Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States

被引:41
作者
Valero-Elizondo, Javier [1 ,2 ]
Chouairi, Fouad [3 ]
Khera, Rohan [3 ,4 ]
Grandhi, Gowtham R. [5 ]
Saxena, Anshul [6 ]
Warraich, Haider J. [7 ,8 ]
Virani, Salim S. [9 ,10 ]
Desai, Nihar R. [3 ,4 ]
Sasangohar, Farzan [2 ,11 ]
Krumholz, Harlan M. [3 ,4 ,12 ]
Esnaola, Nestor F. [13 ,14 ]
Nasir, Khurram [1 ,2 ]
机构
[1] Houston Methodist DeBakey Heart & Vasc Ctr, Div Cardiovasc Prevent & Wellness, Houston, TX 77030 USA
[2] Houston Methodist, Ctr Outcomes Res, Houston, TX USA
[3] Yale New Haven Hosp, Ctr Outcomes Res & Evaluat, 20 York St, New Haven, CT 06504 USA
[4] Yale Sch Med, Dept Ternal Med, Sect Cardiovasc Med, New Haven, CT USA
[5] MedStar Union Mem Hosp, Dept Med, Baltimore, MD USA
[6] Baptist Hlth South Florida, Ctr Healthcare Adv & Outcomes, Miami, FL USA
[7] VA Boston Healthcare Syst, Cardiol Sect, Dept Med, Boston, MA USA
[8] Brigham & Womens Hosp, Dept Med, Div Cardiovasc Med, 75 Francis St, Boston, MA 02115 USA
[9] Michael E DeBakey VA Med Ctr, Houston, TX USA
[10] Baylor Coll Med, Sect Cardiovasc Res, Houston, TX 77030 USA
[11] Texas A&M Univ, Dept Ind & Syst Engn, Texas A&M Coll Engn, College Stn, TX USA
[12] Yale Sch Publ Hlth, Dept Hlth Policy & Management, New Haven, CT USA
[13] Houston Methodist Res Inst, Canc Ctr, Houston, TX USA
[14] Fox Chase Canc Ctr Temple Hlth, Dept Surg Oncol, Philadelphia, PA USA
关键词
atherosclerotic cardiovascular disease; cancer; financial toxicity; health economics; FOOD INSECURITY; COMPREHENSIVE SCORE; MEDICATION NONADHERENCE; HEALTH; COST; CARE; BURDEN; RISK; US; ASSOCIATIONS;
D O I
10.1016/j.jaccao.2021.02.006
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
BACKGROUND Financial toxicity (FT) is a well-established side-effect of the high costs associated with cancer care. In recent years, studies have suggested that a significant proportion of those with atherosclerotic cardiovascular disease (ASCVD) experience FT and its consequences. OBJECTIVES This study aimed to compare FT for individuals with neither ASCVD nor cancer, ASCVD only, cancer only, and both ASCVD and cancer. METHODS From the National Health Interview Survey, we identified adults with self-reported ASCVD and/or cancer between 2013 and 2018, stratifying results by nonelderty (age <65 years) and elderly (age >= 65 years). We defined FT if any of the following were present: any difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and/or foregone/delayed care due to cost. RESULTS The prevalence of FT was higher among those with ASCVD when compared with cancer (54% vs. 41%; p < 0.001). When studying the individual components of FT, in adjusted analyses, those with ASCVD had higher odds of any difficulty paying medical bills (odds ratio [OR]: 1.22; 95% confidence interval [CI]:1.09 to 1.36), inability to pay bills (OR: 1.25; 95% CI: 1.04 to 1.50), cost-related medication nonadherence (OR: 1.28; 95% CI: 1.08 to 1.51), food insecurity (OR: 1.39; 95% 0: 1.17 to 1.64), and foregone/delayed care due to cost (OR: 1.17; 95% 0: 1.01 to 1.36). The presence of >= 3 of these factors was significantly higher among those with ASCVD and those with both ASCVD and cancer when compared with those with cancer (23% vs. 30% vs. 13%, respectively; p < 0.001). These results remained similar in the elderly population. CONCLUSIONS Our study highlights that FT is greater among patients with ASCVD compared with those with cancer, with the highest burden among those with both conditions. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.
引用
收藏
页码:236 / 246
页数:11
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