In a study of National Health Interview Survey (NHIS) data reported in JACC: CardioOncology, Valero-Elizondo et al found that U.S. adult patients with atherosclerotic cardiovascular disease (ASCVD) were at greater risk of financial toxicity than those with cancer alone, with risk being the greatest among patients with both ASCVD and cancer.
As stated by the investigators, “Financial toxicity is a well-established side effect of the high costs associated with cancer care. In recent years, studies have suggested that a significant proportion of those with ASCVD experience [financial toxicity] and its consequences.”
Study Details
The study involved data from the NHIS between 2013 and 2018 on adult patients without and with self-reported ASCVD or cancer. Financial toxicity was defined as any of the following: any difficulty paying medical bills, inability to pay bills at all, high financial distress, cost-related medication nonadherence, food insecurity, and foregone/delayed care due to cost.
Multivariate models were adjusted for age, sex, race/ethnicity, family income, education, insurance type, geographic region, cardiovascular risk factor profile, comorbidities, and, where appropriate (high financial distress, cost-related medication nonadherence, food insecurity, and foregone/delayed care due to cost), burden from medical bills.
Results presented in this study are from an analysis in patients aged 18 to younger than 65 years. As stated by the investigators, financial toxicity outcomes among patients aged 65 years and older were similar to those in the younger population.
KEY POINTS
- Greater proportions of patients with ASCVD or ASCVD and cancer reported financial toxicity compared with patients with cancer alone.
- Presence of three or more financial toxicity factors was significantly more common among patients with ASCVD and those with ASCVD and cancer vs those with cancer alone.
Financial Toxicity According to Disease Status
Among 141,826 persons aged 18 to younger than 65 years in the NHIS cohort, 6,887 (weighted prevalence = 4.5%) had cancer, 6,093 (weighted prevalence = 3.8%) had ASCVD, and 971 (weighted prevalence = 0.6%) had both.
Any financial toxicity was reported by 38.3% of those without ASCVD/cancer vs 41.0% with cancer, 54.1% with ASCVD, and 54.5% with both conditions (P < .001 for trend). On multivariate analysis, odds ratios (all significant unless otherwise noted) vs no ASCVD/cancer were 1.12, 1.35, and 1.39, respectively.
Any difficulty paying medical bills was reported by 28% of those with no ASCVD/cancer vs 35% with cancer, 45% with ASCVD, and 47% with both (P < .001 for trend). Odds ratios vs those with no ASCVD/cancer were 1.29, 1.53, and 1.54, respectively.
Inability to pay bills at all was reported by 8% of those with no ASCVD/cancer vs 10%, 18%, and 23% (P < .001 for trend). Odds ratios were 1.29, 1.54, and 2.02.
High financial distress was reported by 26% vs 29%, 42%, and 45% (P < .001 for trend). Odds ratios were 1.03 (not significant), 1.13, and 1.26.
Cost-related medication nonadherence was reported by 11% vs 13%, 20%, and 25% (P < .001 for trend). Odds ratios were 1.17, 1.48, and 1.63.
Food insecurity was reported by 10% vs 10%, 23%, and 26% (P < .001 for trend). Odds ratios were 0.95 (not significant), 1.27, and 1.34.
Foregone/delayed care due to cost was reported by 11% vs 14%, 21%, and 24% (P < .001 for trend). Odds ratios were 1.14, 1.32, and 1.61.
The presence of three or more financial toxicity factors was significantly higher among patients with ASCVD (23%) and those with both ASCVD and cancer (30%) vs those with cancer alone (13%; P < .001).
The investigators concluded, “Our study highlights that financial toxicity is greater among patients with ASCVD compared with those with cancer, with the highest burden among those with both conditions.”
Khurram Nasir, MD, MPH, MSc, of Houston Methodist DeBakey Heart and Vascular Center, Center for Outcomes Research, Houston Methodist, is the corresponding author for the JACC: CardioOncology article.
