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Multicenter evaluation of financial toxicity and long-term health outcomes after injury
John W Scott1, Geoffrey A Anderson, Amelia Conatser
1From the Department of Surgery (J.W.S.), Harborview Medical Center, University of Michigan, Ann Arbor, Michigan; Department of Surgery (J.W.S., A.C., C.d.S., Z.G., J.L.J., J.K., I.M., J.M., E.J.O., M.R.H.), Center for Healthcare Outcomes and Policy (J.W.S., E.J.O., B.W.O., M.R.H.), University of Michigan, Ann Arbor, Michigan; Department of Surgery (G.A.A.), Brigham and Women's Hospital, Boston, Massachusetts; University of Michigan Medical School (E.E.); and Department of Orthopedic Surgery (B.W.O.), University of Michigan, Ann Arbor, Michigan.
Background:
Despite the growing awareness of the negative financial impact of traumatic injury on patients' lives, the association between financial toxicity and long-term health-related quality of life (hrQoL) among trauma survivors remains poorly understood.
Methods:
Patients from nine trauma centers participating in a statewide trauma quality collaborative had responses from longitudinal survey data linked to inpatient trauma registry data. Financial toxicity was defined based on patient-reported survey responses regarding medical debt, work or income loss, nonmedical financial strain, and forgone care due to costs. A financial toxicity score ranging from 0 to 4 was calculated. Health-related quality of life was assessed using the EuroQol 5 Domain tool. Multivariable regression models evaluated the association between financial toxicity and hrQoL outcomes while adjusting for patient demographics, injury severity and inpatient treatment intensity, and health systems variables.
Results:
Among the 403 patients providing 510 completed surveys, rates of individual financial toxicity elements ranged from 21% to 46%, with 65% of patients experiencing at least one element of financial toxicity. Patients with any financial toxicity had worse summary measures of hrQoL and higher rates of problems in all five EuroQol 5 Domain domains ( p < 0.05 for all). Younger age, lower household income, lack of insurance, more comorbidities, discharge to a facility, and air ambulance transportation were independently associated with higher odds of financial toxicity ( p < 0.05 for all). Injury traits and inpatient treatment intensity were not independently associated with financial toxicity.
Conclusion:
A majority of trauma survivors in this study experienced some level of financial toxicity, which was independently associated with worse risk-adjusted health outcomes across all hrQoL measures. Risk factors for financial toxicity are not related to injury severity or treatment intensity but rather to sociodemographic variables and measures of prehospital and posthospital health care resource utilization. Targeted interventions and policies are needed to address financial toxicity and ensure optimal recovery for trauma survivors.
Level Of Evidence:
Prognostic and Epidemiological; Level III.
