The Financial Burden of Cancer on Families in the United States
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data Source and Participants
2.2. Measurement
2.2.1. Dependent Variables
2.2.2. Independent Variables
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variables | Total Sample (n = 4407) | Any Diagnosis of Cancer (n = 242) | No Diagnosis of Cancer (n = 4165) | p-Value |
---|---|---|---|---|
Means/Prop. | Means/Prop. | Means/Prop. | ||
Dependent Variables | ||||
OOPC | ||||
Any OOPC | 0.78 | 0.91 | 0.78 | 0.0000 |
[0.76,0.81] | [0.88,0.95] | [0.75,0.80] | ||
Medical Debt | ||||
Any Medical Debt | 0.12 | 0.14 | 0.12 | 0.4289 |
[0.10,0.14] | [0.08,0.21] | [0.10,0.14] | ||
Independent Variables | ||||
Any Diagnosis of Cancer (both the head of household and spouse if married) | 0.056 | 1 | 0 | |
[0.05,0.06] | [1.00,1.00] | [0.00,0.00] | ||
Head of Household | ||||
Sex | ||||
Female | 0.24 | 0.18 | 0.24 | 0.0613 |
[0.21,0.26] | [0.12,0.24] | [0.22,0.27] | ||
Male (reference) | 0.76 | 0.82 | 0.76 | |
[0.74,0.79] | [0.76,0.88] | [0.73,0.78] | ||
Age (categories) | ||||
Age 18–34 Years (reference) | 0.26 | 0.078 | 0.28 | 0.0000 |
[0.25,0.28] | [0.04,0.12] | [0.26,0.29] | ||
Age 35–44 Years | 0.25 | 0.15 | 0.25 | 0.0038 |
[0.23,0.27] | [0.08,0.22] | [0.23,0.27] | ||
Age 45–64 Years | 0.49 | 0.77 | 0.47 | 0.0000 |
[0.47,0.51] | [0.69,0.85] | [0.45,0.49] | ||
Race | ||||
White (reference) | 0.74 | 0.89 | 0.74 | 0.0000 |
[0.69,0.79] | [0.84,0.94] | [0.68,0.79] | ||
Black | 0.14 | 0.049 | 0.14 | 0.0000 |
[0.10,0.18] | [0.02,0.08] | [0.10,0.18] | ||
Hispanic | 0.095 | 0.040 | 0.098 | 0.0044 |
[0.07,0.12] | [0.01,0.07] | [0.07,0.13] | ||
Other | 0.024 | 0.020 | 0.024 | 0.7409 |
[0.02,0.03] | [−0.01,0.04] | [0.02,0.03] | ||
Marital Status | ||||
Married (reference) | 0.56 | 0.70 | 0.55 | 0.0015 |
[0.54,0.58] | [0.61,0.78] | [0.53,0.58] | ||
Never Married | 0.24 | 0.13 | 0.24 | 0.0011 |
[0.22,0.26] | [0.07,0.19] | [0.22,0.27] | ||
Not Married ++ | 0.20 | 0.17 | 0.21 | 0.3330 |
[0.18,0.22] | [0.11,0.24] | [0.19,0.22] | ||
Education | ||||
Years of Education | 14.0 | 14.3 | 14.0 | 0.1212 |
[13.87,14.23] | [13.94,14.74] | [13.85,14.21] | ||
Years of Education 2 | 203.3 | 210.0 | 202.8 | 0.2043 |
[198.62,207.89] | [198.36,221.69] | [198.20,207.49] | ||
Household | ||||
Health Insurance Status | ||||
Employer/Private Coverage (reference) | 0.78 | 0.82 | 0.78 | 0.2323 |
[0.76,0.80] | [0.76,0.88] | [0.76,0.80] | ||
Medicaid | 0.047 | 0.040 | 0.047 | 0.6689 |
[0.04,0.06] | [0.01,0.07] | [0.04,0.06] | ||
Uninsured | 0.17 | 0.14 | 0.17 | 0.3584 |
[0.15,0.18] | [0.08,0.20] | [0.15,0.19] | ||
