Risk factors for financial toxicity in health care

Financial toxicity (FT) represents the impact of health care expenses on patients' financial well-being and access to care. Although existing literature has mostly looked at FT in the context of cancer and other medical conditions, we sought to identify risk factors for FT on a population-wide level.

This was a cross-sectional study of the 2022 National Health Interview Survey (NHIS).

Eight financial hardship questions were selected from the 2022 NHIS to represent FT. The unweighted sum of financial hardship questions to which a person responded "yes" was calculated as the FT score (FinTox), and risk factors for FinTox were analyzed using a negative binomial model.

There were 27,246 adults with a mean age of 52.96 years included for analysis, among whom 17.1% (n = 4659) responded "yes" to at least 1 FT question, of whom most had a FinTox of 1 or 2 (n = 3112; 66.8%). Increasing age (β = -0.616; P = .020), higher education (β = -1.08; P = .023), and higher income (β = -0.149; P < .001) were associated with lower FinTox, whereas involuntary unemployment (β = 0.920; P = .001), transient loss of health insurance (β = 1.075; P = .044), and high-deductible health plans (β = 0.519; P = .013) were associated with higher FinTox.

Understanding risk factors for FT at a population level can help identify patients at risk for catastrophic financial effects or inadequate access to care.