Abstract
Purpose: To examine how household income and county income inequality are linked to financial hardship among cancer survivors.
Methods: Cancer survivors (n = 864) identified through the New Jersey State Cancer Registry were surveyed from August 2018 to January 2022. Local area income inequality was reflected by the Gini index a measure of income inequality at the county level. Multivariable logistic regression analyses were performed, and the Average Marginal Effect (AME) calculated.
Results: Compared to survivors residing in households with income of $90,000 or more (higher income), those with household incomes between $50,000 and $89,999 (middle income) had a significantly higher risk of ever been unable to cover their share of the cost of cancer-related medical care (AME=.104, p = .001), higher risk of foregoing care in the past 12 months because of cost, including dental care (AME=.124, p<.001), eye care (AME=.082, p=.005), and mental health care or counseling (AME=.067, p=.002). An increase in Gini index from the 25th to 75th percentile was associated with an increased risk of unmet need in paying for follow-up care or medications related to cancer (AME=.021, p=.014), an increased risk of foregoing doctor visits (AME=.017, p=.02) and eye care (AME=.03, p=.002) because of cost in the past 12 months.
Conclusions: Local area income inequality was associated with certain aspects of cancer survivors’ experience of
financial hardship.
Implications for Cancer Survivors: It is important to consider refining and extending financial navigation
programs to survivors residing in areas with high income inequality.