In a recent cross-sectional study published in JAMA network open, Researchers in the United States examined the association between medical debt and national health outcomes in the United States at the county level.
They found that medical debt is associated with poorer population health and increased premature death and mortality.
study: The relationship between medical debt and health status, premature death, and mortality in the United States. Image credit: Pormezz/Shutterstock.com
background
Financial burdens and out-of-pocket medical costs are increasing in the United States, leading to a concerning increase in medical debt, affecting 17.8% of individuals in 2020.
Certain vulnerable populations, such as racial and ethnic minorities, women, young people, and people with chronic conditions, are at higher risk of incurring medical debt.
This debt is associated with negative impacts on well-being, including delayed medical care, nonadherence to prescriptions, and increased food and housing insecurity. Despite these individual-level associations, the county-level effects of medical debt on health outcomes remain poorly understood.
This study aims to address this gap by examining the relationship between medical debt and health status, mortality, and premature death at the U.S. county level using data from the Urban Institute Debt in America project. It was made.
About research
In this study, debt data were obtained from a nationally representative 2% panel of anonymized records from credit bureaus. A total of 2,943 U.S. counties were included, 39.2% of which were in metropolitan areas. The median number of residents in each county was 18.3% who were 65 years of age or older.
The median racial breakdown of the population was: 0.4% American Indian/Alaska Native, 0.8% Asian/Pacific Islander, 3.0% Black, 4.3% Hispanic, and 84.5% White.
Excluded counties were primarily nonmetropolitan, with smaller population sizes and reduced sociodemographic diversity.
This study examined three health outcome sets from public data sources. This includes self-reported health status, premature death as measured by years of life potentially lost, and age-adjusted all-cause mortality rates and cause-specific mortality rates from major causes such as cancer. , heart disease, Alzheimer's disease, diabetes, and suicide at the county level in the United States.
Additionally, this study considered county-level sociodemographic factors from U.S. Census data, including racial distribution, educational attainment, uninsured status, unemployment, and metropolitan status as potential confounders.
Two measures of medical debt were considered in the analysis. The first measure assesses the proportion of individuals with medical debt as a percentage of recoveries, and the second measure focuses on the median medical debt (in 2018 USD).
Total debt, including medical debt and other types of debt, is also included in the supplementary analysis.
Statistical analyzes included descriptive analysis and the use of bivariate and multivariate linear models, incorporating random state-level intercepts and weighted by county population size.
Results and discussion
An average of 19.8% of the surveyed population had medical debt. Counties with fewer white residents and more black residents, lower educational attainment, increased poverty, lack of insurance, and higher unemployment rates appear to have higher rates of medical debt.
They found that a 1% increase in the population of medical debtors would result in an increase of 18.3 physically unhealthy days and 17.9 mentally unhealthy days per 1,000 people over a 30-day period.
They also found that the rate of increase in medical debt was associated with a loss of 1.12 years of life per 1,000 people and an increase in age-adjusted all-cause mortality of 7.51 years per 100,000 person-years.
They found consistent associations with major causes of death, including heart disease, cancer, chronic obstructive pulmonary disease, diabetes, and suicide.
Similar patterns were found for the associations between median medical debt and selected health outcomes. Supplementary analyzes showed a similar pattern of association between medical debt and health outcomes.
This national study reaffirms that medical debt remains an important social determinant of public health.
However, medical debt may be underestimated in less populated counties, inability to investigate specific causes of medical debt, exclusion of individuals who do not participate in the credit system, and coronavirus infections. This study has limitations, including the need for further research into the effects of this disease. Medical debt and public health 2019 (COVID-19) related policies.
Additionally, a broader focus on overall debt suggested that policies that address different types of debt, such as student loans, could impact people's health.
conclusion
In conclusion, this study revealed an association between medical debt and negative health outcomes, including increased number of unhealthy days, premature death, and higher mortality rates.
These results demonstrate that various stakeholders, including government agencies, health systems, hospitals, and employers, are working together to reduce medical debt through paid sick leave, clear financial aid policies, and improved cost-related communication with patients. This highlights the need to address this issue.
Additionally, strengthening access to affordable health care through policies such as expanding health insurance coverage can improve the overall health status of the U.S. population.
