Unemployment, Bankruptcies, and Deaths From Multiple Causes in the COVID-19 Recession Compared With the 2000‒2018 Great Recession Impact.

Objectives. To determine whether unemployment and bankruptcy rates are related to increased excess deaths during the COVID-19 recession and to examine whether the current recession-based mortality rate not only is dependent on COVID-19 but also continues the pattern of recessions, especially the Great Recession, in relation to chronic disease mortality rates and mental health disturbances (e.g., including suicide) from 2000 to 2018. Methods. This study used pooled cross-sectional time series analysis to determine the impact of unemployment and bankruptcy rates on excess deaths from February to November 2020 for US states. The study used a second pooled cross-sectional time series analysis to determine whether the COVID-19‒ era recessional mortality continues the impact of prepandemic recessions (2000-2018) on multiple causes of mortality. Results. Ten percent unemployment was associated with approximately 48[thin space]149 excess deaths, while, jointly with bankruptcies, their combined effect produced 35 700 and 144 483 excess deaths, for unemployment and bankruptcies, respectively. These health-damaging COVID-19‒recessional findings suggest a reiteration of the significantly increased major cause‒specific mortality during 2000 to 2018, mitigated by the size of the health care workforce. Conclusions. Minimization of deaths attributable to the COVID-19 recession requires ample funding for the unemployed and underemployed, especially Black and Hispanic communities, along with significant investments in the health workforce. (Am J Public Health. 2021;111(11):1950-1959. https://doi.org/10.2105/AJPH.2021.306490).

Undersampling bankruptcy prediction: Taiwan bankruptcy data.

Machine learning models have increasingly been used in bankruptcy prediction. However, the observed historical data of bankrupt companies are often affected by data imbalance, which causes incorrect prediction, resulting in substantial economic losses. Many studies have proposed the insolvency imbalance problem, but little attention has been paid to the effect of the undersampling technology. Therefore, a framework is used to spot-check algorithms quickly and combine which undersampling method and classification model performs best. The results show that Naive Bayes (NB) after Edited Nearest Neighbors (ENN) has the best performance, with an F2-measure of 0.423. In addition, by changing the undersampling rate of the cluster centroid-based method, we find that the performance of the Linear Discriminant Analysis (LDA) and Naive Bayes (NB) are affected by the undersampling rate. Neither of them is uniformly declining, and LDA has higher performance when the undersampling rate is 30%. This study accordingly provides another perspective and a guide for future design.

Breast Cancer-Related Employment Disruption and Financial Hardship in the Sister Study.

Background: More than one-half of breast cancer cases are diagnosed among women aged younger than 62 years, which may result in employment challenges. This study examined whether cancer-related employment disruption was associated with increased financial hardship in a national US study of women with breast cancer. Methods: Women with breast cancer who were enrolled in the Sister or Two Sister Studies completed a survivorship survey in 2012. Employment disruption was defined as stopping work completely or working fewer hours after diagnosis. Financial hardship was defined as: 1) experiencing financial problems paying for cancer care, 2) borrowing money or incurring debt, or 3) filing for bankruptcy because of cancer. Prevalence ratios and 95% confidence intervals for the association between employment disruption and financial hardship were estimated using multivariable Poisson regression with robust variance. Results: We analyzed data from women employed at diagnosis (n = 1628). Women were a median age of 48 years at diagnosis and 5.6 years from diagnosis at survey completion. Overall, 27.3% of women reported employment disruption (15.4% stopped working; 11.9% reduced hours), and 21.0% experienced financial hardship (16.0% had difficulty paying for care; 12.6% borrowed money or incurred debt; 1.8% filed for bankruptcy). In adjusted analysis, employment disruption was associated with nearly twice the prevalence of financial hardship (prevalence ratio = 1.93, 95% confidence interval = 1.58 to 2.35). Conclusions: Women experiencing employment disruptions after breast cancer may be more vulnerable to financial hardship. Findings highlight the need to target risk factors for employment disruption, facilitate return to work or ongoing employment, and mitigate financial consequences after cancer.

