Medical Debt and Related Financial Consequences Among Older African American and White Adults

Wiltshire, Jacqueline; Elder, Keith; Kiefe, Catarina I.; Allison, Jeroan J.

doi:10.2105/ajph.2016.303137

Cited by 30 publications

(26 citation statements)

References 23 publications

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“…Little previous work has focused specifically on financial burden in older cancer survivors. Wiltshire et al reported that odds of medical debt were more than twice as high among older African‐American compared with older white survivors, similar to our findings . Davidoff et al reported that out‐of‐pocket medical costs were higher among Medicare beneficiaries with cancer than without, and that this higher burden was at least partially explained by the presence of comorbidities and lack of supplemental insurance .…”

Section: Discussionsupporting

confidence: 87%

“…Compared with white survivors, black survivors have experienced higher out‐of‐pocket costs, a greater number of financial difficulties, and more financial burden and distress . They were also more likely to file for bankruptcy, experience cancer‐related, and other medical debt, to be contacted by a collection agency and to borrow money to pay for medical debt. Not surprisingly, consistent associations have been demonstrated between low household incomes and financial burden among cancer survivors.…”

Section: Discussionmentioning

confidence: 99%

“…Wiltshire et al reported that odds of medical debt were more than twice as high among older African-American compared with older white survivors, similar to our findings. 34 Davidoff et al reported that out-of-pocket medical costs were higher among Medicare beneficiaries with cancer than without, and that this higher burden was at least partially explained by the presence of comorbidities and lack of supplemental insurance. 35 In an analysis of factors that impact geriatric cancer survivors' quality of life, Pisu et al found that the number of financial hardship events experienced was among the most important predictors of mental health.…”

Section: Discussionmentioning

confidence: 99%

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Financial burden among older, long‐term cancer survivors: Results from the LILAC study

et al. 2018

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BackgroundIncreasing attention is being paid to financial burdens of cancer survivorship, but little is known about the prevalence and predictors of these burdens in older, long‐term survivors.MethodsWe used data from 6012 participants diagnosed with cancer since enrolling in the Women's Health Initiative, and who participated in the Life and Longevity After Cancer (LILAC) ancillary study to estimate prevalence and identify predictors of financial burden. We used logistic regression to identify sociodemographic, socioeconomic, health‐ and cancer‐related factors associated with financial burden and backward selection to build a final multivariable model.ResultsAverage age at LILAC participation was 79 and 9.2 years had elapsed since cancer diagnosis. Overall, 6% experienced some form of financial burden, including having an insurance company refuse a claim (2.6%), being denied loans or insurance due to cancer history (2.2%), or experiencing significant indebtedness (1.8%, including facing large debts or bills or declaring bankruptcy). Eight predictors remained associated (P < 0.05) with financial burden in the fully‐adjusted model: younger age, shorter time since diagnosis, African‐American race, household income <$20 000/year, modified Charlson comorbidity score ≥2, receipt of chemotherapy, regional stage at diagnosis, and no private health insurance. Education, cancer site, social support, receipt of radiation, and receipt of hormone therapy were not associated with financial burden. Predictors differed between types of financial burden experienced and age at diagnosis (<65 vs 65+).ConclusionCancer‐related financial burden was rare in this population of older, female long‐term cancer survivors. The identification of several socioeconomic, health‐related and demographic predictors of financial burden may suggest targets of intervention to reduce financial burdens.PrecisFinancial burden was uncommon in older, female, long‐term survivors. Predictors of financial burden included age, race, income, comorbidities, time since diagnosis, stage, insurance, and receipt of chemotherapy.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Financial burden among older, long‐term cancer survivors: Results from the LILAC study

et al. 2018

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“…When looking at elderly individuals, blacks also tend to be more vulnerable to financial hardship as relates it to medical bills. A national study of elderly individuals demonstrated that blacks had 2.6 times greater odds of having medical debt when compared to whites [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

The Economic Impact of Herpes Zoster Vaccine Disparities in Elderly United States Blacks

Wingate

Stubbs

Ahmed

et al. 2018

IJERPH

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There are persistent disparities with regard to receipt of herpes zoster vaccine among elderly blacks, but no data is available regarding the public health or economic impact of these disparities. A decision tree was constructed with multiple Markov nodes in order to estimate the preventable cases of herpes zoster occurring among elderly blacks due to disparities in receipt of herpes zoster vaccine and to quantify the economic costs associated with these disparities. The model was constructed to examine the number of herpes zoster cases occurring among elderly blacks from the age of 60 to 84 over a 20 year period and also calculated costs due to herpes zoster complications and lost productivity. Achievement of health equity would prevent over 34,500 cases of herpes zoster from occurring in the future and avert over $180 million in lost productivity and treatment costs as a result of these cases of herpes zoster. These results help to show that thousands of cases of herpes zoster could be prevented if blacks were vaccinated at the same frequency as whites and help to show the benefit of implementing viable strategies to achieving this goal.

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“…Even with the decrease in uninsured rates among men, one in five men aged 18–64 years experience difficulty in paying medical bills ( Kaiser’s Men’s Health Survey, 2015 ). Addressing difficulties in paying medical bills has significant implications on one’s debt status ( Wiltshire, Elder, Kiefe, et al., 2016 ). Specifically, the outcomes of a 2019 study by Himmelstein et al found medical-related costs were associated with 66.5% of all bankruptcies, even after the passage of the Affordable Care Act ( Himmelstein et al, 2014 ).…”

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confidence: 99%

Confidence in Understanding Health Insurance and Challenges Paying Medical Bills Among Men in the United States

et al. 2020

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Although the number of men with health insurance has increased, men are less likely to utilize health services than females, and experience difficulty in paying medical bills. Understanding the details of health insurance can be challenging and the lack of understanding can have financial consequences. This study, guided by Andersen’s model of health-care utilization, assessed the relationship between confidence level in understanding health insurance terms and difficulty in paying medical bills among American men. Data were drawn from the Health Reform Monitoring Survey, 2015–2016. The study included 6,643 men aged between 18 and 64. Descriptive statistics examined participants’ difficulty in paying medical bills by predisposing, enabling, and need characteristics, and by confidence in understanding health insurance terms. A modified Poisson regression analysis examined the association between difficulty in paying medical bills, confidence in understanding health insurance terms score, and predisposing, enabling, and need characteristics. An increase in confidence in understanding health insurance terms score was associated with significantly lower reported difficulty in paying medical bills (PR = .98; 95% CI = [.97–.99]; p = .002). Participants with a college degree or higher were less likely to report difficulty in paying their medical bills compared to participants with less than a high school degree (PR = .72; 95% CI = [.56–.92]; p = .009). A better understanding of health insurance might prevent men from experiencing difficulties in paying medical bills. Additional research should be performed to understand the relationship between the level of confidence in understanding health insurance, knowledge level of health insurance terms, use of health insurance, and their impact on difficulty in paying medical bills.

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Medical Debt and Related Financial Consequences Among Older African American and White Adults

Cited by 30 publications

References 23 publications

Financial burden among older, long‐term cancer survivors: Results from the LILAC study

Financial burden among older, long‐term cancer survivors: Results from the LILAC study

The Economic Impact of Herpes Zoster Vaccine Disparities in Elderly United States Blacks

Confidence in Understanding Health Insurance and Challenges Paying Medical Bills Among Men in the United States

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