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Long-term Financial Hardship: Defining who is at risk for this devastating and overlooked complication of trauma
Saba Ilkhani
1, Mary M. Leech
2, John O. Hwabejire
2, Sabrina E. Sanchez
3, Juan P. Herrera-Escobar
1, John W. Scott
4, Ali Salim
1, Geoffrey A. Anderson
1
1Brigham and Women's Hospital, Boston, MA, 2Massachusetts General Hospital, Boston, MA, 3Boston Medical Center, Boston, MA, 4Harborview Medical Center, Seattle, WA
Background: Trauma victims are more likely to have negative social determinants of health and be trapped by cycles of unexpected injury, medical bills, chronic symptoms, inability to return to work, and debt. Necessary medical care becomes cost-prohibitive, compounding chronic illness and resulting in Long-term Financial Hardship (LT-FH). This study aimed to identify those at risk for LT-FH.
Methods: Adult trauma survivors from three Massachusetts Level-1 Trauma Centers were identified and surveyed. LT-FH was defined by at least one characteristic: medical debt, non-medical debt, income loss, or deferred care within one year post-discharge. Adjusted logistic regression was performed to analyze modifiers of LT-FH.
Results: Of 1219 patients, 405 (33.2%) experienced LT-FH (Table 1). Monthly income below $5,000 or out-of-pocket expenses above $2500 significantly increased LT-FH risk. Interestingly, those with out-of-pocket expenses below $500 also faced LT-FH, significantly higher than the $500-$2500 group and comparable to the above $2500 group. Finally, Medicaid or lack of insurance, government assistance, high area deprivation index, and discharge to rehab significantly increased LT-FH risk (Table 2).
Conclusion: This clarifies trauma survivors vulnerable to LT-FH who might benefit most from early intervention or prevention efforts, with uninsured status, receipt of government assistance, and out-of-pocket expenses above $10,000 posing the greatest risk.
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