Age, Financial Hardship, and Catastrophic Health Expenditure After Emergency Surgery

Financial hardship (FH), defined as the adverse effects of medical costs on patients, is common among trauma and emergency surgery populations. Although government-sponsored insurance programs aim to financially protect older adults, this population remains at risk due to lower incomes and higher health care utilization. We evaluated the association between age and FH among emergency surgery patients.

We analyzed adults admitted through the emergency department for surgery using the Medical Expenditure Panel Survey (2017-2022). Age was the primary exposure, with older adults defined as ≥65 y. Outcomes included FH and catastrophic health expenditure (CHE). FH encompassed difficulty paying medical bills, delayed care, or medication nonadherence due to cost. CHE was defined as out-of-pocket spending exceeding 10% of family income. Multivariable logistic regression was used to estimate adjusted odds.

Among 2908 patients (weighted n = 4,905,515), 44.4% were older adults. Overall, 30.7% experienced FH, including 35.2% of younger and 25.0% of older adults (P < 0.01). CHE occurred in 12.7% of patients, with higher rates among older adults (15.9% versus 10.2%, P < 0.01). After adjustment, older adults had lower odds of FH (odds ratio: 0.61; 95% confidence interval: 0.40-0.94) but similar odds of CHE (odds ratio 1.35; 95% confidence interval 0.86-2.14) compared to younger patients.

Older adults undergoing emergency surgery report less FH despite experiencing higher rates of CHE. Although subsidized insurance may reduce perceived financial strain, it does not fully protect against high out-of-pocket costs. Policy efforts should focus on improving insurance design to better limit catastrophic expenditures, including appropriate out-of-pocket maximums.