ORIGINAL RESEARCH
Minal R. Patel, PhD, MPH; Cindy W. Leung, ScD, MPH; Rhea Saksena, MBBS, MPH, MRC; Wei Hao, PhD
Corresponding Author: Minal R. Patel, PhD, MPH; Department of Health Behavior & Health Equity, University of Michigan School of Public Health.
Email: minalrp@umich.edu
DOI: 10.3122/jabfm.2026.260028R2
Keywords: Access to Care, Chronic Disease, Disease Management, Financial Stress, Screening, Social Determinants of Health
Dates: Submitted: 1/21/2026; Accepted: 4/27/2026
Status: In Press.
BACKGROUND: Financial resource strain impairs chronic disease management, yet research treats it as static rather than examining when difficulties arise relative to diagnosis. This study examined the timing of financial resource strain relative to chronic disease diagnosis and identified factors associated with interest in financial assistance.
METHODS: We conducted a health system-based retrospective analysis using standardized social determinants of health screening data from 119,100 adult primary care patients at a large academic medical center between 2017-2024. Financial resource strain was assessed using validated screening questions. We analyzed monthly trends in strain prevalence, differences by chronic condition and diagnosis timing, and factors associated with interest in financial assistance using multivariable logistic regression.
RESULTS: Overall, 7% of patients screened positive for financial resource strain. Among newly diagnosed patients, strain rates increased substantially post-diagnosis: asthma (2.0% to 6.6%, 3.3-fold), hypertension (1.5% to 5.0%, 3.3-fold), and diabetes (2.2% to 5.7%, 2.6-fold). Patients with financial strain often had additional social needs (69%). Those with three or more unmet needs had over four times higher odds of requesting assistance compared to those with financial strain alone (AOR = 4.37, 95% CI: 3.41–5.60). Non-Hispanic Black (AOR = 2.56), Hispanic (AOR = 1.58), and uninsured patients (AOR = 2.02) were significantly more likely to request support.
CONCLUSION: Chronic disease diagnosis represents a critical financial inflection point with marked post-diagnosis increases in strain. Social needs screening identifies patients most receptive to assistance. These findings support integrating proactive financial screening and referral into chronic disease management workflows, particularly at the time of new diagnosis, to reduce downstream financial hardship and improve disease management.