Transportation barriers to health care and mortality risk among the U.S. adults with history of cancer.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 121-121
Author(s):  
Changchuan Jiang ◽  
Lei Deng ◽  
Qian Wang ◽  
Stuthi Perimbeti ◽  
Xuesong Han
Keyword(s):  
Health Care ◽  
Cancer Survivors ◽  
Medical Care ◽  
Mortality Risk ◽  
Cancer History ◽  
Risk Of Mortality ◽  
Transportation Barriers ◽  
History Of ◽  
Barriers To Health ◽  
History Of Cancer

121 Background: Lack of transportation delayed medical care for approximately 6 million Americans in 2017. Prior studies showed cancer survivors tend to have more healthcare service use, higher medical cost, and adverse clinical outcomes. It is important to understand the prevalence of, risk factors for, and long-term health consequences of transportation barrier to health care among cancer survivors. Methods: We identified cohorts of adult with history of cancer (n = 25,317) and adults without history of cancer (n = 422,797) from the 2000-2014 National Health Interview Survey (NHIS). Transportation barriers were measured as medical care delay due to lack of transportation in the past 12 months using a survey question. The prevalence of transportation barriers was estimated using multivariable logistic models. Risk of mortality estimated with weighted Cox’s proportional hazards models with age as the time scale, adjusting for sex, race/ethnicity, educational attainment, marital status, region, comorbidities, and survey year. All analyses accounted for complex survey design using SAS statistical software, version 9.4 (SAS Institute Inc.), and SAS callable SUDAAN 11.0.3. Results: After adjustment for sociodemographic factors and comorbidities, the prevalence of transportation barrier were significantly higher among cancer survivors than among respondents without cancer history (2.1% vs 1.6%, p = 0.001, adjusted odd ratio [OR], 1.22; 95% confidence interval (95CI): 1.10-1.35). Cancer survivors with transportation barrier were more likely to be younger, female, Hispanic or Asian/Pacific Islander, less educated, unmarried, public insurance beneficiary or uninsured, and with more comorbidities. Among all participants, cancer survivors with transportation barrier had the highest adjusted mortality risk (hazard ratio [HR]: 2.12, 95CI: 1.81-2.49); followed by cancer survivors without transportation barrier (HR: 1.53, 95CI: 1.42-1.65); and adults without a cancer history with transportation barrier (HR: 1.50; 95CI: 1.45-1.55) compared with adults with neither a cancer history nor transportation barrier. Conclusions: Transportation barriers to health care had a disproportionate impact on cancer survivors, especially those who are underserved, and who have more medical needs. Increased risk of mortality was observed among adults with and without a cancer history who delayed care due to lack of transportation. It highlights the need for efforts to mitigate transportation barriers to medical care during a time of rapid change in transportation and telehealth technology.

Racial disparities and medical care accessibility in cancer statistics.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18510-e18510
Author(s):  
Noha Soror ◽  
Amany Keruakous
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Cancer Diagnosis ◽  
Health Care Disparities ◽  
Financial Burden ◽  
P Value ◽  
Annual Income ◽  
History Of ◽  
Prevalence Of Cancer ◽  
History Of Cancer

e18510 Background: Cancer is one of the leading causes of death worldwide. It continues to be the second leading cause of death in the United States despite all national efforts aiming to reduce cancer burden and mortality. Delays in medical care and subsequently age-appropriate screening leads to increased cancer burden which reflect on the overall prognosis. Medical care accessibility has been a challenge that is reported by approximately one third of the USA adult population. We aimed to identify health care disparities and its correlation with prevalence of cancer as well as delays in medical care due to financial challenges among Texas residents. Methods: We analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) 2017. We measured specific health care disparities including patient’s gender, age, race/ethnicity, body mass index (BMI), annual income, alcohol consumption, history of cancer, and delays in medical care due to financial burden, among respondents to the 2017 BRFSS survey from Texas. We computed the difference between our comparison groups using chi-square test for categorical variables and t-test for continuous variables. Results: We analyzed the differences in health care disparities among respondents with and without history of cancer. We report results from 11,165 adult respondents who reside in Texas, among which nine percent were diagnosed with cancer. We noticed a higher proportion of females than males among participants with a history of cancer (64% females p < 0.0001). Age did differ between both groups, with the majority of participants with cancer are aged 50 years and older. Interestingly, BMI did not differ between both groups (p-value = 0.6930). Although annual income did not differ between both groups, twelve percent of participants with cancer diagnosis suffered from delays in medical care due to financial burden. Racial disparities were statistically different between participants with or without cancer (p < .0001). Seventy seven percent of patients with cancer diagnosis were White and non-Hispanic with a cancer prevalence rate of 12% in that racial group. On a stratified analysis to compute the relationship between delayed medical care due to financial burden and cancer diagnosis among all ethnic groups, it was not statistically different (p-value = 0.1063). We showed that prevalence of cancer among multiracial participants and other racial minorities was higher in the group of participants who reported delays in medical care due to financial burden (11% versus 7%). Conclusions: Racial and ethnic disparities could affect accessibility to medical services. Race is a significant variable that is associated with cancer, with higher prevalence of cancer in White and non-Hispanic. Delayed medical care due to financial burden is more pronounced in multiracial population and racial minorities and should be targeted in future quality improvement projects.

