Table 2.

Association of financial hardship with mortality among cancer survivors with sequential adjustment for health insurance coverage

Sample characteristicsa	Adjusted model		Adjusted model and health insurance
	HR (95% CI)	P b	HR (95% CI)	P b
Ages 18-64 y, (n = 14 917)
Financial hardship within 12 mo of surveyc
Financial hardship	1.17 (1.04 to 1.30)	.006	1.09 (0.97 to 1.24)	.15
No financial hardship	Referent		Referent
Health insurance coverage
Public only	—	—	1.61 (1.41 to 1.84)	<.001
Uninsured or missing	—	—	1.12 (0.92 to 1.36)	.26
Any private	—	—	Referent
Time since diagnoses
≤2 y	Referent		Referent
>2 y and ≤5 y	0.63 (0.55 to 0.72)	<.001	0.63 (0.55 to 0.72)	<.001
>5 y and ≤10 y	0.50 (0.43 to 0.59)	<.001	0.50 (0.42 to 0.59)	<.001
≥10 y	0.41 (0.36 to 0.48)	<.001	0.41 (0.36 to 0.48)	<.001
Selected cancer sites
Prostate	0.42 (0.33 to 0.54)	<.001	0.43 (0.33 to 0.55)	<.001
Colorectal	1.19 (0.94 to 1.50)	.15	1.20 (0.94 to 1.51)	.14
Others	1.33 (1.15 to 1.53)	<.001	1.31 (1.14 to 1.52)	<.001
Female breast	Referent		Referent
Number of cancers diagnosed
≥2 cancers	1.94 (1.66 to 2.26)	<.001	1.88 (1.61 to 2.19)	<.001
Only 1 cancer	Referent		Referent
Number of health conditionsd
1 condition	0.99 (0.88 to 1.12)	.91	0.97 (0.86 to 1.10)	.66
2 conditions	1.21 (1.05 to 1.39)	.008	1.13 (0.98 to 1.30)	.10
≥3 conditions	1.43 (1.22 to 1.67)	<.001	1.30 (1.11 to 1.53)	.001
0 conditions	Referent		Referent
Sex
Female	0.66 (0.59 to 0.75)	<.001	0.67 (0.59 to 0.76)	<.001
Male	Referent		Referent
Race and ethnicity
Asian and otherse	0.90 (0.64 to 1.27)	.55	0.84 (0.60 to 1.19)	.33
Hispanic	1.07 (0.88 to 1.30)	.52	1.03 (0.84 to 1.25)	.81
Non-Hispanic Black	1.49 (1.28 to 1.73)	<.001	1.40 (1.20 to 1.63)	<.001
Non-Hispanic White	Referent		Referent
Current marital status
Not marriedf	1.42 (1.27 to 1.58)	<.001	1.29 (1.16 to 1.45)	<.001
Married	Referent		Referent
Education
Less than high school	1.63 (1.42 to 1.87)	<.001	1.46 (1.27 to 1.69)	<.001
High school graduate	1.33 (1.19 to 1.49)	<.001	1.30 (1.16 to 1.46)	<.001
Some college or more	Referent		Referent
Era
1997-2000	Referent		Referent
2001-2005	0.97 (0.86 to 1.10)	.67	0.96 (0.85 to 1.09)	.55
2006-2009	0.73 (0.63 to 0.86)	<.001	0.72 (0.61 to 0.84)	<.001
2010-2014	0.57 (0.48 to 0.68)	<.001	0.55 (0.46 to 0.66)	<.001
Region
Midwest	1.01 (0.85 to 1.21)	.88	1.00 (0.84 to 1.19)	.99
South	1.06 (0.90 to 1.24)	.51	1.03 (0.88 to 1.21)	.68
West	0.95 (0.80 to 1.13)	.57	0.92 (0.78 to 1.10)	.37
Northeast	Referent		Referent
Ages 65-79 y (n = 11 391)
Financial hardship within 12 mo of surveyc
Financial hardship	1.14 (1.02 to 1.28)	.02	1.15 (1.02 to 1.29)	.02
No financial hardship	Referent		Referent
Health insurance coverage
Medicare Advantage/HMO	—	—	0.98 (0.88 to 1.09)	.73
Medicare and other public	—	—	0.95 (0.80 to 1.12)	.54
Medicare only/other	—	—	1.24 (1.08 to 1.42)	.003
Medicare and private	—	—	Referent
Time since diagnoses
≤2 y	Referent		Referent
>2 y and ≤5 y	0.76 (0.68 to 0.85)	<.001	0.76 (0.68 to 0.85)	<.001
>5 y and ≤10 y	0.60 (0.53 to 0.67)	<.001	0.60 (0.53 to 0.67)	<.001
≥10 y	0.55 (0.49 to 0.62)	<.001	0.55 (0.49 to 0.62)	<.001
