O3013: Associations Between Perceived Financial Distress and Non-medical Out-of-pocket Expenses Among Caregivers of Critically Ill Children

Background: Financial distress due to critical illness may lead to negative long-term consequences. Encompassing objective (out-of-pocket expenses) and subjective (perception of one’s financial situation) elements, stress is independently associated with worse clinical outcomes and decreased quality of life. Sources of objective distress include direct costs and indirect or non-medical out-of-pocket expenses (NMOOPEs), (e.g. transportation, meals, childcare). The impact of indirect costs is poorly understood. Most research in pediatrics has been in general pediatrics, highlighting the burden of out-of-pocket expenses. High costs of Pediatric Intensive Care Unit (PICU) admissions may worsen this burden, but remains understudied. We hypothesize that families of lower socioeconomic status have higher NMOOPEs relative to income and experience higher rates of financial distress.

Methods: Single-center, prospective, survey of families within 72-120 hours of PICU admission. Exclusion criteria: non-English or Spanish speakers, or no permanent address. Primary outcome was family experience of financial condition, measured by the 8-item self-reported IFDFW questionnaire, scored continuously from 1-10 with distress reported as a trichotomized outcome: high (1.0-4.0), average (4.1-6.9), and low (greater than 7.0) distress. The exposure, NMOOPEs, was assessed as the costs associated with transportation, meals, childcare, housing and reported as percentages of the participant’s weekly income (annual household income divided by 52 weeks). We used the Kruskal-Wallis test for continuous variables and Chi-square or Fisher’s exact test as appropriate for categorical variables.

Results: In 6 months, we approached 219 families and enrolled 180 (82%); 98 returned surveys thus far (54%). Average age of parents was 37 years, with 51% identifying as White/Caucasian, 17% as Black/African American, and 32% as other. 46.9% of families were experiencing average distress, 26.5% high distress, and 26.5% low distress. Families experiencing high financial distress spent 6.16% of their weekly income on food when compared with those experiencing average distress (2.78%) and low distress (1.47%) (p 0.000). Of families who experienced high financial distress, 44% expressed concern for having utilities discontinued, compared to 7.7% of families with low distress (p 0.002).

Conclusion: Initial analyses demonstrate a relationship between higher proportionate food expenditures and family reports of financial distress, and highlight an association between reported concern for utility discontinuation and financial distress. Concern for utility discontinuation is a validated risk factor for unmet social needs in social determinants of health screenings. Positive association between the IFDFW tool and "utilities question" suggests that the IFDFW scale may be another reliable tool to screen for unmet needs, specifically unmet financial needs. These findings provide insight into the impact of family expenditures on perceived financial stress during hospitalization. Understanding this relationship and additional associated attributes is an essential step in guiding future interventions aimed at mitigating financial distress.