A new study led by researchers at the American Cancer Society (ACS) found medical debt is associated with significantly higher cancer mortality rates at the county level in the United States.
On average, an estimated 20% of the population carried medical debt. For every 1% increase in the population with medical debt, there was a 1.12 increase in death rates (per 100,000 person-years) from cancer. The findings [were] presented today at this year’s annual meeting of the American Society of Clinical Oncology (ASCO) in Chicago, June 2-6.
In the study, led by senior author Dr. Xuesong Han, scientific director, health services research at the American Cancer Society, and Xin Hu, lead author on the study, scientists conducted a county-level ecological study using 2018 medical debt data from the Urban Institute linked with 2015-2019 mortality data from the National Centers for Health Statistics. All U.S. counties with non-missing information on medical debt and other covariates were included. Primary outcomes were age-adjusted mortality rates per 100,000 person-years for all malignant cancers and by cancer type.
The results showed that while on average, nearly 20% of the studied population carried medical debt, the percentage carrying medical debt ranged from 0% to 53% across counties. Higher percentages of the population with medical debt were observed in non-metro areas and counties with higher percentages of non-Hispanic Black people, adults without high school education, and those living below the poverty level, uninsured, or unemployed.
A one percentage point increase in the population with medical debt was associated with an increase in mortality for all malignancies, with the highest increases associated with medical debt seen for lung cancer, colorectal cancer, and female breast cancer. In counties where the exact amount of medical debt was known, for every $100 increase in the median debt carried by the population, there was a statistically significant increase of 0.86 per 100,000 person-years in age-adjusted mortality rates for all malignant cancers.
The researchers noted that because medical debt is associated with significantly higher cancer mortality at the county level, policies increasing access to affordable health care may improve cancer outcomes.
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