Racial and Ethnic Differences in the Financial Consequences of Cancer-Related Employment Disruption

IntroductionCancer-related employment disruption contributes to financial toxicity and associated clinical outcomes through income loss and changes in health insurance and may not be uniformly experienced. We examined racial/ethnic differences in the financial consequences of employment disruption.MethodsWe surveyed a national sample of cancer patients employed at diagnosis who had received assistance from a national nonprofit about the impact of cancer diagnosis and treatment on employment. We used logistic regression models to examine racial/ethnic differences in income loss and changes in health insurance coverage.ResultsOf 619 cancer patients included, 63% identified as Non-Hispanic/Latinx (NH) White, 18% as NH Black, 9% as Hispanic/Latinx, 5% as other racial/ethnic identities, and 5% unreported. Over 83% reported taking a significant amount of time off from work during cancer diagnosis and treatment, leading to substantial income loss for 64% and changes in insurance coverage for 31%. NH Black respondents had a 10.2 percentage point (95% CI: 4.8 – 19.9) higher probability of experiencing substantial income loss compared to NH White respondents, and Hispanic or Latinx respondents had a 12.4 percentage point (95% CI: 0.3 – 24.5) higher probability compared to NH White respondents, controlling for clinical characteristics (i.e., cancer type, stage and age at diagnosis, and time since diagnosis). Similarly, NH Black respondents had a 9.3 percentage point (95% CI: -0.7 – 19.3) higher probability of experiencing changes in health insurance compared to NH White respondents, and Hispanic or Latinx respondents had a 10.0 percentage point (95% CI: -3.0 – 23.0) higher probability compared to NH White respondents.DiscussionCompared with NH White respondents, NH Black and Hispanic/Latinx respondents more commonly reported employment-related income loss and health insurance changes. Given documented racial/ethnic differences in job types, benefit generosity, and employment protections as a result of historic marginalization, policies to reduce employment disruption and its associated financial impact must be developed with a racial equity lens.

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Racial/ethnic differences in health insurance adequacy and consistency among children: Evidence from the 2011/12 National Survey of Children’s Health

Journal of Public Health Research ◽

10.4081/jphr.2018.1280 ◽

2018 ◽

Cited By ~ 2

Author(s):

Tulay G. Soylu ◽

Eman Elashkar ◽

Fatemah Aloudah ◽

Munir Ahmed ◽

Panagiota Kitsantas

Keyword(s):

Health Insurance ◽

Ethnic Differences ◽

National Survey ◽

Underserved Populations ◽

Insurance Coverage ◽

Black Children ◽

Children's Health ◽

Children’S Health ◽

Race Ethnicity ◽

Racial Ethnic

Background: Surveillance of disparities in healthcare insurance, services and quality of care among children are critical for properly serving the medical/healthcare needs of underserved populations. The purpose of this study was to assess racial/ethnic differences in children’s (0 to 17 years old) health insurance adequacy and consistency (child has insurance coverage for the last 12 months). Design and methods: We used data from the 2011/2012 National Survey of Children’s Health (n=79,474). Descriptive statistics and logistic regression analyses were conducted to examine the distribution and influence of several sociodemographic/family related factors on insurance adequacy and consistency across different racial/ethnic groups. Results: Stratified analyses by race/ethnicity revealed that white and black children living in households at or below 299% of the Federal Poverty Level (FPL) were approximately 29 to 42% less likely to have adequate insurance compared to children living in families of higher income levels. Regardless of race/ethnicity, we found that children with public health insurance were more likely to have adequate insurance than their privately insured counterparts, while adolescents were at greater risk of inadequate coverage. Hispanic and black children were more likely to lack consistent insurance coverage. Conclusions: This study provides evidence that racial/ethnic differences in adequate and consistent health insurance exists with both white and minority children being affected adversely by poverty. Establishing outreach programs for low income families, and cross-cultural education for healthcare providers may help increase health insurance adequacy and consistency within certain underserved populations.

