The risk of bankruptcy before and after brain or spinal cord injury - A glimpse of the iceberg's tip

Background: Injury and illness are often cited as causes of bankruptcy. However, the incidence of bankruptcy after an acute medical event is unknown. Objectives: Determine the incidence of bankruptcy in survivors of brain and spinal cord trauma, identify vulnerable subgroups, and compare the incidence pre- and postinjury. Design: Retrospective cohort study of patients injured from 1991 to 2002. Bankruptcy tracked from 1991 to 2004. Subjects: Consecutive sample of 6345 adult residents of Western Washington State admitted to hospital with brain or spinal cord injuries. Measures: Multivariate Cox proportional hazard regression to examine incidence of bankruptcy 5 years postinjury. We used Poisson regression to measure the incidence rate ratio (IRR) of bankruptcy before and after injury in a subgroup of 3527 subjects. Results: The incidence of bankruptcy 5 years postinjury was 3.5%. Bankruptcy was more frequent in patients with commercial medical insurance than those insured by Medicaid [hazard ratio (HR), 1.99; 95% confidence interval (CI), 1.47-2.70]. Bankruptcy was not consistently related to injury severity; patients with critical injuries tended to have a lower incidence of bankruptcy than those with mild injuries (HR, 0.65; Cl, 0.41-1.03). Bankruptcy incidence was higher in younger patients and those with positive toxicology or moderately elevated blood alcohol concentration. Compared with preinjury, there was a 33% increase in bankruptcy incidence postinjury (IRR, 1.33; Cl, 0.94-1.89). The relative increase was highest in Medicaid patients (IRR, 2.32; Cl, 1.09-4.95). Conclusions: The risk of bankruptcy postinjury is not negligible. There is an increase in bankruptcy postinjury, most evident in Medicaid patients. Better rehabilitation, workforce reintegration, and disability programs might reduce bankruptcy postinjury.