Association between density of gaming venues in a geographical area and prevalence of insolvency: longitudinal evidence from Australia.

BACKGROUND AND AIMS: Problem gambling can lead to a myriad of harmful consequences, including unmanageable amounts of debt and serious financial problems. The aim of this study was to examine whether changes in the number of electronic gaming machine (EGM) venues within a local area (due to venue openings and closings) are associated with changes in the rates of serious financial problems. DESIGN: Area-level longitudinal multivariate regressions controlling for possible confounders (fixed and time-varying local area characteristics). SETTING: Australia's three largest states (New South Wales, Victoria, Queensland), during the period 2011-18. PARTICIPANTS: A total of 225 local areas (Statistical Area 3 level) within the three states. MEASUREMENTS: Serious financial problems were measured by administrative data on total number of personal insolvencies (bankruptcies, debt agreements and insolvency agreements) in each local area per annum. The number of EGM venues in each local area was the regressor of primary interest. Area-level covariates included the number of non-gaming pubs and clubs, unemployment rate, population count, local area dummies, local area linear time trends and a separate set of state dummies for each year. FINDINGS: A one-venue decrease over time within a local area decreased the number of personal insolvencies by 1.8 per year [95% confidence interval (CI) = 0.4-3.2]. The result is robust to alternative specifications, including allowing for geographical spillovers (ß = 2.2, 95% CI = 0.7-3.7), temporal lagged effects (ß = 1.6, 95% CI = 0.6-2.8) and the spatial variability of venues within areas (ß = 2.7, 95% CI = 0.9-4.5). CONCLUSIONS: There is a positive association between the number of gaming venues in a local geographic area and the number of personal insolvencies in that area. Reducing the number or accessibility of gaming venues could help to reduce financial harms associated with problem gambling.

Financial burden and quality of life among thyroid cancer survivors.

BACKGROUND: Survivors of cancer in the United States are often financially encumbered by expenses and lost wages from cancer treatment. The majority of patients with thyroid cancer are diagnosed before age 65, when they are not eligible for Medicare. We hypothesized that financial distress would be common among thyroid cancer survivors and would be associated with poor health-related quality of life. METHODS: A financial distress questionnaire and Patient-Reported Outcomes Measurement Information System (29-item) were completed online by 1,743 adult thyroid cancer survivors living in the United States. Multivariable modeling was used to identify variables which independently predicted poor health-related quality of life. The magnitude of predicted change was estimated by ß coefficients and 95% confidence intervals. A ß ≥3 was considered clinically significant; α was set at 0.01. RESULTS: Financial difficulties were reported by 43% of thyroid cancer survivors and were associated with worse anxiety (ß = 5.07; P < .01) and depression (ß = 5.47; P < .01). Living in poverty was associated with worse anxiety (ß = 4.14; P < .01) and depression (ß = 4.35; P < .01). Lost productivity at work was associated with worse fatigue (ß = 5.99; P < .01) and social functioning (ß = -4.07; P < .01). Inability to change jobs was associated with worse fatigue (ß = 3.08; P < .01), pain interference (ß = 3.56; P < .01), and social functioning (ß = -3.09; P < .01). Receiving disability benefits was associated with worse pain interference (ß = 3.93; P < .01). Impaired ability to obtain a job was associated with worse social functioning (ß = -3.02; P < .01). Reported unemployment rate was 12.3%. CONCLUSION: Financial distress and negative financial events were common among thyroid cancer survivors and were associated with poorer health-related quality of life across 5 Patient-Reported Outcomes Measurement Information System health domains.