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Long-term employment outcomes among partners of patients with early-stage breast cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.7_suppl.12 ◽

2016 ◽

Vol 34 (7_suppl) ◽

pp. 12-12

Author(s):

Christine Marie Veenstra ◽

Lauren P. Wallner ◽

Cathy Bradley ◽

Sarah T. Hawley

Keyword(s):

Breast Cancer ◽

Health Insurance ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Early Stage ◽

Breast Cancer Diagnosis ◽

Employment Outcomes ◽

Diagnosis And Treatment ◽

Breast Cancer Patients

12 Background: Undesired work loss comprises one of the many personal costs faced by cancer patients and their families. Multiple studies have described the long-term employment outcomes among patients with early-stage breast cancer, and show that a significant proportion of women face long-term job loss as a result of their cancer diagnosis and treatment. However, little is known about the employment outcomes of partners of breast cancer patients. Methods: Women with non-metastatic breast cancer identified by the Detroit and Los Angeles SEER registries between 6/05-2/07 were surveyed at 9 months (Time 1) and 4 years (Time 2) after diagnosis. Latina and black women were oversampled. Partners were surveyed at Time 2. We performed descriptive analyses of those partners who were not retired at the time they completed the survey. As part of a larger survey assessing the experiences of partners of breast cancer patients, partners were queried regarding the impact of the patient’s breast cancer diagnosis and treatment on their own employment and finances. Results: Of 774 eligible partners, 517 (67%) completed the survey. We included 280 non-retired partners in our analyses. 54% were white, 31% were Latino, and 10% were black. The majority of partners (86%) worked during the year following the patient’s diagnosis and 219 (90%) were working at the time of survey 4 years post-diagnosis. 50% of partners reported that work was a welcome source of support; 32% decreased their work hours as a result of the patient’s breast cancer. In order to maintain health insurance, 64% reported it was very/extremely important to keep their jobs and 51% reported it was very/extremely important to avoid changing jobs. 32% of partners reported their financial status was worse off because of the patient’s breast cancer; 20% were worse off regarding health insurance, and 19% were worse off regarding employment status. Conclusions: In contrast to breast cancer patients, most partners reported long-term job retention. Many partners kept working or avoided changing jobs in order to maintain health insurance. Nearly one-third of partners reported that their financial status was worse off because of the patient’s breast cancer diagnosis and treatment.

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What mediates the racial/ethnic disparity in psychosocial stress among breast cancer patients?

Cancer Causes & Control ◽

10.1007/s10552-021-01392-7 ◽

2021 ◽

Author(s):

C. T. Sánchez-Díaz ◽

S. Strayhorn ◽

S. Tejeda ◽

G. Vijayasiri ◽

G. H. Rauscher ◽

...

Keyword(s):

Breast Cancer ◽

Social Support ◽

Cancer Patients ◽

Cancer Diagnosis ◽

Psychosocial Stress ◽

Breast Cancer Diagnosis ◽

Support Needs ◽

Breast Cancer Patients ◽

Hispanic Patients ◽

Racial Ethnic

Abstract Background Prior studies have observed greater levels of psychosocial stress (PSS) among non-Hispanic (nH) African American and Hispanic women when compared to nH White patients after a breast cancer diagnosis. We aimed to determine the independent and interdependent roles of socioeconomic position (SEP) and unmet support in the racial disparity in PSS among breast cancer patients. Methods Participants were recruited from the Breast Cancer Care in Chicago study (n = 989). For all recently diagnosed breast cancer patients, aged 25–79, income, education, and tract-level disadvantage and affluence were summed to create a standardized socioeconomic position (SEP) score. Three measures of PSS related to loneliness, perceived stress, and psychological consequences of a breast cancer diagnosis were defined based on previously validated scales. Five domains of unmet social support needs (emotional, spiritual, informational, financial, and practical) were defined from interviews. We conducted path models in MPlus to estimate the extent to which PSS disparities were mediated by SEP and unmet social support needs. Results Black and Hispanic patients reported greater PSS compared to white patients and greater unmet social support needs (p = 0.001 for all domains). Virtually all of the disparity in PSS could be explained by SEP. A substantial portion of the mediating influence of SEP was further transmitted by unmet financial and practical needs among Black patients and by unmet emotional needs for Hispanic patients. Conclusions SEP appeared to be a root cause of the racial/ethnic disparities in PSS within our sample. Our findings further suggest that different interventions may be necessary to alleviate the burden of SEP for nH AA (i.e., more financial support) and Hispanic patients (i.e., more emotional support).

