Financial hardship influences health-related quality of life (HRQoL) of older adults. However, little is known about the relationship between financial hardship and HRQoL among vulnerable populations.
Objective:
We examined the associations between financial hardship and HRQoL among older Latinos living with chronic disease, including cancer.
Methods:
This cross-sectional study included 68 Latinos (age range 50-87) with one or more chronic health conditions who participated in a pilot randomized clinical trial. Participants responded to 11 financial hardship questions. We used factor analysis to explore constructs of financial hardship. HRQoL was assessed using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G). Multiple linear regression examined the associations between financial hardship and HRQoL subscales (physical, social/family, emotional, functional well-being).
Results:
The factor analysis revealed 3 constructs of financial hardship: medical cost concerns, financial hardship treatment adherence, and financial worry. A 1-point increase in the factor score for financial hardship treatment adherence was associated with a 2.1-point (SE = 0.771) decrease in physical well-being and with a 1.71-point (SE = 0.761) decrease in functional well-being. A 1-point increase in the financial stress factor score was associated with a 2.0-point (SE = 0.833) decrease in social/family well-being, and with a 2.1-point (SE = 0.822) decrease in functional well-being.
Conclusion:
In this study of older Latinos with chronic diseases, financial hardship was associated with worse HRQoL across several domains. Healthcare providers should refer older Latinos living with chronic disease to appropriate support providers, such as care coordinators, social workers, or patient navigators, who can assist them with obtaining financial assistance and other resources.
ValtortaNKHanrattyB. Socioeconomic variation in the financial consequences of ill health for older people with chronic diseases: a systematic review. J Maturitas. 2013;74(4):313–333.
2.
CohenRAKirzingerWK. Financial Burden of Medical Care: a Family Perspective. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics; 2014.
3.
KamdarBBSuriRSuchytaMR, et al.Return to work after critical illness: a systematic review and meta-analysis. Thorax. 2020;75(1):17–27.
4.
McPeakeJMikkelsenMEQuasimT, et al.Return to employment after critical illness and its association with psychosocial outcomes. A systematic review and meta-analysis. Ann Am Thor Soc. 2019;16(10):1304–1311.
5.
EssueBMBeatonAHullC, et al.Living with economic hardship at the end of life. BMJ Support Palliat Care. 2015;5(2):129–137.
6.
StienstraDChochinovHMCareS. Palliative care for vulnerable populations. Palliat Support Care. 2012;10(1):37–42.
7.
EmanuelEJFaircloughDLSlutsmanJEmanuelLL. Understanding economic and other burdens of terminal illness: the experience of patients and their caregivers. J Ann Int Med. 2000;132(6):451–459.
8.
YabroffKRZhaoJHanXZhengZ. Prevalence and correlates of medical financial hardship in the USA. J J General Int Med. 2019;34(8):1494–1502.
CheneyAMNewkirkCRodriguezKMontezA. Inequality and health among foreign-born Latinos in rural borderland communities. J Soc Sci Med. 2018;215:115–122.
11.
CarrilloJETreviñoFMBetancourtJRCoustasseA.Latino access to health care: the role of insurance, managed care, and institutional barriers. In: Aguirre-MolinaMMCZambranaRE, ed. Health Issues in the Latino Community. Jossey-Bass Publishing; 2001.
12.
National Council of La Raza, John Snow Inc, JSI I. An Inside Look at Chronic Disease and Health Care among Hispanics in the United States. 2014. Accessed October 28, 2020. www.lchc.org
13.
BaqueroBParra-MedinaDM. Chronic disease and the Latinx population: threats, challenges, and opportunities. In: New and Emerging Issues in Latinx Health. Springer; 2020:19–44.
14.
SuarezLRamirezAG. Hispanic/Latino health and disease: an overview. J Promoting Health Multicultural Populations. 1999;17:115–136.
EllKXieBWellsANedjat-HaiemFLeeP-JVourlekisB. Economic stress among low-income women with cancer: effects on quality of life. Cancer. 2008;112(3):616–625.
17.
Nedjat-HaiemFRLorenzKAEllKHamiltonAPalinkasL. Experiences with advanced cancer among Latinas in a public health care system. J Pain Symptom Manage. 2012;43(6):1013–1024.
18.
JeonYHEssueBJanSWellsRWhitworthJA. Economic hardship associated with managing chronic illness: a qualitative inquiry. J BMC Health Servi Res. 2009;9(1):182.
19.
KielyKMLeachLSOlesenSCButterworthP. How financial hardship is associated with the onset of mental health problems over time. J Soc Psychiatry Psychiatr Epidemiol. 2015;50(6):909–918.
20.
