Cumulative financial stress and strain in palliative radiation outpatients: The role of age and disability

Figures & data

Figure 1. MIMIC Regression of Subjective Patient Financial Strain: Age and Disability as Co-Moderators.

Table I.  Ordinal Probit MIMIC Model Moderated by Age and Disability ^a.

	Indirect Effects on Latent Construct:	Direct Effects to Latent Y Indictors:^b
	Subjective Patient Financial Strain	Insurance/Finances for Future Health Needs	Difficulty Paying Bills	Worry about Healthcare Expenses
X Variables	b (S.E.)	b (S.E.)	b (S.E.)	b (S.E.)
Sex	−.020
	(.149)
Education	.0035
	(.047)
Marital	.289	−.190		.115
	(.322)	(.332)		(.313)
On-leave/Unemployed	.380		−.653
	(.238)		(.277)
Employed	.071		−.495
	(.192)		(.269)
Age	−.001	.020	−.045 ***** ^c
	(.009)	(.011)	(.012)
Missing 1st Subcomposite	−.049
	(.146)
OFFS	.304 **	.141 ***** ^c,d	.186 ***** ^c
	(.134)	(.148)	(.137)
Disability Days	.022
	(.139)
Age^2	−.0047		−.00054 ** ^c
	(.00042)		(.00061)
OFFS^2	−.037	−.124 ****	.041 *** ^c,d
	(.061)	(.071)	(.088)
Age*OFFS	.002		.016 * ^c	−.013
	(.007)		(.009)	(.007)
Age*Disability Days	b = 0 in final model	.022
		(.019)
Disability Days*OFFS	b = 0 in final model	−.274
		(.170)
Age*Disability Days*	b = 0 in final model^e	−.035 ****
OFFS		(.012)

NOTE: MIMIC = Multiple Indicators-Multiple Causes Regression; OFFS = Objective Family Financial Stress Index

a. n=267. Fit of the data to the MIMIC model is good based on various indices: Chi-Square (23 df) = 16.074 at p=.8521; Descriptive Fit Value=.0030 < 1.5; and Goodness of Fit=.9958. Although the Root Mean Square Residual=.129, which exceeds the value of .08 recommended by Hu and Bentler [23] for adequate model fit, the MIMIC model moderated only by age (and not disability) has a Root Mean Square Residual=.079. Thus, the deterioration in residuals fit can be attributed to a) the information loss when software memory limitations necessitated the collapse at the mean of the continuous disability days variable into a dummy variable; and b) the specification loss of the curvilinear term.

b. The respective lambda loadings, representing acceptable fit of the latent y-indicators to the unidimensional latent construct, are 1.000, .6011, and .8915.

c. The total effect (i.e., direct plus indirect effects) is statistically significant at p<.05 when this unique, direct effect is added to the shared, indirect effect of the latent construct.

d. Not significant in the MIMIC model based only on observations with non-missing data within the first subcomposite of OFFS (n=200). Missing data occurs within two of the variables (family income and out-of-pocket costs) used to calculate the first subcomposite. Interpretations of the follow-up simple slopes plots (Figures 2–4) are unaffected.

e. This final model is more valid than the one that also estimates the indirect effects since disability days co-moderates only one of the shared and unique effect relationships. Statistical inferences are unaffected.

**p<.05 ***p<.02 ****p<.01 *****p<.005.

Figure 2. “Difficulty Paying Bills” as Age Advances across OFFS.

Figure 3. Inadequacy of Insurance/Financial Resources as Age Advances across OFFS: Patients with No Disability Days.

Figure 4. Inadequacy of Insurance/Financial Resources as Age Advances across OFFS: Patients with Above-Average Disability Days.

Hu L, Bentler P. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equations Modeling 1999; 6: 1–55

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