Financial Hardship by Age at Diagnosis Including in Young Adulthood among African American Cancer Survivors

Hastert, Theresa A.; Ruterbusch, Julie J.; Abrams, Judith; Nair, Mrudula; Wenzlaff, Angela S.; Beebe‐Dimmer, Jennifer L.; Pandolfi, Stephanie; Schwartz, Ann G.

doi:10.1158/1055-9965.epi-21-0739

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…All these increase the morbidity and mortality of populations [ 25 , 88 , 106 , 107 , 113 ]. Thus, the harm associated with financial strain has been widespread and sustained [ 114 , 115 , 116 ]. Financial strain also causes biological and social decline [ 92 ].…”

Section: Discussionmentioning

confidence: 99%

Social Determinants of Mental, Physical, and Oral Health of Middle-Aged and Older African Americans in South Los Angeles

Adinkrah

Najand²,

Rahmani³

et al. 2022

IJERPH

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Background. A growing body of research suggests that financial difficulties could weaken the protective effects of socioeconomic status (SES) indicators, including education and income, on the health status of marginalized communities, such as African Americans. Aim. We investigated the separate and joint effects of education, income, and financial difficulties on mental, physical, and oral self-rated health (SRH) outcomes in African American middle-aged and older adults. Methods. This cross-sectional study enrolled 150 middle-aged and older African Americans residing in South Los Angeles. Data on demographic factors (age and gender), socioeconomic characteristics (education, income, and financial difficulties), and self-rated health (mental, physical, and oral health) were collected. Three linear regression models were used to analyze the data. Results. Higher education and income were associated with a lower level of financial strain in a bivariate analysis. However, according to multivariable models, only financial difficulties were associated with poor mental, physical, and oral health. As similar patterns emerged for all three health outcomes, the risk associated with financial difficulties seems robust. Conclusions. According to our multivariable models, financial strain is a more salient social determinant of health within African American communities than education and income in economically constrained urban environments such as South Los Angeles. While education and income lose some protective effects, financial strain continues to deteriorate the health of African American communities across domains.

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Section: Discussionmentioning

confidence: 99%

Social Determinants of Mental, Physical, and Oral Health of Middle-Aged and Older African Americans in South Los Angeles

Adinkrah

Najand²,

Rahmani³

et al. 2022

IJERPH

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“…90 The high cost of treatment for many cancer types 91,92 and increases in private health insurance plans' cost sharing 93,94 can make treatments less affordable to individuals with limited incomes or no or suboptimal insurance, and many individuals with cancer experience challenges in paying for their treatments. 95,96 This financial hardship or financial toxicity results in higher prevalence of financial distress, asset depletion, medical debt, and bankruptcy, especially among people of color and of lower SES, [95][96][97][98] and has been Ever cigarette smoking was defined as smoking at least 100 cigarettes in a lifetime. Current cigarette smoking was defined as smoking at least 100 cigarettes in a lifetime and currently smoking every day or some days.…”

Section: Disparities In Receipt Of Treatmentmentioning

confidence: 99%

American Cancer Society’s report on the status of cancer disparities in the United States, 2023

Islami,

Baeker Bispo,

Lee

et al. 2023

CA A Cancer J Clinicians

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In 2021, the American Cancer Society published its first biennial report on the status of cancer disparities in the United States. In this second report, the authors provide updated data on racial, ethnic, socioeconomic (educational attainment as a marker), and geographic (metropolitan status) disparities in cancer occurrence and outcomes and contributing factors to these disparities in the country. The authors also review programs that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. There are substantial variations in risk factors, stage at diagnosis, receipt of care, survival, and mortality for many cancers by race/ethnicity, educational attainment, and metropolitan status. During 2016 through 2020, Black and American Indian/Alaska Native people continued to bear a disproportionately higher burden of cancer deaths, both overall and from major cancers. By educational attainment, overall cancer mortality rates were about 1.6–2.8 times higher in individuals with ≤12 years of education than in those with ≥16 years of education among Black and White men and women. These disparities by educational attainment within each race were considerably larger than the Black–White disparities in overall cancer mortality within each educational attainment, ranging from 1.03 to 1.5 times higher among Black people, suggesting a major role for socioeconomic status disparities in racial disparities in cancer mortality given the disproportionally larger representation of Black people in lower socioeconomic status groups. Of note, the largest Black–White disparities in overall cancer mortality were among those who had ≥16 years of education. By area of residence, mortality from all cancer and from leading causes of cancer death were substantially higher in nonmetropolitan areas than in large metropolitan areas. For colorectal cancer, for example, mortality rates in nonmetropolitan areas versus large metropolitan areas were 23% higher among males and 21% higher among females. By age group, the racial and geographic disparities in cancer mortality were greater among individuals younger than 65 years than among those aged 65 years and older. Many of the observed racial, socioeconomic, and geographic disparities in cancer mortality align with disparities in exposure to risk factors and access to cancer prevention, early detection, and treatment, which are largely rooted in fundamental inequities in social determinants of health. Equitable policies at all levels of government, broad interdisciplinary engagement to address these inequities, and equitable implementation of evidence‐based interventions, such as increasing health insurance coverage, are needed to reduce cancer disparities.

