Food Security and Medical Delay Among Low-Income Cancer Survivors on Disability Insurance

Background: In 2024, 2 million new cases of cancer diagnosis were projected in the United States (U.S). Although cancer survival rates are increasing, cancer survivors (CS) face substantial financial hardship, especially among those from lower-income households. Cost-coping behavior may include spending less on food and/or delaying medical care. Most CS can receive some financial support by applying for disability insurance, since cancer is considered a disability. To date, no study has examined food security (FS) and medical delay outcomes of low-income CS who are on disability. Purpose: This study aims to examine food security levels and medical delay rates in low-income CS who are on disability.

Methods: A total of 12424 CS were included in this analysis using the 2019 to 2023 National Health Interview Survey (NHIS). The NHIS annually collects U.S. residents’ health behaviors, conditions, and treatment utilization information. Participants who received a cancer diagnosis, were 18 to 84 years of age, and had a ratio family income to poverty threshold of 2.5 and below were included. Disability was determined based on whether a CS received SSI/SSDI income in the previous year. FS was assessed using the U.S. Adult Food Security Survey, with scores ranging from 0 to 10. Using the raw scores, CS were categorized into the high, marginal, and low FS group. Medical adherence was measured using 13-items, which were dichotomously coded. Questions assessed whether participants delayed or missed a medical service in the past-year.

Results: Mean age of participants was 66 (SD=12.1). About 46% of participants were male, 93% White, and 3% Hispanic. Almost all participants (99%) were U.S. citizens. About 1% of participants never worked, 9% worked in the past-year, and 90% worked 1-5+ years ago. Roughly 88% of participants had private insurance. Only 5% (N=591) of CS were on disability while 95% (N=11,358) were not. High FS was more common in CS who were not on disability than those on disability (i.e., 99% vs 96%). Relative to CS not on disability, CS on disability were more worried about paying their medical bills (28% vs. 44%), had more problems paying their medical bills (6% vs. 15%), and more likely to delay medical care due to cost (3% vs. 6%). Simple linear regression indicates that for CS enrolled in disability, predicted FS score increases by 0.08 (p<.001) unit. After controlling for poverty ratio level, predicted FS score increases by 0.21 (p<.001) unit.

Conclusion: While initial results indicate that FS in CS on disability were mixed, regression models suggest that poverty influence FS. CS on disability were also likely to report higher instances of medical delay and worry due to their medical bills. As the number of CS are projected to increase in the U.S., social workers should routinely monitor and assess CSs’ FS and medical delay concerns, regardless of disability insurance. On a larger scale, there is an urgent need to intervene food insecurity and medical delay occurrences in this population, as these may impact CSs’ treatment decisions and health outcom