Optimización de la predicción de problemas financieros en empresas sanitarias privadas españolas aplicando algoritmos genéticos / Optimization of the prediction of financial problems in Spanish private health companies using genetic algorithms

Objetivo: Presentar una metodología para optimizar, a través de la Z'-Score de Altman para empresas privadas, la predicción de entrada en situación de concurso de acreedores (bancarrota) en empresas privadas del sector sanitario español. Método: El método propuesto consiste en la aplicación de los algoritmos genéticos (AG) para encontrar los coeficientes de la fórmula de la cadena de ratios propuestos por Altman en su versión para empresas privadas que optimicen la predicción en empresas privadas sanitarias españolas, maximizando la sensibilidad y la especificidad, y con ello reduciendo los errores de tipo I y tipo II. Con este propósito se ha utilizado una muestra de 5903 empresas del sector sanitario privado español obtenidas de las bases de datos de Sistema de Análisis de Balances Ibéricos (SABI) entre los años 2007 y 2015. Resultados: El modelo predictivo obtenido con los AG presenta mayor exactitud, sensibilidad y especificidad que el propuesto por Altman para empresas privadas, tanto con los datos de test como con todos los datos de la muestra. Conclusiones: El hallazgo más importante del presente estudio es establecer una metodología que logra identificar unos coeficientes optimizados para la Z de Altman, lo cual permite realizar una predicción más precisa de la bancarrota en las empresas sanitarias privadas españolas

Objective: This paper presents a methodology to optimize, using Altman's Z-Score for private companies, the prediction of private companies of the Spanish health sector entering a situation of bankruptcy. Method: The proposed method consists of the application of genetic algorithms (GA) to find the coefficients of the formula of the chain of ratios proposed by Altman in the version of the score for private companies which optimize the prediction for Spanish private health companies, maximizing sensitivity and specificity, and thereby reducing type I and type II errors. For this purpose, a sample of 5,903 companies from the Spanish private health sector obtained from the database of the Iberian Balance Analysis System (SABI) between 2007 and 2015 was used. Results: The results show that the predictive model obtained with the AG presents greater accuracy, sensitivity and specificity than that proposed by Altman for private companies with both test data and all sample data. Conclusions: The most important finding of this study was to establish a methodology that can identify the optimized coefficients for the Altman Z-Score, which allows a more accurate prediction of bankruptcy in Spanish private healthcare companies

Relationship between area mortgage foreclosures, homeownership, and cardiovascular disease risk factors: The Hispanic Community Health Study/Study of Latinos.

BACKGROUND: The risk of mortgage foreclosure disproportionately burdens Hispanic/Latino populations perpetuating racial disparities in health. In this study, we examined the relationship between area-level mortgage foreclosure risk, homeownership, and the prevalence of cardiovascular disease risk factors among participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). METHODS: HCHS/SOL participants were age 18-74 years when recruited from four U.S. metropolitan areas. Mortgage foreclosure risk was obtained from the U.S. Department of Housing and Urban Development. Homeownership, sociodemographic factors, and cardiovascular disease risk factors were measured at baseline interview between 2008 and 2011. There were 13,856 individuals contributing to the analysis (median age 39 years old, 53% female). RESULTS: Renters in high foreclosure risk areas had a higher prevalence of hypertension and hypercholesterolemia but no association with smoking status compared to renters in low foreclosure risk areas. Renters were more likely to smoke cigarettes than homeowners. CONCLUSION: Among US Hispanic/Latinos in urban cities, area foreclosure and homeownership have implications for risk of cardiovascular disease.

Predicting Financial Distress and Closure in Rural Hospitals.

