Decline in credit score and excess mortality risk among cancer patients: Evidence from Washington State.

Abstract

11037 Background: Patients experiencing bankruptcy following a cancer diagnosis have been shown to have increased mortality, but few studies have evaluated the impact of other types of financial hardships on mortality risk. We conducted an analysis to understand the relationship between a drop in credit score, a marker of less severe types of financial strain, and mortality among cancer patients in Washington State. Methods: We linked records from cancer patients (age 18+) diagnosed with any cancer (except in situ) between 2010 - 2023 from the Western Washington SEER cancer registry to credit report data from a national credit reporting agency. We excluded patients without a valid credit score near diagnosis (±100 days). In a Cox proportional hazards model using a landmark approach, we examined the relationship between a drop in credit score (25-49, 50-99, or 100+ points) in the first year of diagnosis and subsequent mortality after year 1, using no- or low-drop (<25 points) as the reference. Hazard ratios (HRs) and 95% confidence intervals were derived. Model covariates included age, gender, race/ethnicity, marital status, Area Deprivation Index, urban/rural residence, diagnosis year, cancer type, stage, and credit score at diagnosis. Results: Among 212,898 evaluable patients [49% male, 84% white, median age 65 (IQR 56 - 73)], credit scores at diagnosis were: 42% excellent (800-850), 25% very good (740-799), 15% good (670-739), 12% fair (580-669), and 6% poor (300-579). In the year following diagnosis, 40,078 patients’ credit scores fell ≥25 points (18.8%), including 21,716 falling 25-49 points (10.2%), 12,954 falling 50-99 points (6.1%), and 5,408 falling ≥100 points (2.5%). Among all cancers combined, patients experiencing 50-99 point and ≥100 point reductions (but not 25-49 point reductions) in credit scores had excess mortality (Table). Excess risk of death was observed for nearly all individual cancer types at the ≥100-point reduction level except kidney. Conclusions: In this retrospective study, a substantial reduction in credit scores, typically reflecting the experience of adverse financial events, was associated excess mortality compared to those with stable credit scores. Future studies are needed to understand the mechanisms of the relationship. Excess risk of death following a post-diagnosis fall in credit score (vs no/low reduction). 25-49 points 50-99 points ≥100 points Cancer Type HR CI HR CI HR CI All 0.96 0.94 - 0.99 1.06 1.02 - 1.10 1.33 1.27 - 1.39 Breast 1.00 0.92 - 1.08 1.07 0.97 - 1.18 1.39 1.23 - 1.59 Colorectal 1.02 0.93 - 1.11 1.11 0.99 - 1.23 1.31 1.14 - 1.51 Kidney 0.85 0.73 - 1.00 0.86 0.70 - 1.05 1.23 0.95 - 1.59 Leukemia/lymphoma 0.87 0.79 - 0.96 0.94 0.82 - 1.07 1.29 1.09 - 1.54 Lung 1.00 0.93 - 1.08 1.13 1.04 - 1.24 1.15 1.02 - 1.30 Melanoma 0.90 0.78 - 1.04 1.01 0.85 - 1.20 1.60 1.23 - 2.09 Prostate 0.95 0.87 - 1.03 1.06 0.96 - 1.17 1.39 1.20 - 1.61 Other 0.97 0.92 - 1.01 1.05 1.00 - 1.11 1.31 1.22 - 1.42