Cost-related care barriers among U.S. women with selected gynecologic cancer histories: a cross-sectional NHIS study, 2019–2024

Cost-related barriers can disrupt surveillance and management of treatment effects after gynecologic cancer. We evaluated cost-related delayed or unmet medical care among U.S. women reporting cervical, ovarian, or uterine cancer histories and assessed variation by cancer subtype, age at the Medicare eligibility threshold, and approximate time since diagnosis. We conducted a cross-sectional analysis of 2019–2024 CDC/NCHS National Health Interview Survey Sample Adult public-use data. For pooled analyses including 2019 and 2020, we used the 2020 Sample Adult Partial file and partial weight according to NCHS guidance. The common complete-case cohort included women aged 18 years or older classified as no cancer, non-gynecologic cancer, or selected gynecologic cancer history. The primary outcome combined delayed medical care because of cost and inability to obtain needed medical care because of cost. Survey-weighted logistic and log-link quasi-Poisson models estimated adjusted odds ratios (ORs), prevalence ratios (PRs), and standardized prevalence differences. Among 84,551 women, 1,909 reported selected gynecologic cancer histories and 7,601 reported the primary outcome. In the primary adjusted model, selected gynecologic cancer history was associated with higher prevalence of cost-related delayed or unmet care versus no cancer (OR 1.280, 95% CI 1.065–1.540; PR 1.221, 95% CI 1.054–1.416). Standardized prevalence was 12.21% versus 9.92%, an adjusted difference of 2.29% points (95% CI 0.43–4.14). Compared with non-gynecologic cancer history, the OR was 1.630 (95% CI 1.326–2.004) and PR was 1.515 (95% CI 1.278–1.796). There was no evidence of heterogeneity across cervical, ovarian, and uterine subtypes (OR P = 0.971), by age < 65 versus > = 65 years (interaction P = 0.992), or across approximate diagnosis-duration categories ( P = 0.400). Associations were directionally consistent for delayed care (OR 1.217) and inability to obtain needed care because of cost (OR 1.360). Women reporting selected gynecologic cancer histories had more cost-related care barriers than women without cancer and women with other cancer histories. Findings were broadly consistent across identifiable gynecologic cancer subtypes, the age-65 threshold, and approximate diagnosis-duration categories.