Financial toxicity and firearm injury: exploring financial needs of participants in a hospital-based violence intervention program

Ana M Reyes; Carlene McKenzie; Meghan Scott; Christopher R Haggerty; Julie Y Valenzuela

doi:10.1136/tsaco-2024-001570

Financial toxicity and firearm injury: exploring financial needs of participants in a hospital-based violence intervention program

Trauma Surg Acute Care Open. 2025 Jan 19;10(1):e001570. doi: 10.1136/tsaco-2024-001570. eCollection 2025.

Authors

Ana M Reyes^{1

2}, Carlene McKenzie^{2

3}, Meghan Scott³, Christopher R Haggerty⁴, Julie Y Valenzuela^{1

2}

Affiliations

¹ Dewitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
² Ryder Trauma Center, Jackson Memorial Hospital, Miami, Florida, USA.
³ Ummah Futures International, Miami, Florida, USA.
⁴ University of Miami Miller School of Medicine, Miami, Florida, USA.

Abstract

Background: Financial toxicity refers to financial hardship experienced because of illness or injury. Poverty is a known driver of community violence, but financial toxicity has not been studied in firearm violence survivors. The objective of our study was to explore the financial needs of firearm violence survivors enrolled in a hospital-based violence intervention program (HVIP). We hypothesized that survivors would report numerous financial needs.

Methods: This was a mixed-methods, retrospective study of firearm violence survivors enrolled in the Miami-Dade County HVIP from 2022 to 2023. Patients were eligible for enrollment if they were injured in shooting incidents that occurred in Miami-Dade police districts with high rates of group violence or gang-related violence. Social worker intake and longitudinal case records were reviewed. A qualitative thematic analysis of social worker notes was performed. Quantitative data were analyzed with descriptive statistics and χ² tests for association.

Results: 103 patients were enrolled in the program. The median age was 27 years. The majority of patients were black (82.5%) and male (83.5%). More patients were insured (59.2%) than uninsured (40.8%). Thematic analysis revealed 10 distinct financial needs, including assistance with victim crime compensation (75.7% of patients), medical bills (35.0%), wage loss (22.3%), insurance applications (14.6%), burial (13.6%), and emergency relocation (12.6%). Overall, financial needs were identified for 94 (91.3%) patients: 91 (88.3%) at initial program intake and 3 additional patients (2.9%) during longitudinal case management.

Conclusions: Survivors of firearm violence experience financial challenges after injury. Thus, financial support and assessment for financial toxicity should be included in firearm violence survivorship programs. Future investigations should use validated measures to study the financial toxicity of firearm violence survivors longitudinally.

Keywords: Firearms; socioeconomic factors; survivors; violence.