ASCVD Presents Greater Risk for Financial Toxicity Than Cancer, Study Says

When comparing atherosclerotic cardiovascular disease (ASCVD) with cancer, patients with both diseases appeared to have the greatest risk of experiencing financial toxicity.

Patients with atherosclerotic cardiovascular disease (ASCVD) are more likely than patients with cancer to experience financial toxicity (FT), but the likelihood is greatest for patients with both conditions, reports a new study in JACC.CardioOncology.

Financial toxicity is characterized by difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and delayed or foregone care due to cost. Patients with cancer might experience short bursts of high expenditures due to chemotherapy treatment, while patients with ASCVD may experience long-term financial distress from drug costs, procedures, clinician visits, and hospital stays.

The present study aimed to compare the health care economic burden on patients with neither ASCVD nor cancer, ASCVD only, cancer only, and ASCVD and cancer. The researchers gleaned data from the National Health Interview Survey (NHIS) from 2013-2018 and enrolled 141,826 nonelderly (18 to <65 years) adults not protected by public insurance. The population included 6887, 6093, and 971 participants who had self-reported cancer, ASCVD, or both, respectively.

The NHIS questionnaire contained these subsections:

  • The Household Composition file gathered information and relationship information about all persons in a household
  • The Family Core file gathered information regarding sociodemographics, indicators of health status, activity limitations, injuries, health insurance coverage, and access to and utilization of health care services
  • The Sample Child and Sample Adult cores contained information on 1 child and 1 adult randomly selected from each family.

The Sample Adult Core, Household Composition, and Family Core files were supplemented with demographic and socioeconomic characteristics, health status, health care services, and health-related behaviors specific to the US adult population.

Females, especially those coming from a middle- or high-income household and with a higher education level, were more likely to report having cancer. In contrast, those reporting ASCVD, regardless of cancer comorbidity, were evenly distributed by sex, education, and income levels, but had a more unfavorable cardiovascular risk profile. The most reported cancers included nonmelanoma skin, breast, cervix, prostate, and other. Similar trends were seen among patients with both ASCVD and cancer.

Other findings showed:

  • The proportion of patients who experienced FT ranged from 38.3% for patients with neither ASCVD nor cancer to 41.0% for patients with cancer, 54.1% for patients with ASCVD, and 54.5% for patients with both
  • Difficulty paying medical bills was higher for patients with ASCVD vs patients with cancer:
    • ASCVD with cancer: 44.8% (95% CI, 43.1%-46.5%)
    • ASCVD without cancer: 47.4% (95% CI, 43.1%-51.7%)
    • Cancer only: 35.0% (95% CI, 33.5%-36.6%)
  • A statistically significant trend was observed for those unable to pay medical bills, with more patients with both conditions having difficulty (all P < .001):
    • Cancer only: 10.1% (95% CI, 9.0%-1.3%)
    • ASCVD only: 18.2% (95% CI, 16.9%-19.5%)
    • Cancer and ASCVD: 23.2% (95% CI,19.8%-26.8%)
  • Patients with ASCVD with or without cancer experienced the greatest FT as measured by high financial distress, cost-related medication nonadherence, food insecurity, and delayed/foregone medical care due to cost, followed by those with ASCVD only, cancer only, and neither
  • Patients with both cancer and ASCVD had high likelihoods of experiencing any FT (odds ratio, 1.93; 95% CI, 1.63-2.28) and any associated FT measures
  • Patients with ASCVD with or without cancer had higher likelihoods for all FT measures compared with patients with cancer
  • The proportion of patients who experienced 3 or more FT measures simultaneously was 9% for patients with neither ASCVD nor cancer, 13% for patients with cancer, 23% for patients with ASCVD, and 30% for patients with both

“Heart disease and cancer are the leading causes of death in the United States, yet most research on financial toxicity has focused on cancer patients. It is important to consider that cancer patients may have short bursts of high expenditures for treatments, while heart disease patients are often incurring a more chronic economic burden,” said senior author Khurram Nasir, MD, MPH, MSc, chief of the Division of Cardiovascular Prevention and Wellness at Houston Methodist DeBakey Heart and Vascular Center, in a statement. “The financial burden created by these diseases manifests as another form of affliction. It does very little good if we can treat the cancer or the heart disease, but the patient can’t afford to eat or pay their mortgage.”


Valero-Elizondo J, Chouairi F, Khera R, et al. Atherosclerotic cardiovascular disease, cancer, and financial toxicity among adults in the United States. J Am Coll Cardiol CardioOnc. 2021;3(2):236-246.

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