Medical Debt In The US: Associations With Cancer Screening, Mortality, And Health Status

The people most vulnerable to medical debt often face systemic barriers to health care that are further exacerbated by debt accumulation, creating a compounding effect leading to adverse health outcomes. This ecological panel study assessed associations among county-level medical debt and cancer screening, cancer mortality, and community-level health status. Medical debt data (from 2017, 2019, and 2021) from the Urban Institute Credit Bureau Panel were analyzed using generalized estimating equations with an exchangeable correlation structure and lagged exposure-outcome modeling. A total of 8,954 county-years were included. In multivariable analysis, each 5-percentage-point increase in medical debt was associated with a 0.43-percentage-point and a 1.35-percentage-point decrease in colorectal and breast cancer screening rates, respectively, and 10.9 per 100,000 population more deaths from cancers with guideline-recommended screening. Medical debt was consistently associated with worse health and cancer outcomes. Addressing this burden is important for improving population health and mitigating cancer-related disparities.