Abstract Background Cancer survivors frequently experience medical financial hardship in the United States. Little is known, however, about long-term health consequences. This study examines the associations of financial hardship and mortality in a large nationally representative sample of cancer survivors. Methods We identified cancer survivors aged 18-64 years (n = 14 917) and 65-79 years (n = 10 391) from the 1997-2014 National Health Interview Survey and its linked mortality files with vital status through December 31, 2015. Medical financial hardship was measured as problems affording care or delaying or forgoing any care because of cost in the past 12 months. Risk of mortality was estimated with separate weighted Cox proportional hazards models by age group with age as the timescale, controlling for the effects of sociodemographic characteristics. Health insurance coverage was added sequentially to multivariable models. Results Among cancer survivors aged 18-64 years and 65-79 years, 29.6% and 11.0%, respectively, reported financial hardship in the past 12 months. Survivors with hardship had higher adjusted mortality risk than their counterparts in both age groups: 18-64 years (hazard ratio [HR] = 1.17, 95% confidence interval [CI] = 1.04 to 1.30) and 65-79 years (HR = 1.14, 95% CI = 1.02 to 1.28). Further adjustment for health insurance reduced the magnitude of association of hardship and mortality among survivors aged 18-64 years (HR = 1.09, 95% CI = 0.97 to 1.24). Adjustment for supplemental Medicare coverage had little effect among survivors aged 65-79 years (HR = 1.15, 95% CI = 1.02 to 1.29). Conclusion Medical financial hardship was associated with mortality risk among cancer survivors in the United States.

中文翻译：

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美国癌症幸存者医疗经济困难和死亡率协会

摘要 背景在美国，癌症幸存者经常遇到医疗经济困难。然而，人们对长期健康后果知之甚少。这项研究在全国范围内具有代表性的癌症幸存者样本中考察了经济困难与死亡率之间的关联。 方法我们从 1997-2014 年全国健康访谈调查及其截至 2015 年 12 月 31 日的生命状况相关死亡率档案中确定了年龄为 18-64 岁 (n = 14 917) 和 65-79 岁 (n = 10 391) 的癌症幸存者。经济困难的衡量标准是过去 12 个月内因费用原因而无法提供护理或延迟或放弃任何护理。死亡风险通过年龄组的单独加权 Cox 比例风险模型进行估计，以年龄为时间尺度，控制社会人口学特征的影响。健康保险覆盖范围依次添加到多变量模型中。 结果在18-64岁和65-79岁的癌症幸存者中，分别有29.6%和11.0%的人表示在过去12个月内遇到过经济困难。在两个年龄组中，困难幸存者的调整后死亡风险均高于同行：18-64 岁（风险比 [HR] = 1.17，95% 置信区间 [CI] = 1.04 至 1.30）和 65-79 岁（HR = 1.14） ，95% CI = 1.02 至 1.28）。健康保险的进一步调整降低了 18-64 岁幸存者的困难和死亡率之间的关联程度（HR = 1.09，95% CI = 0.97 至 1.24）。补充医疗保险覆盖范围的调整对 65-79 岁的幸存者影响不大（HR = 1.15，95% CI = 1.02 至 1.29）。 结论在美国，医疗经济困难与癌症幸存者的死亡风险相关。