Association of Financial Distress With Nonmedical Out-of-Pocket Expenses in Those With Critical Illness

Financial distress related to critical illness worsens clinical outcomes and is affected by objective financial difficulty or subjective perception of financial distress. Sources of financial distress include nonmedical out-of-pocket expenses (NOPEs; eg, food), but their impact on perceived financial distress is poorly understood, especially in pediatric critical care. We examine the association among overall NOPEs, their components, and perceived financial distress in families with children who have a critical illness.

This was a single-site cross-sectional survey (conducted from September 2021 to August2022) of caregivers of children admitted to the pediatric intensive care unit (PICU). Perceived financial condition was measured by the InCharge Financial Distress/Financial Well-Being tool and categorized as high (1.0-4.0), average (4.1-6.9), or low (≥7.0) distress. NOPEs included costs of transportation, food, childcare, and housing, reported as proportions of weekly income. We used ordinal logistic regression to examine the relationship between NOPEs and perceived financial distress.

A total of 332 families were approached, and 279 provided consent (84%); 149 families returned surveys (53%). A total of 30% of families reported high distress, 45% reported average distress, and 25% reported low distress. Median proportion of total NOPEs relative to income was 34.7% for families with high distress, 12.7% for those with average distress, and 5.2% for those with low distress. The odds of increased financial distress was associated with the proportion of weekly income spent on total NOPEs (adjusted odds ratio [aOR], 1.02; 95% CI: 1.01-1.04) and on food (aOR, 1.22; 95% CI: 1.06-1.44).

In this PICU population, proportions of weekly income spent on total NOPEs and, separately, on food were associated with perceived financial distress. Potential policy interventions could target reducing the burden of NOPEs to mitigate financial distress.