Employment outcomes among cancer patients in the United States.
Cancer epidemiology
Disparities
Employment
Great recession
Journal
Cancer epidemiology
ISSN: 1877-783X
Titre abrégé: Cancer Epidemiol
Pays: Netherlands
ID NLM: 101508793
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
16
06
2021
revised:
07
11
2021
accepted:
09
11
2021
pubmed:
27
11
2021
medline:
16
4
2022
entrez:
26
11
2021
Statut:
ppublish
Résumé
Cancer diagnosis and treatment can lead to disruptions in employment, which can, in turn, lead to financial problems and uninsurance. We used a nationally representative survey to describe predictors of non-employment among cancer patients compared to a matched cohort of individuals without cancer. This was a retrospective study of the 2005-2018 nationally representative Medical Expenditure Panel Survey. We included respondents aged 18-64 and identified the cohort with current cancer by healthcare utilization related to a cancer diagnosis in the given year. We propensity-score matched controls to cancer cases in a 2:1 ratio. Survey weights were applied to generate national estimates of non-employment among the study cohort compared to the overall U.S. The Adjusted Wald test was used to compare employment outcomes between groups. Weighted multivariable linear regression was utilized to assess factors independently associated with non-employment. An estimated annual mean of 3.9 million cancer patients in the U.S. were included. Relative to controls, cancer patients had higher rates of part-year (36.0% vs 28.3%, P < 0.0001) and full-year non-employment (22.7% vs 17.5%, P < 0.0001). In a multivariable model, cancer diagnosis was associated with a 6.8% higher risk of part-year non-employment, 4.1% higher risk of full-year non-employment, and 14.8% lower individual earnings relative to the matched U.S. Sub-groups of cancer patients at high risk of negative employment outcomes included those enrolled in Medicaid, those without a high school degree, and those with high healthcare utilization. Low family income was the strongest predictor of non-employment. Cancer patients were at greater risk of non-employment relative to matched controls and adverse employment outcomes disproportionately affected cancer patients from vulnerable populations.
Sections du résumé
BACKGROUND
Cancer diagnosis and treatment can lead to disruptions in employment, which can, in turn, lead to financial problems and uninsurance. We used a nationally representative survey to describe predictors of non-employment among cancer patients compared to a matched cohort of individuals without cancer.
METHODS
This was a retrospective study of the 2005-2018 nationally representative Medical Expenditure Panel Survey. We included respondents aged 18-64 and identified the cohort with current cancer by healthcare utilization related to a cancer diagnosis in the given year. We propensity-score matched controls to cancer cases in a 2:1 ratio. Survey weights were applied to generate national estimates of non-employment among the study cohort compared to the overall U.S.
POPULATION
The Adjusted Wald test was used to compare employment outcomes between groups. Weighted multivariable linear regression was utilized to assess factors independently associated with non-employment.
RESULTS
An estimated annual mean of 3.9 million cancer patients in the U.S. were included. Relative to controls, cancer patients had higher rates of part-year (36.0% vs 28.3%, P < 0.0001) and full-year non-employment (22.7% vs 17.5%, P < 0.0001). In a multivariable model, cancer diagnosis was associated with a 6.8% higher risk of part-year non-employment, 4.1% higher risk of full-year non-employment, and 14.8% lower individual earnings relative to the matched U.S.
POPULATION
Sub-groups of cancer patients at high risk of negative employment outcomes included those enrolled in Medicaid, those without a high school degree, and those with high healthcare utilization. Low family income was the strongest predictor of non-employment.
CONCLUSION
Cancer patients were at greater risk of non-employment relative to matched controls and adverse employment outcomes disproportionately affected cancer patients from vulnerable populations.
Identifiants
pubmed: 34826800
pii: S1877-7821(21)00176-4
doi: 10.1016/j.canep.2021.102059
pmc: PMC10066711
mid: NIHMS1882120
pii:
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
102059Subventions
Organisme : NICHD NIH HHS
ID : K12 HD043446
Pays : United States
Organisme : NCI NIH HHS
ID : P30 CA016672
Pays : United States
Organisme : NCI NIH HHS
ID : T32 CA101642
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Ltd. All rights reserved.
Références
Pharm Stat. 2011 Mar-Apr;10(2):150-61
pubmed: 20925139
Health Aff (Millwood). 2017 Feb 1;36(2):274-281
pubmed: 28167716
Health Aff (Millwood). 2018 Jul;37(7):1099-1108
pubmed: 29924637
J Clin Oncol. 2020 Feb 1;38(4):302-309
pubmed: 31804857
Cancer Epidemiol Biomarkers Prev. 2020 Feb;29(2):308-317
pubmed: 31941708
Am J Manag Care. 2009 Nov;15(11):801-6
pubmed: 19895184
Support Care Cancer. 2020 Dec;28(12):5693-5708
pubmed: 32865673
Med Care. 2009 Jul;47(7 Suppl 1):S44-50
pubmed: 19536015
Int J Health Econ Manag. 2018 Jun;18(2):99-121
pubmed: 28940021
MMWR Morb Mortal Wkly Rep. 2014 Jun 13;63(23):505-10
pubmed: 24918485
J Natl Cancer Inst. 2020 Aug 1;112(8):779-791
pubmed: 32277814
Health Aff (Millwood). 2013 Jun;32(6):1143-52
pubmed: 23676531
J Psychosoc Oncol. 2018 May-Jun;36(3):287-303
pubmed: 29634413
J Natl Compr Canc Netw. 2019 Oct 1;17(10):1184-1192
pubmed: 31590147
J Natl Cancer Inst. 2021 May 4;113(5):641-644
pubmed: 32533839
Cancer. 2021 Mar 1;127(5):801-808
pubmed: 33231882
Stat Methods Med Res. 2018 Apr;27(4):1240-1257
pubmed: 27460539
Cancer. 2015 Dec 15;121(24):4425-32
pubmed: 26501494
J Cancer Surviv. 2019 Apr;13(2):282-291
pubmed: 30900159
Breast Cancer Res Treat. 2010 Jan;119(1):213-20
pubmed: 19360466
J Cancer Surviv. 2020 Apr;14(2):135-150
pubmed: 32162193
J Clin Oncol. 2013 Oct 20;31(30):3749-57
pubmed: 24043731
Crit Rev Oncol Hematol. 2011 Feb;77(2):109-30
pubmed: 20117019
Health Aff (Millwood). 2016 Jan;35(1):54-61
pubmed: 26733701
J Clin Oncol. 2017 Jun 20;35(18):1978-1981
pubmed: 28437163
Cochrane Database Syst Rev. 2015 Sep 25;(9):CD007569
pubmed: 26405010