Study finds medical debt linked to worse health status, increased mortality

At the county level, medical debt is associated with worse health status, premature death, and increased mortality rates, according to a study published online March 4 in JAMA Network Open.

Xuesong Han, Ph.D., from the American Cancer Society in Atlanta, and colleagues conducted a cross-sectional study at the U.S. county level to examine the associations of medical debt with health status, premature death, and mortality. The analysis included data from 2,943 counties.

On average, 19.8 percent of the population had medical debt. The researchers found that a 1-percentage point increase in the population with medical debt was associated with 18.3 and 17.9 more physically and mentally unhealthy days, respectively, per 1,000 people during the past month after adjustment for county-level sociodemographic characteristics, and with 1.12 years of life lost per 1,000 people and an increase of 7.51 per 100,000 person-years in age-adjusted all-cause mortality rate.

For all leading causes of death, including cancer, heart disease, and suicide, associations of medical debt and elevated mortality rates were consistent (1.12, 1.39, and 0.09, respectively, per 100,000 person-years).

"Patients are increasingly burdened by high out-of-pocket costs for health care in the U.S., including problems paying medical bills and medical debt," Han said in a statement. "Our findings reinforce medical debt as an important social determinant of health, which, unfortunately, may threaten public health in the country."

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