Other CHCs | ||||
Number of Other CHCs | 0.75 | 1.18 | 0.73 | 0.0001 |
[0.70,0.81] | [0.97,1.40] | [0.67,0.78] | ||
Children | ||||
Number of Dependent Children | 0.81 | 0.49 | 0.83 | 0.0002 |
[0.75,0.86] | [0.33,0.65] | [0.77,0.89] | ||
Geographic Region | ||||
Northeast (reference) | 0.19 | 0.24 | 0.19 | 0.1654 |
[0.12,0.26] | [0.13,0.34] | [0.12,0.26] | ||
North Central | 0.27 | 0.24 | 0.27 | 0.3325 |
[0.19,0.35] | [0.13,0.34] | [0.19,0.35] | ||
South | 0.32 | 0.36 | 0.32 | 0.2175 |
[0.26,0.38] | [0.26,0.47] | [0.26,0.38] | ||
West | 0.22 | 0.16 | 0.22 | 0.0387 |
[0.15,0.29] | [0.09,0.23] | [0.15,0.29] | ||
Geographic Variation | ||||
Urban (reference) | 0.67 | 0.60 | 0.67 | 0.1080 |
[0.61,0.72] | [0.50,0.71] | [0.61,0.73] | ||
Rural | 0.33 | 0.40 | 0.33 | |
[0.28,0.39] | [0.29,0.50] | [0.27,0.39] |
Variables | Total Sample for Amount of OOPC > 0 (n = 3183) | Any Diagnosis of Cancer for Amount of OOPC > 0 (n = 164) | No Diagnosis of Cancer for Amount of OOPC > 0 (n = 3019) | p-Value | Total Sample for Amount of Medical Debt > 0 (n = 639) | Any Diagnosis of Cancer for Amount of Medical Debt > 0 (n = 30) | No Diagnosis of Cancer for Amount of Medical Debt > 0 (n = 609) | p-Value |
---|---|---|---|---|---|---|---|---|
Means/Prop. | Means/Prop. | Means/Prop. | Means/Prop. | Means/Prop. | Means/Prop. | |||
Dependent Variables | ||||||||
OOPC | ||||||||
Any OOPC | 1 | 1 | 1 | 0.79 | 0.84 | 0.78 | 0.4260 | |
[1.00,1.00] | [1.00,1.00] | [1.00,1.00] | [0.74,0.83] | [0.72,0.96] | [0.73,0.83] | |||
Amount of OOPC (OOPC > 0) | 1060.6 | 1765.5 | 1011.1 | 0.0004 | 1196.2 | 1938.4 | 1143 | 0.0214 |
[975.26,1146.03] | [1347.51,2183.51] | [927.40,1094.84] | [987.82,1404.61] | [1270.23,2606.62] | [920.22,1365.70] | |||
Log Amount of OOPC | 6.08 | 6.59 | 6.05 | 0.0000 | 5.07 | 6.1 | 5 | 0.0343 |
[6.01,6.15] | [6.36,6.83] | [5.97,6.12] | [4.72,5.42] | [5.19,7.00] | [4.62,5.37] | |||
Medical Debt | ||||||||
Any Medical Debt | 0.12 | 0.13 | 0.12 | 0.6902 | 1 | 1 | 1 | |
[0.10,0.14] | [0.07,0.19] | [0.10,0.14] | [1.00,1.00] | [1.00,1.00] | [1.00,1.00] | |||
Amount of Medical Debt (Medical Debt > 0) | 1051.2 | 918.6 | 1060.6 | 0.6803 | 9023 | 7257.2 | 9149.7 | 0.4250 |
[714.81,1387.67] | [317.76,1519.40] | [704.31,1416.82] | [7004.93,11041.05] | [2693.55,11820.83] | [7032.23,11267.17] | |||
Log Amount of Medical Debt | 0.94 | 1.04 | 0.94 | 0.6375 | 7.92 | 7.84 | 7.93 | 0.7830 |
[0.79,1.10] | [0.57,1.51] | [0.78,1.09] | [7.76,8.09] | [7.19,8.49] | [7.77,8.09] | |||
Independent Variables | ||||||||
Any Diagnosis of Cancer (both the head of household and spouse if married) | 0.066 | 1 | 0 | 0.067 | 1 | 0 | ||
