Health Disparities
Racial and Ethnic Disparities in Financial Toxicity among Adults with Early-Onset Cancer in the United States Jennifer S. Wang* Jennifer Wang Bijal A. Balasubramanian Qian Xiao Caitlin C. Murphy
Purpose: We examined racial and ethnic disparities in three aspects of financial toxicity—material hardships, coping behaviors, and psychological effects—among adults with early-onset cancer (diagnosed at age 18-49 years).
Methods: Adults with a self-reported history of early-onset cancer were identified from 2019-2023 National Health Interview Survey data. We used three distinct survey questions to measure each aspect of financial toxicity and estimated prevalence of each aspect, overall and by race and ethnicity. Separately for each aspect of financial toxicity, we used multivariable logistic regression models to estimate associations with race and ethnicity. Models were adjusted for age at diagnosis, sex, insurance, education, and health status.
Results: Among 3,394 adults with early-onset cancer (10.3% Hispanic, 78.6% White, 6.3% Black, 2.1% Asian, 2.9% Other or multiple race), common cancer types were skin (31.3%), breast (14.9%), and cervical (13.7%) cancer. Over half (53.8%) of adults experienced at least one aspect of financial toxicity: 17.7% experienced material hardships, 11.8% experienced coping behaviors, and 49.8% experienced psychological effects. By race and ethnicity, prevalence of material hardships, coping behaviors, and psychological effects was higher among Hispanic and non-Hispanic Black adults compared to all other racial and ethnic groups. For example, 26.4% of Hispanic adults and 26.2% of non-Hispanic Black adults had problems paying or were unable to pay medical bills compared to 16.4% of non-Hispanic White adults. In adjusted analyses, results followed similar patterns. For example, Hispanic and non-Hispanic Black adults had 2.17 (95% CI: 1.49, 3.15) and 1.45 (95% CI: 0.87, 2.43) times increased odds, respectively, of being very worried about medical bills compared to non-Hispanic White adults.
Discussion: Hispanic and non-Hispanic Black adults with early-onset cancer disproportionately experienced all three aspects of financial toxicity.