The costs required to provide acute care for patients with serious burn injuries are significant. In the US, these costs are often shared by patients. However, the impacts of pre-injury 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 pre-injury 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 post-injury. VR-12 scores were evaluated using generalized linear models, adjusting for potential confounders (e.g., age, gender, self-identified race, burn injury severity).
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 $25,000-49,000/year, 23% earned $50,000-99,000/year, 11% earned $100,000-149,000/year, 3% earned $150,000-199,000/year, and 4% earned >$200,000/year. VR-12 mental component (MCS) and physical component summary (PCS) scores were highest for those who earned $150-199k/year (55.8 and 55.8), and lowest for those who earned <$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<0.05). 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.