Financial vulnerability among U.S. cancer survivors: Differences by veteran status and VA health care utilization in the National Health Interview Survey, 2020–2024.

Abstract

1561 Background: Current national comparisons of financial factors affecting cancer care among Veterans and non-Veteran adults with a self-reported history of cancer are limited. Moreover, little is known about how financial vulnerability influences Veterans receiving care primarily through the VA system versus in community settings. We hypothesize that Veteran status and primary care setting (VA vs. community) are associated with differences in financial vulnerability and related barriers to medical care among U.S. adult survivors of cancer. Methods: We pooled 2020–2024 National Health Interview Survey data (n=19,410) to examine associations between Veteran status, VA care use, and financial vulnerability among adult survivors from cancer (including non-melanoma skin cancer). Missing data were addressed using multiple imputation leading to an analytic sample size n=18,846. Survey-weighted logistic regression models accounted for complex sampling and adjusted for age, sex, cancer site, number of cancers, years since diagnosis, poverty ratio, and survey year. Analyses were limited to years when outcomes were collected. Two comparisons were conducted to understand the unique social factors Veterans face compared to non-Veteran patients and differences between primary setting of Veteran care: Model(A) Veterans vs. non-Veterans and (B) VA primary users vs. non-primary VA users. Binary outcomes included delayed care due to cost, delayed care due to transportation barriers, inability to afford care, unpaid medical bills, insurance gaps, medication cost-skipping, and inability to pay expenses. Sensitivity analyses compared weighted and unweighted models. Results: The analytic sample of adult survivors from cancer was n=18,846 from 2020–2024 (mean age 68 years; 43% male) and included 2,511 (13%) who self-reported as Veterans (mean age 74 years; 94% male). Adjusted models showed Veteran status was associated with higher odds in care delay due to transportation barriers (OR 1.57; 95% CI, 1.13-2.19) and lower odds of worry regarding unpaid medical bills (OR 0.79; 95% CI, 0.68-0.91) and difficulty obtaining medical care due to cost OR 0.78(0.63-0.98). All other compared variables were not significant. Among Veterans, those who primarily used the VA had lower odds of delaying care due to cost (OR 0.34; 95% CI, 0.17-0.69), not obtaining medical care due to cost (OR 0.50; 95% CI, 0.35-0.72), and skipping medication due to cost (OR 0.25; 95% CI (0.12-0.49). Sensitivity analyses supported these patterns. Conclusions: Veterans who are primarily VA users have cost-related vulnerability without a difference in delaying care to non-Veteran counterparts. Such systems that remove financial hardship may be an approach to improve care for survivors from cancer in the U.S.