Patient adverse financial outcomes before and after COVID-19 infection

Abstract

Adverse financial outcomes after COVID-19 infection and hospitalization have not been assessed with appropriate comparators to account for other financial disruptions of 2020-2021. Using credit report data from 132,109 commercially insured COVID-19 survivors, we compared the rates of adverse financial outcomes for two cohorts of individuals with credit outcomes measured before and after COVID-19 infection, using an interaction term between cohort and hospitalization to test whether adverse credit outcomes changed more for hospitalized than nonhospitalized COVID-19 patients. Covariates included age group, gender, and several area-level social determinants of health. Adverse financial outcomes were significantly more common after COVID-19 infection than before COVID-19 infection, with greater increases among those hospitalized with COVID-19 (5-8 percentage points) than among nonhospitalized patients (1-3 percentage points). Future work examining longitudinal financial outcomes before and after COVID-19 infection is needed to determine the causal mechanisms of this association to reduce financial hardship from COVID-19 and other conditions.

Figure 1:

Adjusted rates of adverse credit outcomes by COVID-19 hospitalization and cohort. This figure displays adjusted rates of adverse credit outcomes in January 2021 (low credit score, medical debt in collections, and non-medical debt in collections) by COVID-19 hospitalization and cohort (Panel A, non-hospitalized patients; Panel B, hospitalized patients). The comparison cohort includes individuals with COVID-19 diagnoses during February – October 2021 (credit outcomes observed prior to infection) and the post-infection cohort includes individuals with COVID-19 diagnoses during March – July 2020 (credit outcomes observed after COVID-19 diagnosis). The adjusted rates displayed here are predicted using the postestimation margins command in Stata from logistic regressions for each adverse credit outcome, adjusting for gender, age band, and county social vulnerability quartile fixed effects, county-level COVID-19 vaccination rate in October 2021, zip-code median income, zip-code Gini index of income inequality, and percentage of zip-code owner-occupied housing units and limited English-speaking households. All models also include an interaction term between COVID-19 hospitalization and cohort. Odds ratio coefficient estimates from these regressions are available in Table A1.