PURPOSE: Annual rates of rural hospital closure have been increasing since 2010, and hospitals that close have poor financial performance relative to those that remain open. This study develops and validates a latent index of financial distress to forecast the probability of financial distress and closure within 2 years for rural hospitals. METHODS: Hospital and community characteristics are used to predict the risk of financial distress 2 years in the future. Financial and community data were drawn for 2,466 rural hospitals from 2000 through 2013. We tested and validated a model predicting a latent index of financial distress (FDI), measured by unprofitability, equity decline, insolvency, and closure. Using the predicted FDI score, hospitals are assigned to high, medium-high, medium-low, and low risk of financial distress for use by practitioners. FINDINGS: The FDI forecasts 8.01% of rural hospitals to be at high risk of financial distress in 2015, 16.3% as mid-high, 46.8% as mid-low, and 28.9% as low risk. The rate of closure for hospitals in the high-risk category is 4 times the rate in the mid-high category and 28 times that in the mid-low category. The ability of the FDI to discriminate hospitals experiencing financial distress is supported by a c-statistic of .74 in a validation sample. CONCLUSION: This methodology offers improved specificity and predictive power relative to existing measures of financial distress applied to rural hospitals. This risk assessment tool may inform programs at the federal, state, and local levels that provide funding or support to rural hospitals.

Financial Insolvency as a Risk Factor for Early Mortality Among Patients With Cancer.

PURPOSE: Patients with cancer are more likely to file for bankruptcy than the general population, but the impact of severe financial distress on health outcomes among patients with cancer is not known. METHODS: We linked Western Washington SEER Cancer Registry records with federal bankruptcy records for the region. By using propensity score matching to account for differences in several demographic and clinical factors between patients who did and did not file for bankruptcy, we then fit Cox proportional hazards models to examine the relationship between bankruptcy filing and survival. RESULTS: Between 1995 and 2009, 231,596 persons were diagnosed with cancer. Patients who filed for bankruptcy (n = 4,728) were more likely to be younger, female, and nonwhite, to have local- or regional- (v distant-) stage disease at diagnosis, and have received treatment. After propensity score matching, 3,841 patients remained in each group (bankruptcy v no bankruptcy). In the matched sample, mean age was 53.0 years, 54% were men, mean income was $49,000, and majorities were white (86%), married (60%), and urban (91%) and had local- or regional-stage disease at diagnosis (84%). Both groups received similar initial treatments. The adjusted hazard ratio for mortality among patients with cancer who filed for bankruptcy versus those who did not was 1.79 (95% CI, 1.64 to 1.96). Hazard ratios varied by cancer type: colorectal, prostate, and thyroid cancers had the highest hazard ratios. Excluding patients with distant-stage disease from the models did not have an effect on results. CONCLUSION: Severe financial distress requiring bankruptcy protection after cancer diagnosis appears to be a risk factor for mortality. Further research is needed to understand the process by which extreme financial distress influences survival after cancer diagnosis and to find strategies that could mitigate this risk.

For Working-Age Cancer Survivors, Medical Debt And Bankruptcy Create Financial Hardships.

The rising medical costs associated with cancer have led to considerable financial hardship for patients and their families in the United States. Using data from the LIVESTRONG 2012 survey of 4,719 cancer survivors ages 18-64, we examined the proportions of survivors who reported going into debt or filing for bankruptcy as a result of cancer, as well as the amount of debt incurred. Approximately one-third of the survivors had gone into debt, and 3 percent had filed for bankruptcy. Of those who had gone into debt, 55 percent incurred obligations of $10,000 or more. Cancer survivors who were younger, had lower incomes, and had public health insurance were more likely to go into debt or file for bankruptcy, compared to those who were older, had higher incomes, and had private insurance, respectively. Future longitudinal population-based studies are needed to improve understanding of financial hardship among US working-age cancer survivors throughout the cancer care trajectory and, ultimately, to help stakeholders develop evidence-based interventions and policies to reduce the financial hardship of cancer.

Suicide in Northern Ireland: An Analysis of Gender Differences in Demographic, Psychological, and Contextual Factors.

