TY - JOUR
T1 - The Impact of Burn Survivor Preinjury Income and Payer Status on Health-Related Quality of Life
AU - Sheckter, Clifford C.
AU - Carrougher, Gretchen J.
AU - Wolf, Steven E.
AU - Schneider, Jeffrey C.
AU - Gibran, Nicole
AU - Stewart, Barclay T.
N1 - Publisher Copyright:
© 2021 The Author(s) 2021. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: [email protected].
PY - 2022/3/1
Y1 - 2022/3/1
N2 - The costs required to provide acute care for patients with serious burn injuries are significant. In the United States, these costs are often shared by patients. However, the impacts of preinjury finances on health-related quality of life (HRQL) have been poorly characterized. We hypothesized that lower income and public payers would be associated with poorer HRQL. Burn survivors with complete data for preinjury personal income and payer status were extracted from the longitudinal Burn Model System National Database. HRQL outcomes were measured with VR-12 scores at 6, 12, and 24 months postinjury. VR-12 scores were evaluated using generalized linear models, adjusting for potential confounders (eg, age, sex, self-identified race, burn injury severity). About 453 participants had complete data for income and payer status. More than one third of BMS participants earned less than 25,000/year (36%), 24% earned 25,000 to 49,000/year, 23% earned 50,000 to 99,000/year, 11% earned 100,000 to 149,000/year, 3% earned 150,000 to 199,000/year, and 4% earned more than 200,000/year. VR-12 mental component summary (MCS) and physical component summary (PCS) scores were highest for those who earned 150,000 to 199,000/year (55.8 and 55.8) and lowest for those who earned less than 25,000/year (49.0 and 46.4). After adjusting for demographics, payer, and burn severity, 12-month MCS and PCS and 24-month PCS scores were negatively associated with Medicare payer (P <. 05). Low income was not significantly associated with lower VR-12 scores. There was a peaking relationship between HRQL and middle-class income, but this trend was not significant after adjusting for covariates. Public payers, particularly Medicare, were independently associated with poorer HRQL. The findings might be used to identify those at risk of financial toxicity for targeting assistance during rehabilitation.
AB - The costs required to provide acute care for patients with serious burn injuries are significant. In the United States, these costs are often shared by patients. However, the impacts of preinjury finances on health-related quality of life (HRQL) have been poorly characterized. We hypothesized that lower income and public payers would be associated with poorer HRQL. Burn survivors with complete data for preinjury personal income and payer status were extracted from the longitudinal Burn Model System National Database. HRQL outcomes were measured with VR-12 scores at 6, 12, and 24 months postinjury. VR-12 scores were evaluated using generalized linear models, adjusting for potential confounders (eg, age, sex, self-identified race, burn injury severity). About 453 participants had complete data for income and payer status. More than one third of BMS participants earned less than 25,000/year (36%), 24% earned 25,000 to 49,000/year, 23% earned 50,000 to 99,000/year, 11% earned 100,000 to 149,000/year, 3% earned 150,000 to 199,000/year, and 4% earned more than 200,000/year. VR-12 mental component summary (MCS) and physical component summary (PCS) scores were highest for those who earned 150,000 to 199,000/year (55.8 and 55.8) and lowest for those who earned less than 25,000/year (49.0 and 46.4). After adjusting for demographics, payer, and burn severity, 12-month MCS and PCS and 24-month PCS scores were negatively associated with Medicare payer (P <. 05). Low income was not significantly associated with lower VR-12 scores. There was a peaking relationship between HRQL and middle-class income, but this trend was not significant after adjusting for covariates. Public payers, particularly Medicare, were independently associated with poorer HRQL. The findings might be used to identify those at risk of financial toxicity for targeting assistance during rehabilitation.
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U2 - 10.1093/jbcr/irab170
DO - 10.1093/jbcr/irab170
M3 - Article
C2 - 34519793
AN - SCOPUS:85127853553
SN - 1559-047X
VL - 43
SP - 293
EP - 299
JO - Journal of Burn Care and Research
JF - Journal of Burn Care and Research
IS - 2
ER -