256: FAMILY FINANCIAL HARDSHIP BEFORE AND AFTER PEDIATRIC CRITICAL ILLNESS

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Introduction: Little is known about caregiver financial hardship before versus after a child’s Pediatric Intensive Care Unit (PICU) hospitalization. Methods: We used a novel dataset linking statewide commercial insurance claims to cross-sectional commercial credit data. Using validated revenue codes, we identified PICU hospitalizations (age ≤18 years) in January-June 2020 and January-June 2021. Caregivers of these children were identified as adults listed as the primary plan holder or spouse of the primary plan holder. Financial measures in January 2021 assessed pre-PICU status in the January-June 2021 cohort and post-PICU status in the January-June 2020 cohort. Financial measures included delinquent debt, debt in collections by type (medical and non-medical), low credit score(< 660), and financial hardship(composite of any outcome). Logistic and generalized linear regression models were used to compare caregiver financial status in the 2021 vs 2020 cohorts (pre- vs post-PICU). Models were adjusted for child’s age and comorbidity status, hospital length of stay, and household status (primary plan holder with a spouse on the plan; spouse; and primary plan holder with no spouse on the plan). Results: We identified 1038 caregivers for 608 children pre-PICU and 1092 caregivers for 631 children post-PICU. 99.8% (n=2,126) of caregivers were linked to their credit report data; 1035 pre-PICU and 1091 post-PICU caregivers. Post-PICU caregivers had higher adjusted odds of any delinquent debt [adjusted Odds Ratio 1.22; 95%CI 1.00-1.48; p=0.04]. Post-PICU caregivers had higher frequencies of medical and non-medical debt in collections, and low credit score, though not statistically significant. For those with delinquent debt, post-PICU caregivers had higher adjusted mean debt than pre-PICU caregivers ($3692 vs $2536, p< 0.01). Amounts of medical and non-medical debt in collections were similar. 45.7% and 49.8% of pre- and post-PICU families had any measure of financial hardship. Conclusions: Financial hardship is common in caregivers of critically ill children—present in nearly half before and after PICU hospitalization. While delinquent debt was higher after PICU hospitalization, medical debt in collections was similar pre- vs post-PICU, suggesting non-medical costs may be a key driver of financial hardship post-PICU.