Selected cancer sites
Prostate	0.84 (0.72 to 0.99)	.04	0.84 (0.71 to 0.98)	.03
Colorectal	1.05 (0.89 to 1.23)	.58	1.04 (0.89 to 1.23)	.61
Others	1.50 (1.34 to 1.68)	<.001	1.49 (1.34 to 1.67)	<.001
Female breast	Referent		Referent
Number of cancers diagnosed
2 or 3 cancers	1.33 (1.18 to 1.49)	<.001	1.33 (1.18 to 1.49)	<.001
Only 1 cancer	Referent
Number of health conditionsd
1 condition	1.07 (0.96 to 1.20)	.22	1.07 (0.95 to 1.20)	.25
2 conditions	1.33 (1.18 to 1.50)	<.001	1.32 (1.17 to 1.48)	<.001
≥3 conditions	1.78 (1.59 to 2.01)	<.001	1.75 (1.56 to 1.97)	<.001
0 condition	Referent		Referent
Sex
Female	0.71 (0.65 to 0.78)	<.001	0.71 (0.65 to 0.78)	<.001
Male	Referent		Referent
Race and ethnicity
Asian and otherse	0.89 (0.66 to 1.19)	.42	0.87 (0.65 to 1.17)	.36
Hispanic	0.85 (0.71 to 1.02)	.09	0.82 (0.69 to 0.99)	.04
Non-Hispanic Black	1.25 (1.09 to 1.43)	.002	1.22 (1.07 to 1.40)	.004
Non-Hispanic White	Referent
Current marital status
Not marriedf	1.16 (1.07 to 1.25)	<.001	1.14 (1.05 to 1.23)	.001
Married	Referent		Referent
Education
Less than high school	1.27 (1.15 to 1.40)	<.001	1.26 (1.14 to 1.39)	<.001
High school graduate	1.18 (1.07 to 1.31)	.001	1.18 (1.07 to 1.30)	.001
Some college or more	Referent
Survey era, y
1997-2000	Referent		Referent
2001-2005	0.98 (0.90 to 1.07)	.66	0.97 (0.89 to 1.06)	.48
2006-2009	0.90 (0.80 to 1.02)	.09	0.89 (0.79 to 1.00)	.06
2010-2004	0.63 (0.55 to 0.72)	<.001	0.62 (0.54 to 0.71)	<.001
Region
Midwest	1.05 (0.93 to 1.19)	.46	1.05 (0.93 to 1.19)	.42
South	1.03 (0.92 to 1.16)	.61	1.02 (0.91 to 1.15)	.75
West	0.94 (0.83 to 1.08)	.38	0.94 (0.82 to 1.07)	.36
Northeast	Referent		Referent

No value is given because health insurance coverage is added sequentially to multivariable models. ^a: Data from 1997-2014 National Health Interview Survey (NHIS) linked to NHIS mortality files with vital status through December 31, 2015. All models used age as the timescale and adjusted for financial hardship measure, time since diagnosis, major cancer site, multiple cancer status, number of health conditions, sex, race and ethnicity, marital status, educational attainment, survey year, and region. CI = confidence interval; HMO = health maintenance organization; HR = hazard ratio.

^b Two-sided test of statistical significance of differences in hazards from multivariable Cox proportion hazards model.

^c Financial hardship in past 12 months measured as problems affording prescription medicine, mental health care and/or counseling, or dental care or delaying or forgoing any medical care because of cost (Supplementary Table 1, available online, lists exact wording of questions).

^d Conditions included arthritis, asthma, cancer, diabetes, emphysema, heart disease (angina, coronary heart disease, heart attack, other heart condition or disease), high cholesterol, hypertension, and stroke.

^e Other race and ethnicity includes Native American and Alaska Natives, multiple races, Hispanic Black, and unknown race and/or ethnicity.

^f Not married includes widowed, divorced, separated, or never married.