scholarly journals COGNITIVE FUNCTIONING AMONG BREAST CANCER SURVIVORS AND NON-CANCER PARTICIPANTS: EVIDENCE FOR SIMILARITIES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S649-S650
Author(s):  
Giancarlo Pasquini ◽  
Brent J Small ◽  
Jacqueline Mogle ◽  
Martin Sliwinski ◽  
Stacey B Scott
Keyword(s):  
Breast Cancer ◽  
Working Memory ◽  
Executive Functioning ◽  
Cancer Survivors ◽  
Cognitive Functioning ◽  
Processing Speed ◽  
Breast Cancer Survivors ◽  
Cancer History ◽  
History Of ◽  
History Of Cancer

Abstract Breast cancer survivors may experience accelerated decline in cognitive functioning compared to same-aged peers with no cancer history (Small et al., 2015). Survivors may show important differences in mean-level performance or variability in cognitive functioning compared to those without a history of cancer (Yao et al., 2016). This study compared ambulatory cognitive functioning in a sample of breast cancer survivors and an age-matched community sample without a history of cancer (n_cancer=47, n_non-cancer=105, age range: 40-64 years, M=52.13 years). Participants completed three cognitive tasks measuring working memory, executive functioning, and processing speed up to five times per day for 14 days. Results indicated no mean-level differences in cognitive performance on the three tasks between cancer survivors and those without cancer history (p’s&gt;.05). Unexpectedly, women without cancer history showed more variability than survivors on working memory but not on the other two tasks. Across both groups, those without a college education performed worse on executive functioning (B=-0.05, SE=0.03, p&lt;.05) and working memory (B=0.94, SE=0.36, p&lt;.05) compared to those that completed college. Additionally, older age was associated with slower processing speed (B=31.67, SE=7.44, p&lt;.001). In sum, this study did not find mean-level group differences in cognitive functioning between cancer survivors and age-matched women without a history of cancer. Contrary to hypotheses, those without a history of cancer were more variable on working memory. Results suggested similarities in cognitive functioning in the two samples and that education and age are important predictors of cognitive functioning independent of cancer history.

Transportation Barriers to Health Care in the United States: Findings From the National Health Interview Survey, 1997–2017

2020 ◽  
Vol 110 (6) ◽  
pp. 815-822 ◽  
Author(s):  
Mary K. Wolfe ◽  
Noreen C. McDonald ◽  
G. Mark Holmes
Keyword(s):  
United States ◽  
Health Care ◽  
Medical Care ◽  
National Health ◽  
National Health Interview Survey ◽  
The United States ◽  
Health Interview Survey ◽  
Transportation Barriers ◽  
Interview Survey ◽  
Barriers To Health

Objectives. To quantify the number of people in the US who delay medical care annually because of lack of available transportation and to examine the differential prevalence of this barrier for adults across sociodemographic characteristics and patient populations. Methods. We used data from the National Health Interview Survey (1997–2017) to examine this barrier over time and across groups. We used joinpoint regression analysis to identify significant changes in trends and multivariate analysis to examine correlates of this barrier for the year 2017. Results. In 2017, 5.8 million persons in the United States (1.8%) delayed medical care because they did not have transportation. The proportion reporting transportation barriers increased between 2003 and 2009 with no significant trends before or after this window within our study period. We found that Hispanic people, those living below the poverty threshold, Medicaid recipients, and people with a functional limitation had greater odds of reporting a transportation barrier after we controlled for other sociodemographic and health characteristics. Conclusions. Transportation barriers to health care have a disproportionate impact on individuals who are poor and who have chronic conditions. Our study documents a significant problem in access to health care during a time of rapidly changing transportation technology.

