Household income and county income inequality are associated with financial hardship among cancer survivors in New Jersey

Purpose: To examine how household income and county income inequality are linked to financial hardship among cancer survivors. Methods: Cancer survivors (n = 864) identified through the New Jersey State Cancer Registry were surveyed from August 2018 to January 2022. Local area income inequality was reflected by the Gini index a measure of income inequality at the county level. Multivariable logistic regression analyses were performed, and the average marginal effect (AME) was calculated. Results: Compared to survivors residing in households with income of $90,000 or more (higher income), those with household incomes between $50,000 and $89,999 (middle income) had a significantly higher risk of ever being unable to cover their share of the cost of cancer-related medical care (AME =.104, p =.001), higher risk of foregoing care in the past 12 months because of cost, including dental care (AME =.124, p <.001), eye care (AME =.082, p =.005), and mental health care or counseling (AME =.067, p =.002). An increase in the Gini index from the 25th to 75th percentile was associated with an increased risk of unmet needs in paying for follow-up care or medications related to cancer (AME =.021, p =.014) and an increased risk of foregoing doctor visits (AME =.017, p =.02) and eye care (AME =.03, p =.002) because of cost in the past 12 months. Conclusions: Local area income inequality was associated with certain aspects of cancer survivors’ experience of financial hardship. Implications for cancer survivors: It is important to consider refining and extending financial navigation programs to survivors residing in areas with high income inequality.