JMIR Publications

ABSTRACT

Background:

Abstract

Background:

Financial toxicity is an important public health concern among United States veterans, but scalable approaches for identifying veterans at elevated risk remain underdeveloped. Public health informatics frameworks may help translate patient-reported financial risk signals into brief screening, stratification, and navigation workflows.

Objective:

Objective:

To examine concept-level financial literacy and financial toxicity indicators among U.S. Veterans and assess how these findings may inform informatics-enabled screening approaches for identifying subgroups at elevated risk of health-related financial strain.

Methods:

Methods:

We conducted a cross-sectional survey of 88 U.S. veterans in 2024–2025. Financial literacy was assessed using 3 benchmark items from the National Financial Capability Study. Financial toxicity was assessed using items aligned with domains reflected in the Comprehensive Score for Financial Toxicity framework, including difficulty affording care, reduced or quit work, borrowing money or using savings for care, and treatment-adherence impact. Analyses included descriptive statistics, chi-square and Fisher exact tests, and unadjusted logistic regression.

Results:

Results:

Female veterans had lower rates of high financial literacy than male veterans (51.7% vs 81.4%, P=.006) and lower correct-response rates on compound interest (34.5% vs 61.0%, P=.024) and inflation (48.3% vs 72.9%, P=.033). Black veterans had lower correct-response rates than non-Black veterans on inflation (45.8% vs 71.9%, P=.027) and retirement strategy (62.5% vs 87.5%, P=.014), although composite high-literacy rates did not differ significantly by race. In unadjusted models among participants with complete outcome data (n=75), lower financial literacy was directionally associated with higher odds of all 4 financial toxicity outcomes, with the clearest association observed for work disruption (odds ratio 0.56 per 1-point increase in literacy score, 95% CI 0.33-0.95; P=.031). Black female veterans reported elevated financial toxicity across multiple domains. Financial support program use was low overall (29.3%).

Conclusions:

Conclusions:

These findings suggest that financial literacy is not merely a background characteristic, but a potentially important marker of vulnerability to financial toxicity among veterans. The results highlight specific literacy domains, especially compound interest, inflation, and retirement strategy, as actionable targets for intervention, while also identifying work disruption as a key screening signal. Together, these findings support the development of brief screening tools that combine concept-level financial literacy assessment with financial toxicity indicators to identify veterans who may benefit from earlier financial counseling, benefit navigation, and adherence support. Future studies should test whether such approaches improve both financial and health-related outcomes. Clinical Trial: Not applicable; this study was a cross-sectional survey and was not a registered clinical trial.