BACKGROUND: The circumstances surrounding death by suicide can give us insight into the factors affecting suicide risk in particular regions. AIMS: This study examined gender and circumstances surrounding death by suicide in Northern Ireland from 2005 to 2011. METHOD: The study analyzed 1,671 suicides (77% male and 23% female cases) using information contained from the coroner's files on suicides and undetermined deaths. RESULTS: Hanging was the most common method and more than one third of the deceased had prior suicide attempts. There was evidence of alcohol use in 41% of the cases. Only, 61% of cases had recorded adverse events; most had multiple and complex combinations of experiences. Relationship and interpersonal difficulties were the most common category of adverse event (40.3%). However, illness and bereavement, employment /financial crisis, and health problems were also common. One third of those who died by suicide were employed, compared with 50.3% who were not in employment. Just over half (50.1%) were known to have a mental health disorder. CONCLUSION: The results provide the first profile of deaths by suicide in Northern Ireland. They highlight the need to target people who have difficult life experiences in suicide prevention work, notably men, people with employment, financial and relationship crises, and those with mental disorders.

Medical Causes and Consequences of Home Foreclosures.

The objective of this study was to elucidate the medical causes and consequences of foreclosure. We surveyed 90 households undergoing foreclosure in 2013-2014 in Maricopa County, Arizona on two occasions approximately five months apart. At baseline, median monthly household income was $3,000, and median mortgage payment $1,350. Only 10% of respondents lacked health insurance when surveyed, although 28% had experienced a gap in coverage within the past two years. Fifty-seven percent identified a medical debt or another medical cause of their foreclosure, and 54% had taken on new debt to pay medical bills; 10% had mortgaged their home for this reason. Although 57% of respondents had a chronic condition requiring ongoing care, more than half reported delaying or skipping a needed medical visit. At follow-up, one-third of respondents had been unable to afford food, and 3 respondents reported becoming homeless; 46% said foreclosure had worsened their health; and 63% had already incurred new medical debts. Medical debt and medical problems frequently contribute to foreclosure, even among insured families. Foreclosure compromises access to care and basic necessities like food and shelter, and worsens self-reported health.

Risk of Bankruptcy among Applicants to Disability Insurance.

BACKGROUND: Poor health can lead to financial instability and, eventually, bankruptcy. We examined how entrance into the Social Security Disability Insurance (SSDI) program was associated with bankruptcy filings among those who had a disability and applied to the SSDI program. METHODS: We merged dockets from U.S. bankruptcy courts that cover 2000 through 2009 to administrative records on all SSDI applicants from 2000 through 2003 (adults aged > 18, N = 1,500,607). We estimated logistic regression models for bankruptcy declaration within one year of the decision to allow applicants onto the SSDI program. RESULTS: Being allowed onto the SSDI program was associated with a decreased risk of bankruptcy (adjusted odds ratio = 0.754). The association was negative and statistically significant for all age groups, including older applicants nearing eligibility for Medicare. CONCLUSIONS: The findings contribute to a growing body of research suggesting that increased aid to adults with a disability can reduce financial instability.

In Sickness and in Debt: Do Mounting Medical Bills Predict Payday Loan Debt?

Cash-strapped families sometimes turn to small, short-term loans with exorbitant fees­payday loans­to cope with mounting medical bills. Given that about three-fourths of payday loan customers are repeat borrowers, consumer advocates and policymakers have increasingly raised voices of concern about the use of payday loans to finance various household expenses, including, among other things, medical bills. The present study hypothesized that increases in medical debt are associated with increases in payday loan debt among a sample of Chapter 7 bankruptcy filers. The results of a multivariate tobit regression analysis showed that medical debt was associated with increased payday loan debt, controlling for various types of debt and other socioeconomic variables. This article concludes with implications of the results for social work policy- and direct-practice.

The impact of obesity on consumer bankruptcy.

Over the last two decades, both bankruptcy and obesity rates in the U.S. have seen a steady rise. As obesity is one of the leading causes of medical and morbidity related economic costs, its influence on personal bankruptcy is analyzed in this study. Using the National Longitudinal Survey of Youth 1979, we employ a duration model to investigate the relative importance of obesity on the timing of bankruptcy. Even after accounting for possible endogeneity of BMI and controlling for a wide variety of individual and aggregate-level confounding factors, being obese puts one at a greater risk of filing for bankruptcy.