T5 The Impact of Burn Survivor Pre-injury Income and Payer on Health-Related Quality of Life Outcomes

Abstract

Abstract Introduction The critical care, surgery, and rehabilitation required to recover patients with serious burn injuries are associated with high financial costs. In the US, these costs are often borne by patients. However, the relationship between pre-injury finances (personal income and payer) and health-related quality of life (HRQL) of burn survivors has not been reported. We hypothesized that lower income and public payers would be independent predictors of poorer HRQL. Methods Burn survivors with complete data for pre-injury personal income and payer were extracted from the NIDILRR Burn Model System National Database. HRQL outcomes included VA-Rand 12 (VR-12) scores at 6-, 12-, and 24-months post-injury. VR-12 scores were evaluated using generalized linear models and adjusted for potential confounders (age, gender, self-identified race, measures of burn injury severity). Model performance was assessed with Akaike Information Coefficient. Results 453 burn survivors had complete data for income and payer status. 36.4% earned less than $25k/year, 24% earned $25k-49k/year, 23% earned $50k-99k/year, 10% earned $100k-149k/year, 3% earned $150k-199k/year, and 3% earned ≥$200k/year. Mental component summary (MCS) and physical component summary (PCS) scores were highest for those who earned $150-199k/year (55.8, 55.8), and lowest for those who earned < $25k/year (49.0, 46.4). There was a negative relationship between income < $25k/year and MCS scores at 6-, 12-, and 24-months post-injury (p< 0.05). This relationship was not observed with PCS scores. After adjusting for demographics, payer, and burn severity, 24-month PCS scores were negatively associated with Medicare payer (p=0.025), black race (p=0.008) and number of operations during index admission (p=0.026). There were no significant associations with MCS scores. Conclusions HRQL was highest for burn survivors earning between $150-199k/year. Participants who earned < $25k/year had the lowest VR-12 scores and particularly MCS scores. On multivariable analysis, most of the differences in HRQL associated with pre-injury income were explained by differences in demographic, payer and burn severity factors.