LuLO’SullivanESharpL.Cancer-related financial hardship among head and neck cancer survivors: risk factors and associations with health-related quality of life. J Psycho-oncology. 2019;28(4):863–871.
21.
Delgado-GuayMFerrerJRieberAG, et al.Financial distress and its associations with physical and emotional symptoms and quality of life among advanced cancer patients. Oncologist. 2015;20(9):1092–1098.
22.
WalkerAE. Multiple chronic diseases and quality of life: patterns emerging from a large national sample, Australia. J Chronic Illn. 2007;3(3):202–218.
23.
FrankhamCRichardsonTMaguireN. Psychological factors associated with financial hardship and mental health: a systematic review. J Clin Psychol Rev. 2020;77:101832.
24.
YabroffKRDowlingECGuyGPJr, et al.Financial hardship associated with cancer in the United States: findings from a population-based sample of adult cancer survivors. J J Clin Oncol. 2016;34(3):259.
25.
Nedjat-HaiemFRCadetTJAmatyaAThompsonBMishraSI. Efficacy of motivational interviewing to enhance advance directive completion in Latinos with chronic illness: a randomized controlled trial. J Am J Hosp Palliat Med. 2019;36(11):980–992. 1049909119851470.
26.
LuskMStaudtKMoyaEM. Social justice in the US-Mexico border region. In: Social justice in the US-Mexico border region. Springer; 2012:3–38.
27.
ShenMGaiYFengL. Limited access to healthcare among Hispanics in the US-Mexico border region. J Am J Health Behav. 2016;40(5):624–633.
28.
Nedjat-HaiemFRcarrionIVGonzalezK, et al.Implementing an advance care planning intervention in community-settings with older Latinos: a feasibility study. J Palliat Med. 2017;20(9):984–993.
29.
KhodyakovDMikesellLSchraiberRBoothMBromleyEJTR. On using ethical principles of community-engaged research in translational science. Transl Res. 2016;171:52–62. e51.
30.
CellaDFTulskyDSGrayG, et al.The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11(3):570–579.
31.
WebsterKCellaDYostK. The functional assessment of chronic illness therapy (FACIT) measurement system: properties, applications, and interpretation. J Health Qual Life Outcomes. 2003;1(1):79.
32.
CellaDNowinskiCJ. Measuring quality of life in chronic illness: the functional assessment of chronic illness therapy measurement system. J Arch Physical Med Rehabil. 2002;83(12 suppl 2):S10–S17.
33.
DiStefanoCZhuMMindrilaD.Understanding and using factor scores: considerations for the applied researcher. J Pract Assess Res Evaluation. 2009;14(20):1–11.
34.
WagnerIII WE. Using IBM® SPSS® statistics for research methods and social science statistics. Sage Publications; 2019.
35.
RogersSNHarvey-WoodworthCHareJLeongPLoweD. Patients’ perception of the financial impact of head and neck cancer and the relationship to health related quality of life. Br J Oral Maxillofac Surg. 2012;50(5):410–416.
36.
FennKMEvansSBMcCorkleR, et al.Impact of financial burden of cancer on survivors’ quality of life. Journal Oncol Pract. 2014;10(5):332–338.
37.
GallupsSCopelandVCRosenzweigM. Perceived financial hardship among patients with advanced cancer. J Community Supportive Oncol. 2017;15(3):e163–e169.
38.
RoslandA-MHeislerMPietteJD. The impact of family behaviors and communication patterns on chronic illness outcomes: a systematic review. J Behav Med. 2012;35(2):221–239.
39.
Mendez-LuckCAMirandaJMangioneCMYoonJVanGardeA.The Juntos pilot study: a diabetes management intervention for Latino caregiving dyads. J Diabetes Educ. 2019;45(5):507–519.
40.
Tucker-SeeleyRDAbelGAUnoHPrigersonH. Financial hardship and the intensity of medical care received near death. Psycho-Oncology. 2015;24(5):572–578.
41.
SaulsberryLBlendonRJBensonJM. Challenges confronting African Americans and Hispanics living with chronic illness in their families. Chronic Illn. 2016;12(4):281–291.
42.
NippRDSonetEMGuyGPJr. Communicating the financial burden of treatment with patients. Am Soc Clin Oncol Educ Book. 2018;38:524–531.
43.
Nedjat-HaiemFRCarrionIVGonzalezKEllKThompsonBMishraSI. Exploring health care providers’ views about initiating end-of-life care communication. Am J Hosp Palliat Med. 2017;34(4):308–317.
44.
Nedjat-HaiemFRCarrionIVCribbsKLorenzK.Advocacy at the end of life: meeting the needs of vulnerable Latino patients. J Soc Work Health Care. 2013;52(6):558–577.
