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Cancer Epidemiol Biomarkers Prev. 2013 Oct;22(10):1668-76. doi: 10.1158/1055-9965.EPI-13-0421.

Impact of rural residence on forgoing healthcare after cancer because of cost.

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1
Authors' Affiliations: Social Science and Health Policy, Epidemiology and Prevention, Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina; Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Science, National Cancer Institute, Rockville, Maryland.

Abstract

BACKGROUND:

Routine follow-up care is recommended to promote the well-being of cancer survivors, but financial difficulties may interfere. Rural-urban disparities in forgoing healthcare due to cost have been observed in the general population; however, it is unknown whether this disparity persists among survivors. The purpose of this study was to examine rural-urban disparities in forgoing healthcare after cancer due to cost.

METHODS:

We analyzed data from 7,804 cancer survivors in the 2006 to 2010 National Health Interview Survey. Logistic regression models, adjusting for sociodemographic and clinical characteristics, were used to assess rural-urban disparities in forgoing medical care, prescription medications, and dental care due to cost, stratified by age (younger: 18-64, older: 65+).

RESULTS:

Compared with urban survivors, younger rural survivors were more likely to forgo medical care (P < 0.001) and prescription medications (P < 0.001) due to cost; older rural survivors were more likely to forgo medical (P < 0.001) and dental care (P = 0.05). Rural-urban disparities did not persist among younger survivors in adjusted analyses; however, older rural survivors remained more likely to forgo medical [OR = 1.66, 95% confidence interval (CI) = 1.11-2.48] and dental care (OR = 1.54, 95%CI = 1.08-2.20).

CONCLUSIONS:

Adjustment for health insurance and other sociodemographic characteristics attenuates rural-urban disparities in forgoing healthcare among younger survivors, but not older survivors. Financial factors relating to healthcare use among rural survivors should be a topic of continued investigation.

IMPACT:

Addressing out-of-pocket costs may be an important step in reducing rural-urban disparities in healthcare, especially for older survivors. It will be important to monitor how healthcare reform efforts impact disparities observed in this vulnerable population.

PMID:
24097196
PMCID:
PMC3833446
DOI:
10.1158/1055-9965.EPI-13-0421
[Indexed for MEDLINE]
Free PMC Article
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