Financial Toxicity as a Public Health Issue: Intersectional Disparities and Underutilized Financial Support Programs Among Urban U.S. Veterans

Financial toxicity–health-related financial strain—disproportionately affects U.S. veterans and may be influenced by race, gender, and financial-literacy skills. A cross-sectional survey of 88 veterans assessed literacy on compound interest, inflation, and long-horizon investing using adapted National Financial Capability Study items, alongside indicators of financial toxicity adapted from the Comprehensive Score for Financial Toxicity. Black female veterans demonstrated lower literacy than White men (50.0% vs 83.3%, p=0.039; 51.7% vs 83.3%, p=0.016), particularly in compound-interest and inflation (62.5% vs 87.5%, p=0.019; 45.8% vs 71.9%, p=0.043), and reported higher financial toxicity, including borrowing/savings use (60%, p=0.04), reduced work (80%, p=0.013), and treatment-adherence impacts (100%, p=0.006). Support program use was low (29.3%) even among Black women. Black female veterans faced heightened financial toxicity, linked to deficits in foundational financial-literacy skills; targeted screening, culturally adapted education on core financial concepts, and proactive benefit navigation may reduce strain and address inequities among urban veterans.