Job Discrimination Against People With A Cancer History

1995 ◽  
Vol 26 (2) ◽  
pp. 12-16 ◽  
Author(s):  
John V. Conti
Keyword(s):  
Cancer Survivors ◽  
Job Market ◽  
Skill Levels ◽  
Cancer History ◽  
Current Information ◽  
Job Discrimination ◽  
History Of ◽  
History Of Cancer

Job discrimination against persons with a history of cancer is common and is found at all skill levels and throughout all fields of employment. Irrational fears, lack of current information, and distortions in perception prevent counselors, and society in general, from viewing the work potential of persons with a cancer history objectively. Due to significant improvements in the treatment of some forms of cancer, there is a large new group of young cancer survivors in need of guidance and advocacy to enter or re-enter the job market. Legal protections are in place but largely unused by cancer survivors. Suggestions are offeredfor increasing individual and systemic advocacy for this population, and some recommendations for future effort are made.

Is cancer history associated with asset ownership, debt, and net worth in the United States?

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18085-e18085
Author(s):  
Maryam Doroudi ◽  
Diarmuid Coughlan ◽  
Matthew P. Banegas ◽  
K Robin Yabroff
Keyword(s):  
United States ◽  
Cancer Survivors ◽  
The United States ◽  
Medical Expenditure ◽  
Age Group ◽  
Asset Ownership ◽  
Cancer History ◽  
Net Worth ◽  
History Of ◽  
History Of Cancer

e18085 Background: Financial hardships experienced by cancer survivors in the United States have become significant social and public health issues. Few studies have assessed the underlying financial holdings, including ownership and values of assets and debts, of individuals following a cancer diagnosis. This study assessed the association between a cancer history and asset ownership, debt, and net worth. Methods: We identified 1,603 cancer survivors and 34,915 individuals without a history of cancer aged 18-64 from the nationally representative Medical Expenditure Panel Survey (MEPS) Household Component and Asset sections (years 2008-2011). Descriptive statistics were used to assess demographic characteristics, cancer history, asset ownership, debt, and net worth by cancer history. Regression analysis was conducted to assess the association between cancer history and net worth, stratified by age group (18-34, 35-44, 45-54, and 55-64 years) to reflect stages of the life-course. Results: Asset ownership was least common for cancer survivors and individuals without a cancer history in the 18-34 age group and most common in the 55-64 age group. Cancers survivors aged 45-54 had a lower proportion of home ownership than individuals without a cancer history (59% vs 67%; p = 0.001). Nearly 20% of all respondents reported at least some debt. The proportion of cancer survivors with debt was higher than individuals without a history of cancer, especially in the 18-34 age group (41% vs 27%; p < 0.001), although it did not vary by age group. When asset and debt values were combined to assess net worth, cancer survivors aged 45-54 were significantly more likely to have a negative net worth and significantly less likely to have a positive net worth than those individuals without a history of cancer in fully adjusted models. Findings on net worth were similar in the 18-34 age group, although only statistically significant in unadjusted and partially adjusted models. Conclusions: We found that cancer history is associated with asset ownership, debt, and net worth, especially in those aged 45-54 years. Longitudinal studies to assess patterns of financial holdings throughout the cancer experience are warranted.

Population Estimates of Meeting Strength Training and Aerobic Guidelines, by Gender and Cancer Survivorship Status: Findings From the Health Information National Trends Survey (HINTS)

2015 ◽  
Vol 12 (5) ◽  
pp. 675-679 ◽  
Author(s):  
Allison Ottenbacher ◽  
Mandi Yu ◽  
Richard P. Moser ◽  
Siobhan M. Phillips ◽  
Catherine Alfano ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cancer Survivors ◽  
Strength Training ◽  
Health Information ◽  
Population Estimates ◽  
Cancer History ◽  
Aerobic Activity ◽  
History Of ◽  
National Trends ◽  
History Of Cancer

