Financial hardship differences by LGBTQ+ status among assigned female at birth adolescent and young adult cancer survivors: a mixed methods analysis

Austin R Waters; Erin E Kent; Clare Meernik; Darios Getahun; Cecile A Laurent; Lanfang Xu; Sara Mitra; Lawrence H Kushi; Chun Chao; Hazel B Nichols

doi:10.1007/s10552-023-01740-9

Financial hardship differences by LGBTQ+ status among assigned female at birth adolescent and young adult cancer survivors: a mixed methods analysis

Cancer Causes Control. 2023 Nov;34(11):973-981. doi: 10.1007/s10552-023-01740-9. Epub 2023 Jul 1.

Authors

Austin R Waters^{1

2}, Erin E Kent^{1

2}, Clare Meernik³, Darios Getahun⁴, Cecile A Laurent⁴, Lanfang Xu⁵, Sara Mitra², Lawrence H Kushi⁴, Chun Chao⁶, Hazel B Nichols^{7

8}

Affiliations

¹ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
² Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
³ Department of Population Health Sciences, School of Medicine, Duke University, Durham, NC, USA.
⁴ Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA.
⁵ MedHealth Statistical Consulting Inc., Solon, OH, USA.
⁶ Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
⁷ Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. hazel.nichols@unc.edu.
⁸ Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 2102A Mcgavran-Greenberg Hall, CB #7435, Chapel Hill, NC, 27599, USA. hazel.nichols@unc.edu.

PMID: 37392265
PMCID: PMC10688151 (available on 2024-11-01)
DOI: 10.1007/s10552-023-01740-9

Abstract

Background: Adolescent and young adult (AYA) cancer survivors are at an elevated risk of financial hardship. However, financial hardship among LGBTQ+ AYAs has not been widely explored. Thus, we used qualitative and quantitative survey data from the Horizon Study cohort to assess financial hardship of AYAs by LGBTQ+ status.

Methods: Multivariable logit models, predicted probabilities, average marginal effects or differences in predicted probabilities (AME) and 95% confidence intervals (CI) were used to assess the association of LGBTQ+ status and two components of financial hardship: material and psychological. Qualitative content analysis of an open-ended survey question about financial sacrifices was used to describe the third component of financial hardship, behavioral.

Results: Among 1,635 participants, 4.3% self-identified as LGBTQ+. Multivariable logit models controlling for demographic factors revealed that LGBTQ+ AYAs had an 18-percentage point higher probability of experiencing material financial hardship (95%CI 6-30%) and a 14-percentage point higher probability of experiencing psychological financial hardship (95%CI 2-26%) than non-LGBTQ+ AYAs. Controlling for economic factors attenuated the association of LGBTQ+ status with psychological financial hardship (AME = 11%; 95%CI - 1-23%), while the material financial hardship association remained statistically significant (AME = 14%; 95%CI 3-25%). In the qualitative analysis, LGBTQ+ AYAs frequently reported educational changes and costs (e.g., quitting school), unpaid bills and debt (e.g., medical debt, taking on credit card debt), as well as changes in housing and poor housing conditions (e.g., moving into less expensive house).

Conclusions: LGBTQ + targeted and tailored interventions are needed to move toward equity for LGBTQ+ AYAs-an overlooked minority population.

Keywords: Adolescent and young adult; Financial burden; Financial hardship; Financial toxicity; LGBTQ+; SGM; Sexual and gender minority.

MeSH terms

Adolescent
Cancer Survivors*
Female
Financial Stress
Humans
Infant, Newborn
Neoplasms* / epidemiology
Sexual and Gender Minorities*
Surveys and Questionnaires
Young Adult

Abstract

MeSH terms

Grants and funding