Rural-urban differences in financial burden among cancer survivors: an analysis of a nationally representative survey

• Published in: Supportive care in cancer 2019-12, Vol.27 (12), p.4779-4786
• Main Authors: Zahnd, Whitney E., Davis, Melinda M., Rotter, Jason S., Vanderpool, Robin C., Perry, Cynthia K., Shannon, Jackilen, Ko, Linda K., Wheeler, Stephanie B., Odahowski, Cassie L., Farris, Paige E., Eberth, Jan M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Cancer; Cancer survivors; Cancer Survivors - statistics & numerical data; Care and treatment; Costs; Diagnosis; Female; Health insurance; Humans; Income; Logistic Models; Male; Medical debt; Medical diagnosis; Medicine; Medicine & Public Health; Middle Aged; Neoplasms - economics; Neoplasms - epidemiology; Neoplasms - therapy; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Rehabilitation Medicine; Rural areas; Rural Population - statistics & numerical data; Self Report; Surveys; Survivor; United States - epidemiology; Urban areas; Urban Population - statistics & numerical data; Young Adult
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-019-04742-z

Purpose Rural cancer survivors may disproportionately experience financial problems due to their cancer because of greater travel costs, higher uninsured/underinsured rates, and other factors compared to their urban counterparts. Our objective was to examine rural-urban differences in reported financial problems due to cancer using a nationally representative survey. Methods We used data from three iterations of the National Cancer Institute’s Health Information and National Trends Survey (2012, 2014, and 2017) to identify participants who had a previous or current cancer diagnosis. Our outcome of interest was self-reported financial problems associated with cancer diagnosis and treatment. Rural-urban status was defined using 2003 Rural-Urban Continuum Codes. We calculated weighted percentages and Wald chi-square statistics to assess rural-urban differences in demographic and cancer characteristics. In multivariable logistic regression models, we examined the association between rural-urban status and other factors and financial problems, reporting the corresponding adjusted predicted probabilities. Findings Our sample included 1359 cancer survivors. Rural cancer survivors were more likely to be married, retired, and live in the Midwest or South. Over half (50.5%) of rural cancer survivors reported financial problems due to cancer compared to 38.8% of urban survivors ( p  = 0.02). This difference was attenuated in multivariable models, 49.3 and 38.7% in rural and urban survivors, respectively ( p  = 0.06). Conclusions A higher proportion of rural survivors reported financial problems associated with their cancer diagnosis and treatment compared to urban survivors. Future research should aim to elucidate these disparities and interventions should be tested to address the cancer-related financial problems experienced by rural survivors.