Financial fragility in adults with CHD: a report from the CHD Project to Understand Lifelong Survivor Experience
Cassidy Golden, Caroline Shi, Matthew E. Oster, Lazaros Kochilas, Bradley Marino, Mansi Gaitonde, Dawn Ilardi, Michael FundoraAbstract
Background:
Understanding the long-term implications of CHD has become a priority as survival rates have improved. Little is understood about the economic implications of living with CHD into adulthood.
Objectives:
We aimed to determine the prevalence and risk factors of financial fragility (i.e., ability to pay $2,000 for an emergency expense) among adults with CHD in the United States and compare outcomes to their healthy siblings.
Methods:
We conducted a cross-sectional study using data from the CHD Project to Understand Lifelong Survivor Experience survey (2021–2023). The survey assessed demographics, medical history, and economic outcomes, including financial fragility. Analyses included chi-square and Wilcoxon rank-sum tests with multivariable logistic regression models adjusted for demographic and socioeconomic factors.
Results:
There were 3074 adults with CHD and 324 siblings who answered the financial fragility question. The prevalence of financial fragility was 20.6% for individuals with CHD versus 12.7% in siblings ( p = 0.02); individuals with CHD had higher odds (OR 1.50, 95% CI 1.04–2.17, p = 0.029) of financial fragility compared to siblings. Single ventricle anatomy was the only CHD group significantly associated with financial fragility (aOR 1.59, 95% CI 1.12–2.26). Financially fragile individuals were more likely to report blindness, be female or a race other than non-Hispanic white, and have single ventricle CHD.
Conclusion:
Adults with CHD experience greater financial fragility than their siblings and disease severity is associated with increased risk. Addressing financial fragility is essential to mitigate the long-term economic burden of CHD on patients and families.