Understanding racial differences in financial hardship among older adults surviving cancer.

in Cancer by Elizabeth S Davis, Michael R Poulson, Alaina A Yarbro, Jeffrey A Franks, Smita Bhatia, Kelly M Kenzik

TLDR

  • The study looked at how financial hardship is different for Black and White people who are over 65 and have cancer. The study found that Black people had more financial hardship than White people, mainly because they had lower income and lived in areas with more poverty. The study also found that Black people had more financial hardship in general, including material, psychological, and behavioral hardship. The study suggests that to help Black people with financial hardship, we should focus on improving their income and reducing poverty in the areas where they live.

Abstract

Despite Medicare coverage, financial hardship is a prevalent issue among those diagnosed with cancer at age 65 years and older, particularly among those belonging to a racial or ethnic minority group. Sociodemographic, clinical, and area-level factors may mediate this relationship; however, no studies have assessed the extent to which these factors contribute to the racial/ethnic disparities in financial hardship. Surveys assessing financial hardship were completed by 721 White (84%) or Black (16%) patients (aged 65 years and older) who were diagnosed with breast (34%), prostate (27%), lung (17%), or colorectal (14%) cancer or lymphoma (9%) at the University of Alabama at Birmingham between 2000 and 2019. Financial hardship included material, psychological, and behavioral domains. Nonlinear Blinder-Oaxaca effect decomposition methods were used to evaluate the extent to which individual and area-level factors contribute to racial disparities in financial hardship. Black patients reported lower income (65% vs. 34% earning <$50,000) and greater scores on the Area Deprivation Index (median, 93.0 vs. 55.0). Black patients reported significantly higher rates of overall (39% vs. 18%), material (29% vs. 11%), and psychological (27% vs. 11%) hardship compared with White patients. Overall, the observed characteristics explained 51% of racial differences in financial hardship among cancer survivors, primarily because of differences in income (23%) and area deprivation (11%). The current results identify primary contributors to racial disparities in financial hardship among older cancer survivors, which can be used to develop targeted interventions and allocate resources to those at greatest risk for financial hardship.

Overview

  • The study aims to assess the extent to which sociodemographic, clinical, and area-level factors contribute to racial/ethnic disparities in financial hardship among older cancer survivors in the United States. The study uses surveys completed by 721 White and Black patients diagnosed with various types of cancer at the University of Alabama at Birmingham between 2000 and 2019. Financial hardship is assessed through material, psychological, and behavioral domains. The study uses nonlinear Blinder-Oaxaca effect decomposition methods to evaluate the contribution of individual and area-level factors to racial disparities in financial hardship. The primary objective of the study is to identify primary contributors to racial disparities in financial hardship among older cancer survivors, which can be used to develop targeted interventions and allocate resources to those at greatest risk for financial hardship.

Comparative Analysis & Findings

  • The study found that Black patients reported significantly higher rates of overall, material, and psychological hardship compared with White patients. The observed characteristics explained 51% of racial differences in financial hardship among cancer survivors, primarily because of differences in income (23%) and area deprivation (11%). The study also identified that Black patients reported lower income and greater scores on the Area Deprivation Index compared with White patients. The findings suggest that racial/ethnic disparities in financial hardship among older cancer survivors are primarily driven by differences in income and area deprivation.

Implications and Future Directions

  • The study's findings highlight the importance of addressing financial hardship among older cancer survivors, particularly among those belonging to a racial or ethnic minority group. The study suggests that targeted interventions and resource allocation should focus on addressing income and area deprivation as primary contributors to racial disparities in financial hardship. Future research should explore the impact of other factors, such as clinical characteristics and social support, on financial hardship among older cancer survivors. Additionally, future research should investigate the effectiveness of targeted interventions in reducing financial hardship among older cancer survivors.
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