Age-related disparities in catastrophic health expenditures among cancer survivors in the United States: Evidence from MEPS, 2018-2022.

Abstract

e23108 Background: Cancer survivorship carries substantial financial burden, yet age-related differences in catastrophic health expenditure (CHE) remain poorly characterized. We examined age-specific patterns and determinants of CHE among U.S. cancer survivors. Methods: We conducted a pooled cross-sectional analysis of adult cancer survivors using MEPS 2018-2022. Survivors aged 18-39 (<40) were compared with those ≥65 years. CHE was defined as out-of-pocket spending ≥10% of household income (CHE10); progressive CHE (CHE_PROG) applied income-adjusted thresholds (≥5% for poor/near-poor, ≥10% for middle/high-income). Survey-weighted logistic regression adjusted for sociodemographics, insurance, poverty level, and dual Medicare-Medicaid coverage. Results: Among 8,504 cancer survivors weighted N = 17.7 million), pooled prevalence of CHE10 was 9.1% among those aged ≥65 and 4.8% among those aged < 40 (p = 0.002). Progressive CHE prevalence was higher overall, affecting 13.2% of survivors aged ≥65 and 6.7% of those aged < 40 (p < 0.001). Year-specific analyses demonstrated consistently higher CHE prevalence among older survivors across all study years. In adjusted models, survivors aged < 40 had significantly lower odds of CHE10 (aOR 0.36, 95% CI 0.19-0.66) and CHE_PROG (aOR 0.28, 95% CI 0.16-0.49) compared with those aged ≥65. Poverty showed strong graded associations, with poor survivors having 25-fold (CHE10) and 49-fold (CHE_PROG) higher odds than high-income survivors. Dual Medicare-Medicaid eligibility was protective (CHE10: aOR 0.29, 95% CI 0.20-0.44; CHE_PROG: aOR 0.25, 95% CI 0.18-0.36), representing 71-75% reduced odds. No significant temporal trend was observed (p = 0.58). Conclusions: Catastrophic health expenditure disproportionately affects older cancer survivors. Although younger survivors experienced lower CHE prevalence, income level and dual insurance eligibility, rather than age alone, were the dominant drivers of financial toxicity. The strong protective effect of dual insurance coverage underscores the importance of comprehensive insurance. Policies improving affordability for low-income and older survivors are essential to mitigate financial hardship.