Financial toxicity among US adults with rheumatic disease and prior cancer: a nationally representative cross-sectional study.

OBJECTIVE

Financial toxicity (FT), the financial burden of accessing health care, is well known in oncology care and increasingly seen in rheumatic disease (RD). We compared FT among adults with neither condition, RD only, cancer only, and both.

METHODS

We used data from the National Health Interview Survey, a nationally representative sample of US adults from 2019 to 2023. Adults were categorized by self-reported diagnosis of a RD, including arthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia, and cancer. FT was defined as one or more of the following: financial distress, difficulty paying bills, delayed or forgone care, cost related medication nonadherence, or food insecurity. Weighted logistic regressions examined associations between disease groups and FT, adjusting for demographics, comorbidities, and insurance. Analyses were stratified by age (< 65 versus ≥ 65 years).

RESULTS

Among 149,905 adults, 100,652 had neither condition, 10,094 had cancer only, 30,446 had RD only, and 8,713 had both. Those with both conditions were older and had the highest multimorbidity. Among adults < 65 years, FT was highest in RD only and both groups (63.9% and 64.3%) vs neither (54.0%). Cost-related medication nonadherence was more common in RD. Among adults ≥ 65 years, FT remained highest in RD only (41.4%). In adjusted analyses, RD only and both conditions were associated with increased FT, whereas cancer only was not.

CONCLUSION

RD is associated with substantial financial burden across domains. These findings highlight the need for greater recognition of financial toxicity in rheumatology.