Differential impact of financial hardship on food security between lesbian, gay, and bisexual and heterosexual cancer survivors in the United States.

137 Background: Lesbian, gay, and bisexual (LGB) cancer survivors experience more food insecurity as well as financial hardship than heterosexual cancer survivors. However, how financial hardship impacts food security differently between LGB and heterosexual survivors has not been explored. Methods: National Health Interview Survey data from 2019-2022 were pooled and weighted. Outcomes included a food insecurity measure (food secure, low food security, very low food security) and the manifestations of food insecurity (e.g., cutting size of meals, losing weight due to lack of food). Financial hardship was captured as a binary measure, dichotomized from an 11-item scale which included ability to pay medical bills, worry about paying bills, and delayed or foregone care due to costs. Bivariate analyses were conducted using Chi-Squared tests. Multinomial logistic regression models with an interaction between LGB status and financial hardship status were used to generate relative risk ratios controlling for age, time since last cancer diagnosis, sex, race, region, and year. Results: Of N=13,131 cancer survivors, 2.8% (n=374) identified as LGB. Low/very low food security was reported by 15.6% of LGB survivors in comparison to 6.1% of heterosexual survivors (p<0.001). When stratified by financial hardship, LGB survivors were more likely to report food insecurity in the presence of (22.3% vs. 11.2%, p<0.001) and absence of (6.8% vs. 2.2%, P<0.001) financial hardship. LGB survivors with very low food security often reported cutting the size/cutting meals (93.4%), eating less than they should (94.7%), and being hungry because they could not afford food (80.7%). In the multinomial model, LGB survivors with financial hardship had 5.6 (95%CI:2.9-10.7) times the relative risk of low food security, while heterosexual survivors with financial hardship had 3.9 the relative risk of low food security (95%CI: 2.9-5.2) in comparison to heterosexual survivors with no financial hardship. Furthermore, LGB survivors with financial hardship had 11.8 (95%CI:6.2-22.5) the relative risk of very low food security, LGB survivors with no financial hardship had 6.4 (95%CI: 2.0-20.2) the relative risk of very low food security, and heterosexual survivors with financial hardship had 5.3 the relative risk of low food security (95%CI: 3.6-7.7) in comparison to heterosexual survivors with no financial hardship. Conclusions: Experiencing financial hardship was associated with an increased risk of food insecurity among LGB and heterosexual cancer survivors. However, LGB survivors were more likely to experience food insecurity than heterosexual survivors even when controlling for financial hardship.