Immigrant Cancer Survivors Face Higher Rates of Uninsurance, Financial Hardship, Food Insecurity

Immigrants and foreign-born citizens experienced higher rates of uninsurance, financial hardship and food insecurity in a nationwide analysis of adult cancer survivors, despite a lack of differences in health care access and utilization, researchers found.

Presented by study co-author Dr. Patricia Mae Garcia Santos of the department of radiation oncology at Memorial Sloan Kettering Cancer Center in New York during a June 3 poster session as part of the American Society of Clinical Oncology annual meeting in Chicago, the research utilized information on 8,923 adult participants of the National Health Interview Survey from 2019 to 2022, among whom 90% were natives, 7% were foreign-born citizens and 3% were noncitizens.

While cancer, according to the poster, is among the leading causes of morbidity and mortality among immigrants in the United States, noncitizens were three times more likely than natives to be uninsured, foreign-born citizens were twice as likely to be covered by Medicaid and financial hardship was more than 1.5 times as common among foreign-born citizens. Thirty-five percent of noncitizens had household incomes less than 125% of the federal poverty line, as opposed to 12% of natives and 18% of foreign-born citizens, while foreign-born citizens and noncitizens were both more than twice as likely as natives to receive housing assistance.

Researchers stated that while 18% of foreign-born citizens and 33% of noncitizens were food insecure versus 11% of natives, there were no associations with nativity or citizenship. It was also found that there were no significant differences between patient populations in use of urgent care, emergency room or hospital facilities, according to the poster.

“Although there were no differences in health care access/utilization, immigrants and foreign-born citizens had higher rates of uninsurance and affordability concerns — suggestive of barriers to care,” the authors wrote. “This may portend worse health outcomes in cancer survivorship.”

These findings are consistent with those of a 2021 study of insurance disparity and cardiovascular mortality among non-elderly cancer survivors published in Cardio-Oncology, which found that patients with cancer who were uninsured or enrolled in Medicaid experienced significantly higher cardiovascular disease (CVD) mortality than those covered by non-Medicaid insurance—regardless of type of CVD, cancer site, year of diagnosis or follow-up time.

Among the 768,000 subjects of the 2021 study, 1.1% died as a result of CVD and the frequencies of those deaths, the authors wrote, “varied significantly according to insurance status, with the highest proportion of deaths occurring in Medicaid insured (1.65%) and proportionally fewer deaths among uninsured (1.28%) and non-Medicaid insured patients (.91%).”

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