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

Citation:

Valero-Elizondo J, Chouairi F, Khera R, Grandhi GR, Saxena A, Warraich HJ, Virani SS, Desai NR, Sasangohar F, Krumholz HM, et al. Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States. JACC CardioOncol. 2021;3 :236-246.

Date Published:

Jun

Abstract:

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 nonelderly (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% CI: 1.17 to 1.64), and foregone/delayed care due to cost (OR: 1.17; 95% CI: 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.

Notes:

Valero-Elizondo, JavierChouairi, FouadKhera, RohanGrandhi, Gowtham RSaxena, AnshulWarraich, Haider JVirani, Salim SDesai, Nihar RSasangohar, FarzanKrumholz, Harlan MEsnaola, Nestor FNasir, KhurramengJACC CardioOncol. 2021 Jun 15;3(2):236-246. doi: 10.1016/j.jaccao.2021.02.006. eCollection 2021 Jun.