The term “financial toxicity” (FT) describes the financial difficulties experienced by patients due to medical expenses, including both monetary burdens and emotional suffering. FT has commonly occurred in people from a wide range of socioeconomic backgrounds and with various medical conditions. This study used data from the 2022 National Health Interview Survey (NHIS) to identify risk factors for FT at the population level.
Previous research has focused on disease-specific factors to generate findings that inform broader health policy and actions. Risk factors for Financial Toxicity Score (FinTox) were examined using a negative binomial model, and the FT score was determined by adding the unweighted sum of financial hardship items.
A 2022 KFF study found that 47% of people in the US find it “very or somewhat difficult” to pay for their medical expenses, with 69% of families with yearly incomes under $40,000 reporting the same issue. Previous research on the impact of health insurance on FT shows coverage of general terms, including insurance in place. This is possible because health insurance is partly intended to guard against financial burden.
The NHIS is an annual cross-sectional survey conducted among approximately 27,000 non-institutionalized adult citizens in the United States to track changes in their health. If the respondent was covered during the time of the survey, researchers included that information, together with any coverage lapses throughout the previous year, to examine insurance coverage.
Data were expressed as mean (SD) for continuous variables and as percentages for categorical variables. To compare the percentage of respondents who said “yes” for at least one item about financial hardship. Higher wealth (β = -0.149; P <0.001), higher education (β = -1.08; P = 0.023), and increasing age (β = -0.616; P = 0.020) were all linked to decreased FinTox. While high FinTox was linked to temporary loss of health insurance (β = 1.075; P = 0.044), involuntary unemployment (β = 0.920; P = 0.001), and high-deductible health plans (β = 0.519; P = 0.013).
To create the final model, a negative binomial model was constructed step-by-step using all risk factor variables that achieved a level of significance with P < 0.2 based on univariate analysis. A zero-inflated model was not required because the logit predicting excess zeros did not indicate zero inflation; however, a negative binomial model was selected due to data overdispersion. At the age of 65 years, Medicare coverage provides a substantial barrier against FT as it offers low out-of-pocket costs and a high predictability rate.
The difference between voluntary and involuntary unemployment shows that the cause of unemployment has a major impact on financial distress. The possible weaknesses identified by this cross-sectional study point to areas that require more research. The use of FT screening in clinical settings, based on these FinTox risk indicators, helps identify patients who require support.
This study highlighted that subjective FinTox ratings were higher for markers of lower socioeconomic status, which suggests a potential opportunity for targeted insurance reform. Researchers believe that FT screening and policy reforms will help to reduce the financial burden of seeking care by addressing the underlying risk factors.
Reference: Bloch RA, Nguyen LL. Risk factors for financial toxicity in health care. Am J Manag Care. 2025;31(Spec No. 6):SP337-SP350. Accessed June 18, 2025 Risk Factors for Financial Toxicity in Health Care
