Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Nov;87(5):1189-1196.
doi: 10.1097/TA.0000000000002409.

Financial toxicity is associated with worse physical and emotional long-term outcomes after traumatic injury

Patrick B Murphy  1 , Sarah Severance, Stephanie Savage, Samilia Obeng-Gyasi, Lava R Timsina, Ben L Zarzaur
Affiliations

Financial toxicity is associated with worse physical and emotional long-term outcomes after traumatic injury

Patrick B Murphy et al. J Trauma Acute Care Surg. 2019 Nov.

Abstract

Background: Increasing health care costs and high deductible insurance plans have shifted more responsibility for medical costs to patients. After serious illnesses, financial responsibilities may result in lost wages, forced unemployment, and other financial burdens, collectively described as financial toxicity. Following cancer treatments, financial toxicity is associated with worse long-term health-related quality of life (HRQoL) outcomes. The purpose of this study was to determine the incidence of financial toxicity following injury, factors associated with financial toxicity, and the impact of financial toxicity on long-term HRQoL.

Methods: Adult patients with an Injury Severity Score of 10 or greater and without head or spinal cord injury were prospectively followed for 1 year. The Short-Form-36 was used to determine overall quality of life at 1 month, 2 months, 4 months, and 12 months. Screens for depression and posttraumatic stress syndrome were administered. The primary outcome was any financial toxicity. A multivariable generalized estimating equation was used to account for variability over time.

Results: Five hundred patients were enrolled, and 88% suffered financial toxicity during the year following injury (64% reduced income, 58% unemployment, 85% experienced stress due to financial burden). Financial toxicity remained stable over follow-up (80-85%). Factors independently associated with financial toxicity were lower age (odds ratio [OR], 0.96 [0.94-0.98]), lack of health insurance (OR, 0.28 [0.14-0.56]), and larger household size (OR, 1.37 [1.06-1.77]). After risk adjustment, patients with financial toxicity had worse HRQoL, and more depression and posttraumatic stress syndrome in a stepwise fashion based on severity of financial toxicity.

Conclusion: Financial toxicity following injury is extremely common and is associated with worse psychological and physical outcomes. Age, lack of insurance, and large household size are associated with financial toxicity. Patients at risk for financial toxicity can be identified, and interventions to counteract the negative effects should be developed to improve long-term outcomes.

Level of evidence: Prognostic/epidemiologic study, level III.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest and Source of Funding: None declared

References

    1. Centers for Disease Control and Protection. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Data; Accessed 01–04-2019.
    1. Abedzadeh-Kalahroudi M, Razi E, Sehat M. The relationship between socioeconomic status and trauma outcomes. J Public Health (Bangkok). 2018;40(4):e431–9. - PubMed
    1. Gordon LG, Merollini KMD, Lowe A, Chan RJ. A Systematic Review of Financial Toxicity Among Cancer Survivors: We Can’t Pay the Co-Pay. Patient. 2017;10(3):295–309. - PubMed
    1. Gilligan AM, Alberts DS, Roe DJ, Skrepnek GH. Death or Debt? National Estimates of Financial Toxicity in Persons with Newly-Diagnosed Cancer. Am J Med. 2018;131(10):1187–1199.e5. - PubMed
    1. Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, Abernethy AP. The Financial Toxicity of Cancer Treatment: A Pilot Study Assessing Out-of-Pocket Expenses and the Insured Cancer Patient’s Experience. Oncologist. 2013;18(4):381–90. - PMC - PubMed

Publication types

MeSH terms