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Financial Distress among US Adults with Cardiovascular and Cerebrovascular Disease History: A Nationally
Soonmyung Andrew Hwang1, Jaan K Nandwani2, Laura Katherine Stein1
1Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, USA.
Insights
Individuals with cardiovascular and cerebrovascular diseases experience higher financial distress, including difficulty paying medical bills and affording medications. Targeted strategies are needed to alleviate these cost-related healthcare barriers for this population.
Area of Science:
- Public Health
- Health Economics
- Cardiology
Background:
- Cardiovascular and cerebrovascular diseases are leading causes of U.S. morbidity, mortality, and economic burden.
- High rates of financial distress, stemming from medical costs, are reported among patients with these conditions.
- Understanding the link between disease history and financial strain is crucial for targeted interventions.
Purpose of the Study:
- To examine the association between cardiovascular/cerebrovascular disease history and financial distress in U.S. adults.
- To identify specific factors contributing to financial distress within this high-risk patient group.
Main Methods:
- Cross-sectional analysis of pooled 2021-2023 National Health Interview Survey data.
- Financial distress measured by self-reported medical affordability and cost-related medication nonadherence.
- Propensity score matching and multivariable logistic regression used to analyze associations.
Main Results:
- The disease cohort showed higher prevalence of financial distress (47.1% vs. 45.9%) and increased odds of overall financial distress (OR=1.05).
- Patients with cardiovascular/cerebrovascular disease had greater odds of problems paying medical bills (OR=1.32) and affording medications (OR=1.20).
- Factors associated with distress in the disease cohort included female sex, Hispanic ethnicity, lower education, and lack of insurance; older age and Medicaid coverage were protective.
Conclusions:
- Cardiovascular/cerebrovascular disease is significantly linked to increased financial distress across various aspects of healthcare costs.
- Urgent development and implementation of targeted strategies are necessary to reduce healthcare cost barriers for individuals with these diseases.
Introduction:
Cardiovascular and cerebrovascular diseases represent major causes of morbidity, mortality, and economic burden in the USA. Growing evidence demonstrates high rates of financial distress, defined as the negative impact of medical costs on a person's financial wellbeing, among individuals with cardiovascular and cerebrovascular disease. This study aimed to examine the association between cardiovascular/cerebrovascular disease history and financial distress among US adults and to identify factors associated with financial distress in this high-risk population.
Methods:
We conducted a cross-sectional analysis of pooled 2021-2023 National Health Interview Survey data. Financial distress was defined using self-reported measures of medical affordability and cost-related medication nonadherence. Propensity score matching was used to balance cardiovascular/cerebrovascular disease and non-disease cohorts. Multivariable logistic regression models assessed the association between disease history and financial distress and identified factors associated with financial distress among the disease cohort.
Results:
After matching, 20,246 respondents were included in each cohort. Financial distress was more prevalent among the disease cohort than the non-disease cohort (47.1% vs. 45.9%, p = 0.042), with higher odds of any financial distress (OR = 1.05, 95% CI: 1.01-1.09, p = 0.014). The disease cohort had greater odds of problems paying medical bills (OR = 1.32, 95% CI: 1.24-1.41, p < 0.001) and inability to afford prescription medications (OR = 1.20, 95% CI: 1.11-1.31, p < 0.001). Among the disease cohort, female sex, Hispanic ethnicity, lower educational attainment, and lack of insurance were associated with higher odds of financial distress, whereas older age and Medicaid coverage were associated with lower odds.
Conclusions:
Cardiovascular/cerebrovascular disease is associated with greater financial distress across multiple domains. Targeted strategies to reduce cost-related healthcare barriers in this population are urgently needed.
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