Background:Evidence is building that strength training may reduce complications associated with cancer such as fatigue, muscle wasting, and lymphedema, particularly among breast and prostate cancer survivors. Population estimates are available for rates of aerobic physical activity; however, data on strength training in this population are limited. The objective of this study was to identify rates of meeting public health recommendations for strength training and aerobic activity among cancer survivors and individuals with no cancer history.Methods:Data from the Health Information National Trends Survey (HINTS), Iteration 4 Cycle 1 and Cycle 2 were combined to conduct the analyses. Missing data were imputed, and weighted statistical analyses were conducted in SAS.Results:The proportion of individuals meeting both strength training and aerobic guidelines were low for both cancer survivors and those without a history of cancer. The odds of meeting strength training guidelines were significantly lower for women with a history of any cancer except breast, compared with women with no history of cancer (OR: 0.70, 95% CI: 0.51−0.96).Conclusions:More work needs to be done to understand why women with cancers other than breast, may be less inclined to engage in aerobic physical activity and strength training.

Physical activity participation and functional limitations in geriatric cancer survivors.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9009-9009 ◽  
Author(s):  
Lisa Sprod ◽  
Supriya Gupta Mohile ◽  
Lin Fan ◽  
Michelle Christine Janelsins ◽  
Luke Joseph Peppone ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cancer Survivors ◽  
Functional Limitations ◽  
Community Dwelling ◽  
Cancer History ◽  
Risk Of Recurrence ◽  
History Of ◽  
Geriatric Cancer ◽  
Risk Of Cancer ◽  
History Of Cancer

9009 Background: Functional limitations (FL) increase with age, as does cancer incidence. Treatments for cancer may exacerbate age-related FL. Physical activity (PA) reduces the risk of recurrence of some cancers and may improve survival. FL may reduce PA participation in geriatric cancer survivors (>65 yrs.) which could increase the risk of recurrence and reduce survival. This investigation describes and compares patterns of PA and FL in geriatric cancer survivors versus those without a cancer history. Methods: Using a national sample of community-dwelling elders (> 65 yrs.) from the 2003 Medicare Current Beneficiary Survey (N=14,887), we characterized the differences between cancer survivors and those without a cancer history in FL, current amount of PA, and current amount of PA compared to PA one year prior. Respondents rated FL on a 1-5 scale (1=no difficulty, 5=can’t do): stooping, crouching, or kneeling (stoop), carrying objects up to 10 lbs (lift), extending arms above shoulder level (reach), grasping small objects (grasp), and walking ¼ of a mile (walk). Frequency of walking for a least 10 minutes (1-5 rating scale; 1=daily, 5=never), weekly participation in PA, exercise, or sports (yes/no), and time spent doing moderate or vigorous PA (hrs/wk) were reported. Multivariate logistic regression was used to determine associations. Results: Of the 14,887 participants, 2,603 (6%) reported a history of cancer. Compared to those without a cancer history, a greater proportion of cancer survivors reported having difficulty or being unable to stoop, lift, reach, grasp or walk (all p<0.01). Cancer survivors who had more FL were less likely to engage in PA (all p<0.01). Cancer survivors reported a lower frequency of walking at least 10 minutes at a time (p<0.01). Cancer survivors were more likely to decrease PA from the previous year (p<0.01) and spent less time doing moderate (p=0.01) or vigorous activity (p<0.01) than those without a cancer history. Conclusions: Older cancer survivors engage in less PA and are at greater risk of FL than those without a history of cancer. This may lead to reduced independence, a greater risk of cancer recurrence, and reduced survival. Therefore, PA interventions are important in this population.

scholarly journals Association of Smartphone Ownership and Internet Use With Markers of Health Literacy and Access: Cross-sectional Survey Study of Perspectives From Project PLACE (Population Level Approaches to Cancer Elimination)

10.2196/24947 ◽  
2021 ◽  
Vol 23 (6) ◽  
pp. e24947
Author(s):  
Sachiko M Oshima ◽  
Sarah D Tait ◽  
Samantha M Thomas ◽  
Oluwadamilola M Fayanju ◽  
Kearston Ingraham ◽  
...  
Keyword(s):  
Health Care ◽  
Health Literacy ◽  
Medical Care ◽  
Health Information ◽  
Health Care Access ◽  
Internet Use ◽  
Prior History ◽  
Care Access ◽  
History Of ◽  
History Of Cancer