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ARE HEALTH INSURANCE ITEM ALLOCATIONS IN THE AMERICAN COMMUNITY SURVEY MISSING COMPLETELY AT RANDOM?

Journal of Frailty & Aging ◽

10.14283/jfa.2013.29 ◽

2013 ◽

pp. 1-7

Author(s):

C. SIORDIA

Keyword(s):

Health Insurance ◽

Minority Groups ◽

Insurance Coverage ◽

Health Insurance Coverage ◽

Community Survey ◽

American Community Survey ◽

Data Sets ◽

Missing Responses ◽

Missing Completely At Random ◽

Racial Ethnic

Background:Item allocation (the assignment of plausible values to missing or illogical responses insurvey studies) is at times necessary in the production of complete data sets. In the American Community Survey(ACS), missing responses to health insurance coverage questions are allocated. Objectives:Because allocationrates may vary as a function of compositional characteristics, this project investigates how seven different healthinsurance coverage items vary in their degree of allocation along basic demographic variables. Methods: Datafrom the ACS 2010 1-year Public Use Microdata Sample file are used in a logistic regression model and tocalculate allocations rates. Results:The findings reveal that: males; people aged 65 and older; those who speakEnglish “very well” or “well”; US citizens; those out-of-poverty; and all racial/ethnic minority groups havehigher odds of experiencing a health insurance item allocation relative to their counterparts. Conclusions: Sincehealth insurance coverage allocations vary by demographic characteristics, further research is needed toinvestigate their mechanisms of missingness and how these may have implications for frailty related research.

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Impact of cancer on the risk of unplanned 30-day readmissions.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.6581 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 6581-6581

Author(s):

Alexander Qian ◽

Edmund Qiao ◽

Vinit Nalawade ◽

Nikhil V. Kotha ◽

Rohith S. Voora ◽

...

Keyword(s):

Cancer Patients ◽

Cancer Diagnosis ◽

Hospital Admissions ◽

Reference Group ◽

Cancer Site ◽

Cancer Type ◽

Logistic Regression Models ◽

Increased Risk ◽

Initial Hospitalization ◽

The Impact

6581 Background: Hospital readmission are associated with unfavorable patient outcomes and increased costs to the healthcare system. Devising interventions to reduce risks of readmission requires understanding patients at highest risk. Cancer patients represent a unique population with distinct risk factors. The purpose of this study was to define the impact of a cancer diagnosis on the risks of unplanned 30-day readmissions. Methods: We identified non-procedural hospital admissions between January through November 2017 from the National Readmission Database (NRD). We included patients with and without a cancer diagnosis who were admitted for non-procedural causes. We evaluated the impact of cancer on the risk of 30-day unplanned readmissions using multivariable mixed-effects logistic regression models. Results: Out of 18,996,625 weighted admissions, 1,685,099 (8.9%) had record of a cancer diagnosis. A cancer diagnosis was associated with an increased risk of readmission compared to non-cancer patients (23.5% vs. 13.6%, p < 0.001). However, among readmissions, cancer patients were less likely to have a preventable readmission (6.5% vs. 12.1%, p < 0.001). When considering the 10 most common causes of initial hospitalization, cancer was associated with an increased risk of readmission for each of these 10 causes (OR range 1.1-2.7, all p < 0.05) compared to non-cancer patients admitted for the same causes. Compared to patients aged 45-64, a younger age was associated with increased risk for cancer patients (OR 1.29, 95%CI [1.24-1.34]) but decreased risk for non-cancer patients (OR 0.65, 95%CI [0.64-0.66]). Among cancer patients, cancer site was the most robust individual predictor for readmission with liver (OR 1.47, 95%CI [1.39-1.55]), pancreas (OR 1.36, 95%CI [1.29-1.44]), and non-Hodgkin’s lymphoma (OR 1.35, 95%CI [1.29-1.42]) having the highest risk compared to the reference group of prostate cancer patients. Conclusions: Cancer patients have a higher risk of 30-day readmission, with increased risks among younger cancer patients, and with individual risks varying by cancer type. Future risk stratification approaches should consider cancer patients as an independent group with unique risks of readmission.

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