[0.06,0.08] | [1.00,1.00] | [0.00,0.00] | [0.04,0.09] | [1.00,1.00] | [0.00,0.00] | |||
Head of Household | ||||||||
Sex | ||||||||
Female | 0.22 | 0.17 | 0.22 | 0.1182 | 0.35 | 0.3 | 0.36 | 0.6367 |
[0.20,0.24] | [0.10,0.23] | [0.20,0.25] | [0.30,0.41] | [0.07,0.53] | [0.30,0.41] | |||
Male (reference) | 0.78 | 0.83 | 0.78 | 0.65 | 0.7 | 0.64 | ||
[0.76,0.80] | [0.77,0.90] | [0.75,0.80] | [0.59,0.70] | [0.47,0.93] | [0.59,0.70] | |||
Age (categories) | ||||||||
Age 18–34 Years (reference) | 0.22 | 0.067 | 0.23 | 0.0000 | 0.34 | 0.075 | 0.36 | 0.0000 |
[0.20,0.24] | [0.03,0.11] | [0.21,0.25] | [0.28,0.41] | [−0.01,0.16] | [0.30,0.43] | |||
Age 35–44 Years | 0.25 | 0.15 | 0.26 | 0.0050 | 0.28 | 0.35 | 0.27 | 0.4583 |
[0.23,0.28] | [0.07,0.23] | [0.24,0.29] | [0.23,0.32] | [0.14,0.57] | [0.22,0.32] | |||
Age 45–64 Years | 0.53 | 0.78 | 0.51 | 0.0000 | 0.38 | 0.57 | 0.36 | 0.0779 |
[0.50,0.55] | [0.70,0.86] | [0.48,0.53] | [0.32,0.44] | [0.32,0.82] | [0.31,0.42] | |||
Race | ||||||||
White (reference) | 0.78 | 0.9 | 0.77 | 0.0000 | 0.68 | 0.87 | 0.66 | 0.0090 |
[0.74,0.83] | [0.85,0.95] | [0.73,0.82] | [0.61,0.75] | [0.74,1.00] | [0.59,0.74] | |||
Black | 0.11 | 0.033 | 0.11 | 0.0000 | 0.2 | 0.081 | 0.21 | 0.0178 |
[0.07,0.14] | [0.01,0.06] | [0.08,0.15] | [0.14,0.26] | [−0.02,0.18] | [0.14,0.28] | |||
Hispanic | 0.087 | 0.043 | 0.09 | 0.0217 | 0.1 | 0.048 | 0.11 | 0.2833 |
[0.06,0.11] | [0.01,0.08] | [0.06,0.12] | [0.06,0.15] | [−0.05,0.15] | [0.06,0.16] | |||
Other | 0.023 | 0.022 | 0.023 | 0.9146 | 0.017 | 0 | 0.018 | 0.0070 |
[0.02,0.03] | [−0.01,0.05] | [0.01,0.03] | [0.00,0.03] | [0.00,0.00] | [0.01,0.03] | |||
Marital Status | ||||||||
Married (reference) | 0.62 | 0.72 | 0.61 | 0.0340 | 0.45 | 0.62 | 0.44 | 0.1524 |
[0.59,0.65] | [0.63,0.80] | [0.59,0.64] | [0.39,0.51] | [0.36,0.88] | [0.37,0.50] | |||
Never Married | 0.19 | 0.13 | 0.19 | 0.0783 | 0.3 | 0.12 | 0.31 | 0.0734 |
[0.16,0.21] | [0.06,0.20] | [0.17,0.22] | [0.23,0.36] | [−0.10,0.35] | [0.25,0.37] | |||
Not Married ++ | 0.19 | 0.15 | 0.19 | 0.2548 | 0.25 | 0.26 | 0.25 | 0.9883 |
[0.17,0.21] | [0.09,0.22] | [0.17,0.22] | [0.21,0.30] | [0.02,0.49] | [0.21,0.30] | |||
Education | ||||||||
Years of Education | 14.2 | 14.4 | 14.2 | 0.2054 | 12.9 | 13.1 | 12.9 | 0.5267 |
[14.01,14.36] | [14.00,14.84] | [13.99,14.34] | [12.61,13.13] | [12.31,13.94] | [12.57,13.13] | |||
Years of Education 2 | 206.8 | 212.2 | 206.4 | 0.3130 | 171.4 | 174.7 | 171.1 | 0.7604 |
[202.15,211.44] | [199.99,224.32] | [201.83,211.00] | [165.52,177.20] | [152.14,197.26] | [164.83,177.40] | |||
Household | ||||||||
Health Insurance Status | ||||||||
