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Peer-reviewedCC BY-NC 4.0Cerebrovascular Diseases (Basel, Switzerland)

Financial Distress among US Adults with Cardiovascular and Cerebrovascular Disease History: A Nationally Representative Analysis

  • Soonmyung A. Hwang1
  • Jaan K. Nandwani2
  • Laura K. Stein1
  • Parul Agarwal3,4
4 affiliations
  1. 1Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  2. 2Department of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  3. 3Department of Population Science and Health Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
  4. 4Institute for Health Care Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Abstract

Introduction: Cardiovascular and cerebrovascular diseases represent major causes of morbidity, mortality, and economic burden in the USA. Growing evidence demonstrates high rates of financial distress, defined as the negative impact of medical costs on a person’s financial wellbeing, among individuals with cardiovascular and cerebrovascular disease. This study aimed to examine the association between cardiovascular/cerebrovascular disease history and financial distress among US adults and to identify factors associated with financial distress in this high-risk population.

Methods: We conducted a cross-sectional analysis of pooled 2021–2023 National Health Interview Survey data. Financial distress was defined using self-reported measures of medical affordability and cost-related medication nonadherence. Propensity score matching was used to balance cardiovascular/cerebrovascular disease and non-disease cohorts. Multivariable logistic regression models assessed the association between disease history and financial distress and identified factors associated with financial distress among the disease cohort.

Results: After matching, 20,246 respondents were included in each cohort. Financial distress was more prevalent among the disease cohort than the non-disease cohort (47.1% vs. 45.9%, p = 0.042), with higher odds of any financial distress (OR = 1.05, 95% CI: 1.01–1.09, p = 0.014). The disease cohort had greater odds of problems paying medical bills (OR = 1.32, 95% CI: 1.24–1.41, p < 0.001) and inability to afford prescription medications (OR = 1.20, 95% CI: 1.11–1.31, p < 0.001). Among the disease cohort, female sex, Hispanic ethnicity, lower educational attainment, and lack of insurance were associated with higher odds of financial distress, whereas older age and Medicaid coverage were associated with lower odds.

Conclusions: Cardiovascular/cerebrovascular disease is associated with greater financial distress across multiple domains. Targeted strategies to reduce cost-related healthcare barriers in this population are urgently needed.

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Cite

BibTeXRIS
BibTeX
@article{hwang2026financial,
  title = {{Financial Distress among US Adults with Cardiovascular and Cerebrovascular Disease History: A Nationally Representative Analysis}},
  author = {Soonmyung A. Hwang and Jaan K. Nandwani and Laura K. Stein and Parul Agarwal},
  journal = {Cerebrovascular Diseases (Basel, Switzerland)},
  year = {2026},
  month = aug,
  doi = {10.1159/ced/accag003},
  url = {https://doi.org/10.1159/ced/accag003},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - Financial Distress among US Adults with Cardiovascular and Cerebrovascular Disease History: A Nationally Representative Analysis
AU  - Soonmyung A. Hwang
AU  - Jaan K. Nandwani
AU  - Laura K. Stein
AU  - Parul Agarwal
PY  - 2026
DA  - 2026/08/10
JO  - Cerebrovascular Diseases (Basel, Switzerland)
DO  - 10.1159/ced/accag003
UR  - https://doi.org/10.1159/ced/accag003
AB  - Introduction: Cardiovascular and cerebrovascular diseases represent major causes of morbidity, mortality, and economic burden in the USA. Growing evidence demonstrates high rates of financial distress, defined as the negative impact of medical costs on a person’s financial wellbeing, among individuals with cardiovascular and cerebrovascular disease. This study aimed to examine the association between cardiovascular/cerebrovascular disease history and financial distress among US adults and to identify factors associated with financial distress in this high-risk population.  Methods: We conducted a cross-sectional analysis of pooled 2021–2023 National Health Interview Survey data. Financial distress was defined using self-reported measures of medical affordability and cost-related medication nonadherence. Propensity score matching was used to balance cardiovascular/cerebrovascular disease and non-disease cohorts. Multivariable logistic regression models assessed the association between disease history and financial distress and identified factors associated with financial distress among the disease cohort.  Results: After matching, 20,246 respondents were included in each cohort. Financial distress was more prevalent among the disease cohort than the non-disease cohort (47.1% vs. 45.9%, p = 0.042), with higher odds of any financial distress (OR = 1.05, 95% CI: 1.01–1.09, p = 0.014). The disease cohort had greater odds of problems paying medical bills (OR = 1.32, 95% CI: 1.24–1.41, p < 0.001) and inability to afford prescription medications (OR = 1.20, 95% CI: 1.11–1.31, p < 0.001). Among the disease cohort, female sex, Hispanic ethnicity, lower educational attainment, and lack of insurance were associated with higher odds of financial distress, whereas older age and Medicaid coverage were associated with lower odds.  Conclusions: Cardiovascular/cerebrovascular disease is associated with greater financial distress across multiple domains. Targeted strategies to reduce cost-related healthcare barriers in this population are urgently needed.
SN  - 1015-9770
SN  - 1421-9786
ER  -