Financial Burden of Cardiovascular Disease Equals or Exceeds Burden Imposed by Cancer

Khurram Nasir, MD, MPH

A new study using data from the National Health Interview Survey suggests the current financial burden imposed by cardiovascular disease was similar, or greater, than the financial burden imposed by cancer.

An analysis of nearly 150,000 non-elderly patients with cancer or cardiovascular disease between 2013 and 2018, results demonstrate financial toxicity associated with cardiovascular disease was equal to or greater than that seen with cancer and also highlighted the significant financial burden imposed by either disease was most severe among those impacted by both.

"Heart disease and cancer are the leading causes of death in the United States, yet most research on financial toxicity has focused on cancer patients. It is important to consider that cancer patients may have short bursts of high expenditures for treatments, while heart disease patients are often incurring a more chronic economic burden due to drug costs, procedures, clinician visits and hospital stays," said senior investigator Khurram Nasir, MD, MPH, MSc, chief of the Division of Cardiovascular Prevention and Wellness at Houston Methodist DeBakey Heart and Vascular Center, in a statement. "Also, as the rate of cancer survival grows, the population of patients with both heart disease and cancer is growing. The financial burden created by these diseases manifests as another form of affliction. Without the ability to pay, our patients can suffer from financial, health and non-health related difficulties that the health care field must be prepared to address. It does very little good if we can treat the cancer or the heart disease, but the patient can't afford to eat or pay their mortgage."

With an interest in further describing trends of financial toxicity among patients with cancer and cardiovascular disease, Nasir and a team of colleagues designed the current study as an analysis of the National Health Interview Survey, which is a weighted survey conducted by the National Center for Health Statistics/Centers for Disease Control and Prevention. Comprised of 4 components—a Household Composition, Family Core, Sample Child Core, and Sample Adult Core—the survey collected detailed information related to demographic and socioeconomic information as well as data related to health status, health care utilization, and other relevant information.

Using data obtained from the Sample Adult Core and the Household and Family Corte components between 2013-2018, investigators identified a cohort of 141,826 patients aged 18-64 years of age for inclusion in their study. Of these, 6887 had cancer, 6093 had atherosclerotic cardiovascular disease (ASCVD), and 971 had both. Investigator noted 65 years was chosen as a cutoff age as populations younger than this age do not have access to universal financial protections such as public insurance like Medicare. Investigators also pointed out diagnoses of ASCVD or cancer were based on self-reporting by patients.

For the purpose of analysis, the incidence of financial toxicity was chosen as the primary outcome of interest. Financial toxicity was defined as the presence of any of the following criteria: difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and forgoing or delaying medical care due to cost.

Upon analysis, investigators found the prevalence of financial toxicity was 54% among those with self-reported ASCVD and 41% among those with cancer (P <.001). In assessments of individual components of financial toxicity, results of adjusted analyses indicated those with ASCVD were more likely to report difficulty paying medical bills, inability to pay bills (OR, 1.25; 95% CI, 1.04-1.50), cost-related medication nonadherence (OR, 1.28; 95% CI, 1.08-1.51), food insecurity (OR, 1.39; 95% CI, 1.17-1.64), and foregone/delayed care due to cost (OR, 1.17; 95% CI, 1.01-1.36).

Further analysis suggested the presence of 3 or more of these factors was significantly greater among those with ASCVD and those with both ASCVD and cancer compared to those with cancer (23% vs 30% vs 13%, respectively; P <.001).

Investigators also noted they conducted analyses using a sample of elderly patients from within the National Health Interview Survey and the results of these analyses were consistent with those observed in the study population.

"The current manuscript gives us an overall picture of the economic burden suffered by patients with heart disease and/or cancer on a national level, and to tackle the two top causes of mortality in the U.S., we have to more aggressively consider the financial toxicity associated with both these diseases, and their treatment," said lead investigator Javier Valero-Elizondo, MD, MPH, from the Division of Cardiovascular Prevention and Wellness at Houston Methodist DeBakey Heart and Vascular Center, in the aforementioned statement. "While this study is amongst the first of its kind, we hope it helps not only to build on current literature, but also serve as an idea generating paper to fight financial toxicity."

This study, “Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States,” was published in JACC: CardioOncology.