County-level medical debt and treatment initiation among individuals newly diagnosed with cancer.
The high costs of cancer care may lead to medical debt for patients and families. This study examined the association of county-level medical debt and timely treatment initiation among individuals newly diagnosed with cancer.
Individuals aged 19 years and older who were newly diagnosed with acute leukemias, diffuse large B-cell lymphoma, Hodgkin lymphoma, female breast cancer, colorectal cancer, and lung cancer with consecutive enrollment in the same insurance type from the month of diagnosis through 90 days afterward were identified from the 2012-2021 Colorado Central Cancer Registry linked to the Colorado All-Payer Claims Database with information about county-level medical debt from the Urban Institute (N = 35,789). The exposure was the county-level share of adults with medical debt in collections, categorized in four quartiles (Q1-Q4). The outcome was timely treatment initiation-defined as the receipt of any cancer-directed treatment within 90 days after cancer diagnosis. The association of county-level medical debt and time to treatment initiation was examined by using multivariable Cox models.
Higher county-level medical debt was associated with lower likelihood of timely treatment initiation for all selected cancers combined (Q4 [counties with the highest medical debt rate; n = 8652] vs. Q1 [counties with the lowest medical debt rate; n = 9042]: hazard ratio [HR], 0.916; 95% confidence interval [CI], 0.871-0.963; p for trend = .001), for female breast cancer (Q4 vs. Q1: HR, 0.910; 95% CI, 0.847-0.978; p for trend = .011), and among individuals aged 19-64 years with private health maintenance organization plans (Q4 vs. Q1: HR, 0.790; 95% CI, 0.699-0.893; p for trend = .002) or Medicaid coverage (Q4 vs. Q1: HR, 0.869; 95% CI, 0.786-0.960; p for trend = .013).
Policies aimed at preventing and alleviating medical debt could be effective strategies for improving access to timely treatment.
Individuals aged 19 years and older who were newly diagnosed with acute leukemias, diffuse large B-cell lymphoma, Hodgkin lymphoma, female breast cancer, colorectal cancer, and lung cancer with consecutive enrollment in the same insurance type from the month of diagnosis through 90 days afterward were identified from the 2012-2021 Colorado Central Cancer Registry linked to the Colorado All-Payer Claims Database with information about county-level medical debt from the Urban Institute (N = 35,789). The exposure was the county-level share of adults with medical debt in collections, categorized in four quartiles (Q1-Q4). The outcome was timely treatment initiation-defined as the receipt of any cancer-directed treatment within 90 days after cancer diagnosis. The association of county-level medical debt and time to treatment initiation was examined by using multivariable Cox models.
Higher county-level medical debt was associated with lower likelihood of timely treatment initiation for all selected cancers combined (Q4 [counties with the highest medical debt rate; n = 8652] vs. Q1 [counties with the lowest medical debt rate; n = 9042]: hazard ratio [HR], 0.916; 95% confidence interval [CI], 0.871-0.963; p for trend = .001), for female breast cancer (Q4 vs. Q1: HR, 0.910; 95% CI, 0.847-0.978; p for trend = .011), and among individuals aged 19-64 years with private health maintenance organization plans (Q4 vs. Q1: HR, 0.790; 95% CI, 0.699-0.893; p for trend = .002) or Medicaid coverage (Q4 vs. Q1: HR, 0.869; 95% CI, 0.786-0.960; p for trend = .013).
Policies aimed at preventing and alleviating medical debt could be effective strategies for improving access to timely treatment.
Authors
Zhao Zhao, Perraillon Perraillon, Clark Clark, Greenwald Greenwald, Pollyea Pollyea, Han Han, Yabroff Yabroff, Bradley Bradley, Parsons Parsons
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