确定受伤后的财务困境是先前存在的还是由受伤引起的：一项针对下肢创伤患者的前瞻性队列研究。

Determining If Post-Injury Financial Distress Was Preexisting or Injury-Induced: A Prospective Cohort Study of Patients with Lower-Extremity Trauma.

作者信息

O'Hara Nathan N, Gage Mark J, Loudermilk Casey, Bell Alice, Okhuereigbe David, Li Vivian, Lawrence Joshua E, Turner Kristin E, Kovvur Murali, O'Toole Robert V, Slobogean Gerard P, Mundy Lily R

机构信息

R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland.

Department of Plastic and Reconstructive Surgery, Johns Hopkins University, Baltimore, Maryland.

出版信息

J Bone Joint Surg Am. 2024 Dec 24. doi: 10.2106/JBJS.24.00345.

DOI:10.2106/JBJS.24.00345

PMID:39719002

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12185770/

Abstract

BACKGROUND

Previous research has estimated that over one-half of patients with orthopaedic trauma experience financial distress after the injury. However, it is unknown what proportion of patients lived under financial distress before the injury and, therefore, the causal effect of the injury on financial distress. This study examined changes in financial distress after the injury and factors associated with new post-injury financial distress.

METHODS

A prospective cohort study was performed at a single academic trauma center, leveraging patients' 2-week recall of their pre-injury financial circumstances to permit a quasi-experiment design. Adult patients with a surgically treated lower-extremity fracture were included. The primary outcome was self-reported financial distress. Pre-injury financial distress was compared with financial distress in the 6 months after the injury. Multinomial logistic regression was used to identify factors associated with new financial distress after the injury.

RESULTS

A total of 200 study participants were enrolled (median age, 42 years [interquartile range, 32 to 59 years]); 56% of patients were male. Financial distress was present in 40% of the study participants before the injury. The fracture was associated with an absolute increase of 19% (95% confidence interval [CI], 5% to 34%; p < 0.001) in the prevalence of financial distress. New post-injury financial distress was associated with working before the injury (odds ratio [OR], 6.9 [95% CI, 2.2 to 22]; p < 0.001) and earning <$70,000 per year (OR, 3.6 [95% CI, 1.2 to 10]; p = 0.02).

CONCLUSIONS

The findings suggest that 2 of 5 patients with a lower-extremity fracture had experienced financial distress before the injury. The prevalence of financial distress increased to 3 of 5 after the injury. Working and earning <$70,000 per year before the injury substantially elevated the patients' risk of new financial distress post-injury. Future efforts should target interventions to reduce financial distress in this at-risk population.

LEVEL OF EVIDENCE

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

先前的研究估计，超过一半的骨科创伤患者在受伤后会经历经济困境。然而，尚不清楚受伤前有多大比例的患者生活在经济困境中，因此也不清楚受伤对经济困境的因果影响。本研究调查了受伤后经济困境的变化以及与受伤后新出现的经济困境相关的因素。

方法

在一个单一的学术创伤中心进行了一项前瞻性队列研究，利用患者对受伤前经济状况的两周回忆来进行准实验设计。纳入接受手术治疗的下肢骨折成年患者。主要结局是自我报告的经济困境。将受伤前的经济困境与受伤后6个月的经济困境进行比较。采用多项逻辑回归来确定与受伤后新出现的经济困境相关的因素。

结果

共纳入200名研究参与者（中位年龄42岁[四分位间距，32至59岁]）；56%为男性。40%的研究参与者在受伤前存在经济困境。骨折与经济困境患病率绝对增加19%（95%置信区间[CI]，5%至34%；p<0.001）相关。受伤后新出现的经济困境与受伤前工作（优势比[OR]，6.9[95%CI，2.2至22]；p<0.001）以及年收入低于70,000美元（OR，3.6[95%CI，1.2至10]；p = 0.02）相关。