Employer/Private Coverage (reference) | 0.85 | 0.86 | 0.85 | 0.7435 | 0.59 | 0.67 | 0.59 | 0.3803 |
[0.83,0.87] | [0.80,0.92] | [0.83,0.87] | [0.53,0.66] | [0.46,0.89] | [0.53,0.65] | |||
Medicaid | 0.022 | 0.0061 | 0.023 | 0.0054 | 0.081 | 0.095 | 0.08 | 0.7672 |
[0.01,0.03] | [−0.00,0.02] | [0.02,0.03] | [0.05,0.11] | [−0.00,0.19] | [0.05,0.11] | |||
Uninsured | 0.12 | 0.13 | 0.12 | 0.7252 | 0.32 | 0.23 | 0.33 | 0.3269 |
[0.11,0.14] | [0.07,0.20] | [0.11,0.14] | [0.26,0.38] | [0.02,0.44] | [0.27,0.38] | |||
Other CHCs | ||||||||
Number of Other CHCs | 0.81 | 1.16 | 0.79 | 0.0014 | 1.06 | 1.75 | 1.01 | 0.0241 |
[0.75,0.87] | [0.94,1.38] | [0.72,0.85] | [0.91,1.20] | [1.09,2.41] | [0.86,1.15] | |||
Children | ||||||||
Number of Dependent Children | 0.8 | 0.45 | 0.83 | 0.0001 | 0.84 | 0.5 | 0.87 | 0.0137 |
[0.74,0.86] | [0.27,0.62] | [0.77,0.89] | [0.73,0.96] | [0.23,0.76] | [0.74,0.99] | |||
Geographic Region | ||||||||
Northeast (reference) | 0.2 | 0.23 | 0.2 | 0.3307 | 0.11 | 0.12 | 0.11 | 0.9310 |
[0.12,0.28] | [0.13,0.34] | [0.12,0.27] | [0.04,0.17] | [−0.11,0.34] | [0.05,0.17] | |||
North Central | 0.27 | 0.24 | 0.27 | 0.3749 | 0.31 | 0.4 | 0.31 | 0.3652 |
[0.19,0.35] | [0.13,0.35] | [0.19,0.35] | [0.21,0.42] | [0.17,0.62] | [0.20,0.41] | |||
South | 0.32 | 0.37 | 0.32 | 0.1528 | 0.39 | 0.31 | 0.4 | 0.3926 |
[0.26,0.38] | [0.26,0.47] | [0.25,0.38] | [0.30,0.49] | [0.05,0.57] | [0.31,0.50] | |||
West | 0.21 | 0.16 | 0.21 | 0.0846 | 0.18 | 0.18 | 0.18 | 0.9442 |
[0.14,0.28] | [0.09,0.24] | [0.14,0.29] | [0.09,0.28] | [0.00,0.36] | [0.09,0.28] | |||
Geographic Variation | ||||||||
Urban (reference) | 0.67 | 0.61 | 0.67 | 0.1241 | 0.56 | 0.27 | 0.58 | 0.0057 |
[0.61,0.73] | [0.50,0.71] | [0.61,0.73] | [0.47,0.64] | [0.04,0.51] | [0.49,0.66] | |||
Rural | 0.33 | 0.39 | 0.33 | 0.1241 | 0.44 | 0.73 | 0.42 | |
[0.27,0.39] | [0.29,0.50] | [0.27,0.39] | [0.36,0.53] | [0.49,0.96] | [0.34,0.51] |
Variable | Odds Ratios | Log Amount | ||
---|---|---|---|---|
Any OOPC (n = 4407) | Any Medical Debt (n = 4407) | OOPC (n = 3183) | Medical Debt (n = 639) | |
Any Diagnosis of Cancer (both the head of household and spouse if married) | 2.13 *** | 1.55 * | 1.73 *** | 0.87 |
[1.27,3.57] | [0.93,2.58] | [1.33,2.25] | [0.47,1.62] | |
Sex (Male) | ||||
Female | 1.53 *** | 2.02 *** | 1.19 | 1.28 |
[1.13,2.06] | [1.32,3.08] | [0.88,1.61] | [0.83,1.98] | |
Age (categories) (Ref: Age 18–34 years) | ||||
Age 35–44 Years | 1.58 *** | 0.77 | 1.11 | 1.35 |
[1.21,2.07] | [0.53,1.12] | [0.91,1.35] | [0.91,2.00] | |
Age 45–64 Years | 1.72 *** | 0.40 *** | 1.18 | 1.41 * |
[1.33,2.23] | [0.27,0.59] | [0.96,1.46] | [0.93,2.13] | |