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“…19 Younger age at diagnosis has consistently been identified as a risk factor for financial hardship because of cancer, 20,21 and this is particularly pronounced for young adult survivors. 22 In addition, a cancer diagnosis can affect young adults' ability to complete their desired level of education or professional training and has implications for long-term career development and potential earnings 23 as well as future access to employer-sponsored health insurance. 24 Little is known about the association between age at diagnosis and experience of social risks among people with cancer.…”

Section: Introductionmentioning

confidence: 99%

“…Young adults represent a financially fragile population, with the lowest levels of wealth, job security, and employer‐provided benefits of any age group in the United States, 16–18 and the wealth gap between households headed by older adults compared with younger adults has widened in recent years 19 . Younger age at diagnosis has consistently been identified as a risk factor for financial hardship because of cancer, 20,21 and this is particularly pronounced for young adult survivors 22 . In addition, a cancer diagnosis can affect young adults’ ability to complete their desired level of education or professional training and has implications for long‐term career development and potential earnings 23 as well as future access to employer‐sponsored health insurance 24 …”

Section: Introductionmentioning

confidence: 99%

Age at diagnosis and social risks among Black cancer survivors: Results from the Detroit Research on Cancer Survivors cohort

Hastert,

McDougall,

Robinson

et al. 2024

Cancer

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BackgroundSocial risks are common among cancer survivors who have the fewest financial resources; however, little is known about how prevalence differs by age at diagnosis, despite younger survivors’ relatively low incomes and wealth.MethodsThe authors used data from 3703 participants in the Detroit Research on Cancer Survivors (ROCS) cohort of Black cancer survivors. Participants self‐reported several forms of social risks, including food insecurity, housing instability, utility shut‐offs, not getting care because of cost or lack of transportation, and feeling unsafe in their home neighborhood. Modified Poisson models were used to estimate prevalence ratios and 95% confidence intervals (CIs) of social risks by age at diagnosis, controlling for demographic, socioeconomic, and cancer‐related factors.ResultsOverall, 35% of participants reported at least one social risk, and 17% reported two or more risks. Social risk prevalence was highest among young adults aged 20–39 years (47%) followed by those aged 40–54 years (43%), 55–64 years (38%), and 65 years and older (24%; p for trend < .001). Compared with survivors who were aged 65 years and older at diagnosis, adjusted prevalence ratios for any social risk were 1.75 (95% CI, 1.42–2.16) for survivors aged 20–39 years, 1.76 (95% CI, 1.52–2.03) for survivors aged 40–54 years, and 1.41 (95% CI, 1.23–1.60) for survivors aged 55‐64 years at diagnosis. Similar associations were observed for individual social risks and experiencing two or more risks.ConclusionsIn this population of Black cancer survivors, social risks were inversely associated with age at diagnosis. Diagnosis in young adulthood and middle age should be considered a risk factor for social risks and should be prioritized in work to reduce the financial effects of cancer on financially vulnerable cancer survivors.

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Financial Hardship by Age at Diagnosis Including in Young Adulthood among African American Cancer Survivors

Cited by 6 publications

References 31 publications

Social Determinants of Mental, Physical, and Oral Health of Middle-Aged and Older African Americans in South Los Angeles

Social Determinants of Mental, Physical, and Oral Health of Middle-Aged and Older African Americans in South Los Angeles

American Cancer Society’s report on the status of cancer disparities in the United States, 2023

Age at diagnosis and social risks among Black cancer survivors: Results from the Detroit Research on Cancer Survivors cohort

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