Atherosclerotic Cardiovascular Disease, Cancer, and Financial Toxicity Among Adults in the United States

Javier Valero-Elizondo, Fouad Chouairi, Rohan Khera, Gowtham R. Grandhi, Anshul Saxena, Haider J. Warraich, Salim S. Virani, Nihar R. Desai, Farzan Sasangohar, Harlan M. Krumholz, Nestor F. Esnaola, Khurram Nasir

Research output: Contribution to journalArticlepeer-review

26 Citations (Scopus)


Background: Financial toxicity (FT) is a well-established side-effect of the high costs associated with cancer care. In recent years, studies have suggested that a significant proportion of those with atherosclerotic cardiovascular disease (ASCVD) experience FT and its consequences. Objectives: This study aimed to compare FT for individuals with neither ASCVD nor cancer, ASCVD only, cancer only, and both ASCVD and cancer. Methods: From the National Health Interview Survey, we identified adults with self-reported ASCVD and/or cancer between 2013 and 2018, stratifying results by nonelderly (age <65 years) and elderly (age ≥65 years). We defined FT if any of the following were present: any difficulty paying medical bills, high financial distress, cost-related medication nonadherence, food insecurity, and/or foregone/delayed care due to cost. Results: The prevalence of FT was higher among those with ASCVD when compared with cancer (54% vs. 41%; p < 0.001). When studying the individual components of FT, in adjusted analyses, those with ASCVD had higher odds of any difficulty paying medical bills (odds ratio [OR]: 1.22; 95% confidence interval [CI]: 1.09 to 1.36), inability to pay bills (OR: 1.25; 95% CI: 1.04 to 1.50), cost-related medication nonadherence (OR: 1.28; 95% CI: 1.08 to 1.51), food insecurity (OR: 1.39; 95% CI: 1.17 to 1.64), and foregone/delayed care due to cost (OR: 1.17; 95% CI: 1.01 to 1.36). The presence of ≥3 of these factors was significantly higher among those with ASCVD and those with both ASCVD and cancer when compared with those with cancer (23% vs. 30% vs. 13%, respectively; p < 0.001). These results remained similar in the elderly population. Conclusions: Our study highlights that FT is greater among patients with ASCVD compared with those with cancer, with the highest burden among those with both conditions.

Original languageEnglish
Pages (from-to)236-246
Number of pages11
JournalJACC: CardioOncology
Issue number2
Publication statusPublished - Jun 2021
Externally publishedYes


  • atherosclerotic cardiovascular disease
  • cancer
  • financial toxicity
  • health economics


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