Black‐White racial disparities in health care utilization and self‐reported health among cancer survivors: The role of food insecurity

Abstract

BACKGROUND: Non-Hispanic Blacks continue to have worse cancer outcomes than non-Hispanic Whites. Suboptimal health care utilization and poor self-reported health among non-Hispanic Blacks contribute to these disparities. The relationship between race, food security status (FSS), and health care utilization or self-reported health among cancer survivors is not clear. This study aims to fill this gap in the science. METHODS: The 2011-2018 National Health Interview Survey data were used. Bivariate and multivariable logistic regression analyses were used to examine the relationship between race (non-Hispanic Whites or non-Hispanic Blacks), FSS (high, marginal, low, or very low), health care utilization, and self-reported health among cancer survivors. Analyzed health care utilization measures included cost-related medication underuse (CRMU), cost-related delayed care, cost-related forgone care, seeing/talking to a medical specialist, seeing/talking to a general doctor, and overnight hospital stay. RESULTS: A higher proportion of Blacks reported very low food security in comparison with Whites (10.58% vs 4.24%; P ≤ .0001). Blacks were significantly less likely to report a medical specialist visit and more likely to report fair/poor health in the past 12 months even after adjustments for FSS. There was a dose-response relationship between FSS and CRMU, cost-related delayed care, cost-related forgone care, overnight hospital stay, and self-reported health status for both Whites and Blacks. CONCLUSIONS: Significant disparities in health care utilization and self-reported health across race and FSS persist among cancer survivors. Interventions that target food insecurity have the potential to reduce suboptimal health care utilization and self-reported health among cancer survivors. Cancer 2021;127:4620-4627.

Age at diagnosis and social risks among Black cancer survivors: Results from the Detroit Research on Cancer Survivors cohort

“…4 among patients with cancer. 9 Additional work has identified associations between food insecurity and forgoing and delaying medical care as well as with lower self-reported health status 10,34 and between housing insecurity and several adverse cancer outcomes, including lower levels of screening, as well as worse care and mortality. 34,35 38 ; this coincides with financial demands related to starting and raising families, purchasing homes, and paying costs related to higher education.…”

“…4,[7][8][9] Social risks are consistently found to be more common among racial and ethnic minorities and low-income populations compared with other groups, and these disparities are also observed among cancer survivors. Food insecurity is more than twice as common in Black cancer survivors compared with White cancer survivors, 10 and the prevalence of food insecurity among low-income and medically underserved patients who have cancer can be as high as 55%-70%, 11,12 compared with approximately 10% in the US population. 13 Among cancer survivors, 3.1% reported delays in care because of lack of transportation; however, the prevalence of transportation insecurity was approximately four times as high among cancer survivors with incomes below the federal poverty level.…”

Air pollution is linked to higher cancer rates among black or impoverished communities in Louisiana

“…This finding may reflect the well-documented disparities in health risk factors and medical care that leave Black and impoverished communities more vulnerable to negative health outcomes [54][55][56]. For example, these communities are more likely to delay or forgo preventative medical visits due to the high cost of healthcare [57]. Empirical research indicates that physicians serving Black communities are often less effective at cancer education and cancer screening compared to physicians serving White communities [58,59].…”

The Potential of Cancer Care Settings to Address Food Insecurity

“…[3][4][5][6][7] Although estimates vary on the basis of the population included and measures used, previous work suggests that approximately 15%-25% of cancer survivors experience food insecurity. [8][9][10][11][12] As in the general population, food insecurity is more than twice as common in Black compared with White cancer survivors, 11 and estimates of food insecurity among low-income and medically underserved patients with cancer can be as high as 55%-70%. 13,14 Food insecurity is also more prevalent among young adult cancer survivors, who typically have fewer assets than older adults and are largely dependent on employment for both income and health insurance.…”

“…Much of the work has so far been observational, describing the prevalence of and risk factors for food insecurity among patients with cancer and cancer survivors. 8,9,11,12,20 Observational analytic studies have established associations between food insecurity and cost-related medication underuse 11 and lower treatment adherence among patients with cancer, 21 and with lower health-related quality of life in cancer survivors. 10,22 A cancer diagnosis and cancer treatment may increase the risk of food insecurity among financially vulnerable patients with cancer through reduced income because of cancer-related employment disruptions as well as through the financial strain imposed by out-of-pocket costs for cancer treatment.…”