The association of disability and medical financial hardship among cancer survivors in the US.

136 Background: Medical financial hardship (MFH) in cancer survivors is well-documented. Little is known about how disability impacts healthcare needs and costs in cancer survivorship. We examined associations of disability and MFH among survivors in the US. Methods: We identified cancer survivors ≥18 years with (n=2,795) and without (n=12,263) a disability from the National Health Interview Survey 2019 to 2022. The Washington Group Short Set, a validated six-item measure intended to describe the functional status of adults (e.g. disability in seeing, hearing, or walking) was used to identify those with disabilities. MFH was categorized into three domains: 1) material (e.g. problems paying medical bills), 2) psychological (e.g. worrying about medical bills), and 3) behavioral (e.g. delaying/forgoing care due to cost). Adjusted logistic regressions were used to examine associations of disability and MFH among cancer survivors. Results: Cancer survivors with a disability were more likely to experience any MFH (57.2% vs. 47.0%, p<0.05) or any individual domain (Material: 26.4% vs. 13.3%, p<0.05; Psychological: 50.5% vs. 43.0%, p<0.05; Behavioral: 23.2% vs. 12.9%, p<0.05) compared with those without a disability. In addition, survivors with a disability were more likely to report experiencing multiple domains of MFH (29.1% vs. 15.9%; p<0.05). Conclusions: Cancer survivors with a disability face higher risks of MFH. Our findings can inform interventions alleviating MFH in this especially vulnerable population. Association of disability with medical financial hardship among cancer survivors, National Health Interview Survey 2019-2022. Cancer Survivors with a Disabilityn = 2,795 Cancer Survivors without a Disabilityn = 12,263 AME(95% CI) AME(95% CI) Any material financial hardship 26.4(24.7, 28.0) 13.3(12.5, 14.2) Any psychological financial hardship 50.5(49.1, 52.0) 43.0(42.0, 44.0) Any behavioral financial hardship 23.2(21.7, 24.7) 12.9(12.0, 13.7) Any MFH 57.2(55.8, 58.6) 47.0(46.0, 48.0) 1 domain of MFH 57.2(55.8, 58.6) 47.0(46.0, 48.0) 2+ domains of MFH 29.1(27.5, 30.6) 15.0(14.1, 15.8) Note: In adjusted analyses, covariates included age, sex, race/ethnicity, marital status, education, family income as % of Federal Poverty Level, insurance, year, and survey design; AME=Average Marginal Effect; CI = Confidence Interval.