弃治疗、延迟治疗和药物调整）以及与费用无关的延迟治疗方面的不平等情况。使用多变量逻辑模型生成预测概率、平均边际效应和95%置信区间。然后，在对LGBTQ+身份进行分类以及将LGBTQ+身份与年龄、种族、族裔和治疗状态相结合时，使用这些模型来估计不平等情况。
该分析纳入了N = 36217名癌症幸存者（6.6%，n = 2399名LGBTQ+）。在多变量模型中，LGBTQ+身份与所有类型的行为性经济困难（放弃治疗：31.1%对19.4%；延迟治疗：22.6%对15.6%；药物调整：19.2%对11.9%）以及与费用无关的延迟治疗（14.3%对7.2%）的较高概率和显著平均边际效应相关。在分类分析中，顺性别双性恋和其他/多种性取向女性以及性别少数群体幸存者在所有结果中预测概率最高。在交叉分析中，年龄在18 - 39岁且为LGBTQ+、黑人且为LGBTQ+或西班牙裔/拉丁裔且为LGBTQ+的幸存者在所有结果中预测概率最高。
LGBTQ+癌症幸存者比非LGBTQ+癌症幸存者经历了显著更多的行为性经济困难和与费用无关的延迟治疗。需要在个人、系统和政策层面进行干预，以解决LGBTQ+在经济困难方面的不平等问题。
