Journal of the National Medical Association · 2026
Financial toxicity of stroke: racial and ethnic disparities among working-age and elderly stroke survivors.
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Jacobs Molly M, Ellis Charles
Аннотация
BACKGROUND: Financial toxicity refers to the financial strain caused by the costs of medical care, indirect cost, and lost wages. In stroke survivors, financial toxicity is particularly severe due to the high costs of acute care, rehabilitation, and long-term disability resulting from stroke, often leading to delayed care and worse health outcomes. Evaluating variations in the financial toxicity of stroke among racial and ethnic groups is crucial because disparities in healthcare access, socioeconomic status, and insurance coverage can exacerbate the financial burden for certain populations. Understanding these differences can inform policies to reduce inequities for underserved groups.
METHODS: Individual-level income and wealth values were calculated from self-reported financial data in the Medical Expenditure Panel Survey collected between 2018 and 2021. The analysis employed fixed effects regression to control for unobserved individual heterogeneity, thereby isolating the impact of stroke on income and wealth from other time-invariant personal characteristics with greater accuracy than other analytic methods. Interaction terms were included to assess the differential impacts of stroke on racial and ethnic groups. Due to changing financial dynamics, individuals over age 65 were assessed differentials financial dynamics Heckman regression models tested the robustness of findings to skewness in the distribution of income and wealth.
RESULTS: About 2.73% (N = 414) of respondents under age 65 and 10.8% (N = 667) of respondents aged 65 and above reported having had a stroke. After controlling for demographic, health, and household characteristics, stroke was associated with 13% to 15% reduction in income among those less than age 65 and a 16% to 18% reduction is wealth among those age 65 and above. Stroke had a disparate impact on the income of young Black (-10.04%) and Hispanic (-19.19%) respondents and the wealth of older Black (-6.05%) and Hispanic (-3.01%) respondents. These findings were consistent across different model specifications, highlighting the robustness of the results.
CONCLUSION: This study offers robust estimates of the financial impact of stroke indicating significantly difference financial burdens among Black and Hispanic respondents. These findings indicate the need to address the income and wealth impacts of stroke to mitigate financial toxicity in vulnerable populations.
METHODS: Individual-level income and wealth values were calculated from self-reported financial data in the Medical Expenditure Panel Survey collected between 2018 and 2021. The analysis employed fixed effects regression to control for unobserved individual heterogeneity, thereby isolating the impact of stroke on income and wealth from other time-invariant personal characteristics with greater accuracy than other analytic methods. Interaction terms were included to assess the differential impacts of stroke on racial and ethnic groups. Due to changing financial dynamics, individuals over age 65 were assessed differentials financial dynamics Heckman regression models tested the robustness of findings to skewness in the distribution of income and wealth.
RESULTS: About 2.73% (N = 414) of respondents under age 65 and 10.8% (N = 667) of respondents aged 65 and above reported having had a stroke. After controlling for demographic, health, and household characteristics, stroke was associated with 13% to 15% reduction in income among those less than age 65 and a 16% to 18% reduction is wealth among those age 65 and above. Stroke had a disparate impact on the income of young Black (-10.04%) and Hispanic (-19.19%) respondents and the wealth of older Black (-6.05%) and Hispanic (-3.01%) respondents. These findings were consistent across different model specifications, highlighting the robustness of the results.
CONCLUSION: This study offers robust estimates of the financial impact of stroke indicating significantly difference financial burdens among Black and Hispanic respondents. These findings indicate the need to address the income and wealth impacts of stroke to mitigate financial toxicity in vulnerable populations.