Nearly 1 in 5 Americans has medical debt, which is no longer a surprise. What is a surprise is that medical debt is linked to early death, a recent study found.
The study, published in JAMA Network, found that a higher share of the population with more medical debt was linked to more days of poor physical and mental health, higher mortality rates and more years of life lost.
The authors are American Cancer Society researchers Xuesong Han, PhD; Xin Hu, PhD; Zhiyuan Zheng, PhD; Kewei Sylvia Shi, MPH; and K. Robin Yabroff, PhD, “Associations of Medical Debt With Health Status, Premature Death, and Mortality in the US.“ studied 2,943 U.S. counties.
Their results findings suggest that medical debt is associated with worse population health, and that any policies that can increase access to affordable health care, such as expanding health insurance coverage or reducing debt, may improve population health.
Correlation, not causation
The authors were careful to note that this was a correlation, and that no causal link could be drawn.
However, it is generally true that people with more debt have lower income and may have less money to spend on things like wholesome food, gym memberships and so on. It’s also possible that people with medical debt are unable to get healthcare. People that have medical bills outstanding have refused to treat patients in some cases.
“These findings suggest that medical debt is associated with worse health status, more premature deaths, and higher mortality rates at the county level in the US. Therefore, policies increasing access to affordable health care, such as expanding health insurance coverage, may improve population health,” the researchers wrote.
“Patients are increasingly burdened by high out-of-pocket costs for health care in the US, including problems paying medical bills and medical debt. A recent study of credit report data estimated that 17.8% of individuals had medical debt in collections in 2020.”
The authors did suggest that policy efforts to reduce medical debt could improve population health.
“By linking recent nationwide county-level medical debt data with health surveillance data in this cross-sectional study, we observed associations between medical debt and worse health outcomes, including more unhealthy days, more premature deaths, and higher mortality rates. These findings suggest that efforts from multiple stakeholders, including federal, state, hospital and health care systems, and employers, to address medical debt may also improve population health in the US.”
“After adjusting for county-level sociodemographic characteristics, a 1–percentage point increase in the population with medical debt was associated with 18.3 (95% CI, 16.3-20.2) more physically unhealthy days and 17.9 (95% CI, 16.1-19.8) more mentally unhealthy days per 1000 people during the past month, 1.12 (95% CI, 1.03-1.21) years of life lost per 1000 people, and an increase of 7.51 (95% CI, 6.99-8.04) per 100 000 person-years in age-adjusted all-cause mortality rate. Associations of medical debt and elevated mortality rates were consistent for all leading causes of death, including cancer (1.12 [95% CI, 1.02-1.22]), heart disease (1.39 [95% CI, 1.21-1.57]), and suicide (0.09 [95% CI, 0.06-0.11]) per 100 000 person-years.”
