Reducing disparities between urban and rural health care may involve addressing out-of-pocket costs, particularly for older persons who have survived cancer, researchers found.
Financial difficulties may interfere with a cancer survivor’s ability to seek the routine follow-up care recommended to promote his or her well-being. Although urban-rural disparities have been seen in the general population in terms of abstaining from health care services due to cost, it was unknown whether this disparity persists among cancer survivors.
Nynikka R.A. Palmer, DrPH, MPH, of the Wake Forest School of Medicine in Winston-Salem, North Carolina, and colleagues analyzed data from 7,804 cancer survivors participating in the National Health Interview Survey from 2006 to 2010. They stratified the participants by younger age (18 to 64 years; n=3,799) and older age (65 years and older; n=4,005).
Overall, the investigators found that rural cancer survivors were more likely than their urban counterparts to delay or do without medical care because of cost, particularly older survivors. Survivors with public or no insurance, and those with more comorbidities and in poor health, were more likely than others to forgo care.
Rural-urban disparities in the forgoing of medical and dental care persisted for older survivors but not for younger survivors after adjustments for clinical and sociodemographic characteristics. The fact that no disparity was noted in terms of forgoing prescription medications was likely due to enhanced prescription drug coverage through Medicare, wrote Palmer and coauthors in Cancer Epidemiology, Biomarkers & Prevention (2013;22:1668-1676).
Yet despite Medicare, older rural survivors are still forgoing care because of cost at higher rates than urban survivors, noted the researchers, who theorized that out-of-pocket costs may be a significant reason for this.