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Pre- and postinjury financial hardship among trauma survivors: A national survey study
Nina M Clark1, Alex H Hernandez, Lisa M Knowlton
1From the Department of Surgery (N.M.C., A.H.H., B.T.S., E.M.B., A.M., J.W.S.), Harborview Medical Center, University of Washington, Seattle, Washington; Department of Surgery (L.M.K.), Stanford University, Palo Alto, California; Division of Trauma, Burn, and Critical Care Surgery (B.T.S., E.M.B., A.M., J.W.S.), University of Washington, Seattle, Washington; Department of Surgery (G.A.), Brigham and Women's Health, Boston, Massachusetts; Institute for Health Metrics and Evaluation (J.L.D., J.W.S.) and Department of Psychiatry and Behavioral Sciences (D.Z.), University of Washington, Seattle, Washington.
Background:
National estimates of financial hardship because of injury are lacking, which limits our ability to both define and mitigate the impacts of financial outcomes of trauma care. Furthermore, the absence of preinjury data limits our understanding of the association between injury and financial hardship.
Methods:
We analyzed data from the 2014-2021 Medical Expenditure Panel Survey. We compared injured adults (18-64 years old) to uninjured controls using coarsened-exact matching on age, sex, race/ethnicity, income, payer, survey panel, and comorbidities. Our main outcome of interest was financial hardship, a composite of difficulty paying medical bills, paying medical bills off over time, and delaying medical care because of cost. As a secondary analysis, we evaluated the link between difficulty paying medical bills, delaying care, and poor health.
Results:
We included a weighted sample of more than 79 million injured patients over the 8-year study period. Difference-in-differences analysis using uninjured, matched controls showed that injured patients experienced an 8.2 percentage point increase in financial hardship (23% relative increase, with 40.6% reporting financial hardship postinjury, p < 0.001) and 4.5 percentage point increase in poor health (20% relative increase, p < 0.001). Injured patients who reported difficulty with medical bills were more likely to report delaying care because of costs (adjusted odds ratio, 3.3; 95% confidence interval, 2.5-4.4), and those who delayed care were more likely to report poor health (adjusted odds ratio, 1.5; 95% confidence interval, 1.2-2.0).
Conclusion:
In this national analysis of financial hardship before and after injury, 40% of injured patients reported difficulty with medical bills and delayed medical care because of cost. Programs aimed at disrupting the path from injury to financial hardship to poor long-term health have the potential to benefit millions of injury survivors.
Level Of Evidence:
Prognostic and Epidemiological; Level III.
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