Background Telehealth is an increasingly important component of health care delivery in response to the COVID-19 pandemic. However, well-documented disparities persist in the use of digital technologies. Objective This study aims to describe smartphone and internet use within a diverse sample, to assess the association of smartphone and internet use with markers of health literacy and health access, and to identify the mediating factors in these relationships. Methods Surveys were distributed to a targeted sample designed to oversample historically underserved communities from April 2017 to December 2017. Multivariate logistic regression was used to estimate the association of internet and smartphone use with outcomes describing health care access and markers of health literacy for the total cohort and after stratifying by personal history of cancer. Health care access was captured using multiple variables, including the ability to obtain medical care when needed. Markers of health literacy included self-reported confidence in obtaining health information. Results Of the 2149 participants, 1319 (61.38%) were women, 655 (30.48%) were non-Hispanic White, and 666 (30.99%) were non-Hispanic Black. The median age was 51 years (IQR 38-65). Most respondents reported using the internet (1921/2149, 89.39%) and owning a smartphone (1800/2149, 83.76%). Compared with the respondents with smartphone or internet access, those without smartphone or internet access were more likely to report that a doctor was their most recent source of health information (344/1800, 19.11% vs 116/349, 33.2% for smartphone and 380/1921, 19.78% vs 80/228, 35.1% for internet, respectively; both P<.001). Internet use was associated with having looked for information on health topics from any source (odds ratio [OR] 3.81, 95% CI 2.53-5.75) and confidence in obtaining health information when needed (OR 1.83, 95% CI 1.00-3.34) compared with noninternet users. Smartphone owners had lower odds of being unable to obtain needed medical care (OR 0.62, 95% CI 0.40-0.95) than nonsmartphone owners. Among participants with a prior history of cancer, smartphone ownership was significantly associated with higher odds of confidence in ability to obtain needed health information (OR 5.63, 95% CI 1.05-30.23) and lower odds of inability to obtain needed medical care (OR 0.17, 95% CI 0.06-0.47), although these associations were not significant among participants without a prior history of cancer. Conclusions We describe widespread use of digital technologies in a community-based cohort, although disparities persist. In this cohort, smartphone ownership was significantly associated with ability to obtain needed medical care, suggesting that the use of smartphone technology may play a role in increasing health care access. Similarly, major illnesses such as cancer have the potential to amplify health engagement. Finally, special emphasis must be placed on reaching patient populations with limited digital access, so these patients are not further disadvantaged in the new age of telehealth.

scholarly journals Association of Smartphone Ownership and Internet Use With Markers of Health Literacy and Access: Cross-sectional Survey Study of Perspectives From Project PLACE (Population Level Approaches to Cancer Elimination) (Preprint)

2020 ◽  
Author(s):  
Sachiko M Oshima ◽  
Sarah D Tait ◽  
Samantha M Thomas ◽  
Oluwadamilola M Fayanju ◽  
Kearston Ingraham ◽  
...  
Keyword(s):  
Health Care ◽  
Health Literacy ◽  
Medical Care ◽  
Health Information ◽  
Health Care Access ◽  
Internet Use ◽  
Prior History ◽  
Care Access ◽  
History Of ◽  
History Of Cancer