Race (Ref: White) | ||||
Black | 0.46 *** | 1.24 | 0.81 | 1.4 |
[0.34,0.63] | [0.86,1.78] | [0.61,1.08] | [0.93,2.10] | |
Hispanic | 0.87 | 0.79 | 0.66 *** | 0.75 |
[0.59,1.29] | [0.47,1.32] | [0.53,0.82] | [0.44,1.28] | |
Other | 0.7 | 1.16 | 1.04 | 2.78 * |
[0.34,1.44] | [0.54,2.48] | [0.74,1.45] | [0.83,9.34] | |
Marital Status (Married) | ||||
Never Married | 0.40 *** | 1.07 | 0.57 *** | 0.77 |
[0.28,0.57] | [0.70,1.64] | [0.45,0.73] | [0.46,1.31] | |
Not Married ++ | 0.45 *** | 1.17 | 0.71 *** | 1.12 |
[0.31,0.66] | [0.69,1.98] | [0.57,0.88] | [0.70,1.79] | |
Education | ||||
Years of Education | 1.01 | 1.16 | 0.91 | 0.99 |
[0.79,1.29] | [0.86,1.59] | [0.80,1.04] | [0.82,1.20] | |
Years of Education 2 | 1 | 0.99 ** | 1 | 1 |
[0.99,1.01] | [0.97,1.00] | [1.00,1.01] | [0.99,1.00] | |
Health Insurance Status (Employer/Private Coverage) | ||||
Medicaid | 0.12 *** | 1.14 | 0.57 ** | 1.77 * |
[0.08,0.18] | [0.70,1.87] | [0.38,0.88] | [0.95,3.27] | |
Uninsured | 0.34 *** | 1.77 *** | 1.2 | 2.20 *** |
[0.25,0.47] | [1.29,2.42] | [0.94,1.54] | [1.49,3.25] | |
Other CHCs | ||||
Log Number of Other CHCs | 1.59 *** | 2.27 *** | 1.22 *** | 1.57 *** |
[1.22,2.08] | [1.80,2.87] | [1.06,1.41] | [1.14,2.17] | |
Children | ||||
Log Number of Children | 1 | 1 | 1.41 *** | 1.28 |
[0.79,1.27] | [0.77,1.30] | [1.21,1.65] | [0.94,1.74] | |
Geographic Region (Northeast) | ||||
North Central | 0.89 | 1.66 ** | 1.31 ** | 2.06 ** |
[0.62,1.29] | [1.11,2.47] | [1.00,1.73] | [1.08,3.93] | |
South | 0.91 | 1.89 *** | 1.2 | 1.54 |
[0.63,1.31] | [1.31,2.73] | [0.95,1.52] | [0.84,2.84] | |
West | 0.81 | 1.41 | 1.1 | 1.13 |
[0.55,1.21] | [0.83,2.40] | [0.85,1.43] | [0.60,2.11] | |
Geographic Variation (Urban) | ||||
Rural | 0.96 | 1.41 *** | 1.08 | 0.94 |
[0.74,1.26] | [1.13,1.77] | [0.91,1.28] | [0.64,1.38] |
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Richard, P.; Patel, N.; Lu, Y.-C.; Walker, R.; Younis, M. The Financial Burden of Cancer on Families in the United States. Int. J. Environ. Res. Public Health 2021, 18, 3790. https://doi.org/10.3390/ijerph18073790
Richard P, Patel N, Lu Y-C, Walker R, Younis M. The Financial Burden of Cancer on Families in the United States. International Journal of Environmental Research and Public Health. 2021; 18(7):3790. https://doi.org/10.3390/ijerph18073790
Chicago/Turabian StyleRichard, Patrick, Nilam Patel, Yuan-Chiao Lu, Regine Walker, and Mustafa Younis. 2021. "The Financial Burden of Cancer on Families in the United States" International Journal of Environmental Research and Public Health 18, no. 7: 3790. https://doi.org/10.3390/ijerph18073790