LGBTQ+ inequity in crowdfunding cancer costs: The influence of online reach and LGBTQ+ state policy

Austin R Waters; Caleb W Easterly; Cindy Turner; Lauren Ghazal; Ida Tovar; Megan Mulvaney; Matt Poquadeck; Stephen A Rains; Kristin G Cloyes; Anne C Kirchhoff; Erin E Kent; Echo L Warner

doi:10.1002/cam4.6926

LGBTQ+ inequity in crowdfunding cancer costs: The influence of online reach and LGBTQ+ state policy

Cancer Med. 2024 Feb;13(3):e6926. doi: 10.1002/cam4.6926. Epub 2024 Jan 26.

Authors

Austin R Waters^{1

2}, Caleb W Easterly¹, Cindy Turner³, Lauren Ghazal^{4

5}, Ida Tovar³, Megan Mulvaney^{4

6}, Matt Poquadeck^{4

7}, Stephen A Rains⁸, Kristin G Cloyes⁹, Anne C Kirchhoff^{2

10}, Erin E Kent¹, Echo L Warner^{2

3}

Affiliations

¹ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
² Cancer Control and Population Sciences, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA.
³ College of Nursing, University of Utah, Salt Lake City, Utah, USA.
⁴ Crowdfunding Cancer Costs (C3) LGBTQ+ Study Advisory Board, Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, USA.
⁵ School of Nursing, University of Rochester, Rochester, New York, USA.
⁶ School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA.
⁷ Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA.
⁸ Department of Communication, University of Arizona, Tucson, Arizona, USA.
⁹ School of Nursing, Oregon Health and Science University, Portland, Oregon, USA.
¹⁰ Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA.

Abstract

Background: Emerging literature suggests that LGBTQ+ cancer survivors are more likely to experience financial burden than non-LGBTQ+ survivors. However, LGBTQ+ cancer survivors experience with cost-coping behaviors such as crowdfunding is understudied.

Methods: We aimed to assess LGBTQ+ inequity in cancer crowdfunding by combining community-engaged and technology-based methods. Crowdfunding campaigns were web-scraped from GoFundMe and classified as cancer-related and LGBTQ+ or non-LGBTQ+ using term dictionaries. Bivariate analyses and generalized linear models were used to assess differential effects in total goal amount raised by LGBTQ+ status. Stratified models were run by online reach and LGBTQ+ inclusivity of state policy.

Results: A total of N = 188,342 active cancer-related crowdfunding campaigns were web-scraped from GoFundMe in November 2022, of which N = 535 were LGBTQ+ and ranged from 2014 to 2022. In multivariable models of recent campaigns (2019-2022), LGBTQ+ campaigns raised $1608 (95% CI: -2139, -1077) less than non-LGBTQ+ campaigns. LGBTQ+ campaigns with low (26-45 donors), moderate (46-87 donors), and high (88-240 donors) online reach raised on average $1152 (95% CI: -$1589, -$716), $1050 (95% CI: -$1737, -$364), and $2655 (95% CI: -$4312, -$998) less than non-LGBTQ+ campaigns respectively. When stratified by LGBTQ+ inclusivity of state level policy states with anti-LGBTQ+ policy/lacking equitable policy raised on average $1910 (95% CI: -2640, -1182) less than non-LGBTQ+ campaigns from the same states.

Conclusions and relevance: Our findings revealed LGBTQ+ inequity in cancer-related crowdfunding, suggesting that LGBTQ+ cancer survivors may be less able to address financial burden via crowdfunding in comparison to non-LGBTQ+ cancer survivors-potentially widening existing economic inequities.

Keywords: cost of care; crowdfunding; financial burden; financial hardship; financial toxicity; gender expansive; gender identity; sexual and gender minority; sexual minority; sexual orientation; transgender.

MeSH terms

Crowdsourcing* / methods
Fund Raising* / methods
Healthcare Financing
Humans
Neoplasms* / epidemiology
Neoplasms* / therapy
Sexual and Gender Minorities*

Abstract

MeSH terms

Grants and funding