BACKGROUND Telehealth is an increasingly important component of health care delivery in response to the COVID-19 pandemic. However, well-documented disparities persist in the use of digital technologies. OBJECTIVE This study aims to describe smartphone and internet use within a diverse sample, to assess the association of smartphone and internet use with markers of health literacy and health access, and to identify the mediating factors in these relationships. METHODS Surveys were distributed to a targeted sample designed to oversample historically underserved communities from April 2017 to December 2017. Multivariate logistic regression was used to estimate the association of internet and smartphone use with outcomes describing health care access and markers of health literacy for the total cohort and after stratifying by personal history of cancer. Health care access was captured using multiple variables, including the ability to obtain medical care when needed. Markers of health literacy included self-reported confidence in obtaining health information. RESULTS Of the 2149 participants, 1319 (61.38%) were women, 655 (30.48%) were non-Hispanic White, and 666 (30.99%) were non-Hispanic Black. The median age was 51 years (IQR 38-65). Most respondents reported using the internet (1921/2149, 89.39%) and owning a smartphone (1800/2149, 83.76%). Compared with the respondents with smartphone or internet access, those without smartphone or internet access were more likely to report that a doctor was their most recent source of health information (344/1800, 19.11% vs 116/349, 33.2% for smartphone and 380/1921, 19.78% vs 80/228, 35.1% for internet, respectively; both <i>P</i>&lt;.001). Internet use was associated with having looked for information on health topics from any source (odds ratio [OR] 3.81, 95% CI 2.53-5.75) and confidence in obtaining health information when needed (OR 1.83, 95% CI 1.00-3.34) compared with noninternet users. Smartphone owners had lower odds of being unable to obtain needed medical care (OR 0.62, 95% CI 0.40-0.95) than nonsmartphone owners. Among participants with a prior history of cancer, smartphone ownership was significantly associated with higher odds of confidence in ability to obtain needed health information (OR 5.63, 95% CI 1.05-30.23) and lower odds of inability to obtain needed medical care (OR 0.17, 95% CI 0.06-0.47), although these associations were not significant among participants without a prior history of cancer. CONCLUSIONS We describe widespread use of digital technologies in a community-based cohort, although disparities persist. In this cohort, smartphone ownership was significantly associated with ability to obtain needed medical care, suggesting that the use of smartphone technology may play a role in increasing health care access. Similarly, major illnesses such as cancer have the potential to amplify health engagement. Finally, special emphasis must be placed on reaching patient populations with limited digital access, so these patients are not further disadvantaged in the new age of telehealth.

Association of cancer history and medical financial hardship with mortality in the United States.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 86-86
Author(s):  
K Robin Yabroff ◽  
Xuesong Han ◽  
Weishan Song ◽  
Jingxuan Zhao ◽  
Ahmedin Jemal ◽  
...  
Keyword(s):  
United States ◽  
Health Insurance ◽  
Cancer Survivors ◽  
Mortality Risk ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Financial Hardship ◽  
Cancer History ◽  
Risk Of Mortality

86 Background: Cancer survivors frequently experience medical financial hardship in the United States. Little is known, however, about its long-term health consequences. In this study, we examine the associations of cancer history, medical financial hardship and mortality in a large nationally representative sample. Methods: We identified cohorts of adults aged 18-64 years (n = 415,114) and 65-79 years (n = 73,571) from the 1997-2014 National Health Interview Survey (NHIS) and the NHIS Linked Mortality Files with vital status through December 31, 2015. Medical financial hardship was measured as problems affording care or delaying or forgoing any medical care due to cost in the past 12 months using survey questions consistently available in all NHIS years. Risk of mortality estimated with weighted Cox’s proportional hazards models with age as the time scale, controlling for the effects of sex, race/ethnicity, educational attainment, marital status, comorbid conditions, region, and survey year. Health insurance coverage was added separately to multivariable models. All estimates accounted for the complex survey design. Results: Among adults aged 18-64 years, 29.6% with and 21.3% without a cancer history reported financial hardship Among adults aged 65-79 years with and without a cancer history, the same percentage reported financial hardship: 11.1%. Among adults aged 18-64 years, cancer survivors with financial hardship had the highest adjusted mortality risk (hazard ratio [HR]: 2.14, 95% confidence interval [95CI]: 1.92-2.37); followed by cancer survivors without medical financial hardship (HR: 1.93, 95CI: 1.81-2.06); and adults without a cancer history with medical financial hardship (HR: 1.36; 95CI: 1.31-1.41) compared with adults with neither a cancer history nor financial hardship. Similar pattern was observed among adults aged 65-79 years: cancer survivors with (HR: 1.62, 95CI: 1.45-1.82) and without (HR: 1.34, 95CI: 1.28-1.24) medical financial hardship and adults without a cancer history with financial hardship (HR: 1.17, 95CI: 1.10-1.24) had elevated mortality risk. Further adjustment for health insurance coverage reduced the magnitude of association of financial hardship and mortality among adults 18-64 years, but further adjustment for insurance had little effect on mortality risk among those aged 65-79 years. Conclusions: Medical financial hardship was associated with increased risk of mortality among adults with and without a cancer history, highlighting the need for efforts to mitigate financial hardship in the United States.

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