Medical financial hardship reported by Native Hawaiian and Pacific Islander cancer survivors compared with non-Hispanic whites

Abstract

Background: Although medical financial hardship (MFH) resulting from sequelae of cancer and treatment has been reported in other racial/ethnic populations, little is known about MFH among Native Hawaiian and Pacific Islander (NHPI) cancer survivors. Methods: One hundred fifty adult NHPI cancer survivors were identified from the 2014 NHPI National Health Interview Survey (NHIS). Cancer survivors were those with a history of cancer (excluding nonmelanoma/unknown type of skin cancer). MFH was defined by 3 domains: 1) material (problem paying or unable to pay medical bills); 2) psychological (worrying about paying medical bills); and 3) behavioral (delaying or forgoing medical care for financial reasons). For comparison, 2098 non-Hispanic white (NHW) cancer survivors were identified from the 2014 NHIS. Logistic regressions were used to identify sociodemographic and health factors associated with experiencing MFH. Stratified analysis by age (<65 vs ≥65 years) and sensitivity analysis using propensity score-matched NHPI and NHW cancer survivors were conducted. Nationally representative estimates were generated using survey weights. Results: Among elderly cancer survivors, more NHPIs reported any MFH (59% vs 32%; P =.001), psychological MFH (36% vs 22%; P =.040), and behavioral MFH (27% vs 9%; P =.004) than NHWs. Among survivors aged <65 years, NHPIs reported less MFH (46% vs. 65%; P =.034). Even after propensity score matching, these patterns persisted. Female NHPIs and NHPIs with a college degree were significantly more likely to report MFH, especially material and psychological MFH. Conclusions: A significantly higher proportion of elderly NHPI cancer survivors reported MFH, and this difference persisted even after propensity score matching, which warrants further investigation.