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By Dr. Sushama R. Chaphalkar, PhD. Mar 7 2024 Reviewed by Lily Ramsey, LLM

In a recent cross-sectional study published in JAMA Network Open, researchers from the United States of America (US) investigated, at the county level, the association between medical debt and population health outcomes in the US.

They found that medical debt is associated with worsened health status and increased premature deaths and mortality in the population.

​​​​​​​Study:  Associations of Medical Debt With Health Status, Premature Death, and Mortality in the US . Image Credit: Pormezz/Shutterstock.com Background

Increasing economic burden and out-of-pocket costs for healthcare in the US have led to a concerning rise in medical debt, affecting 17.8% of individuals in 2020.

Certain vulnerable populations, including racial and ethnic minorities, females, younger individuals, and those with chronic diseases face a higher risk of incurring medical debt.

This debt is linked to adverse impacts on well-being, such as delayed healthcare, prescription nonadherence, and increased food and housing insecurity. Despite these individual-level associations, the county-level impact of medical debt on health outcomes remains poorly understood.

The present study aimed to address this gap by examining the relationships between medical debt and health status, mortality, and premature death at the county level in the US, using data from the Urban Institute Debt in America project. About the study

In the present study, debt data was obtained from a 2% nationally representative panel of deidentified records from a credit bureau. A total of 2,943 US counties were included, of which 39.2% were in metropolitan regions. The counties had a median 18.3% of residents above 65 years of age.

The median racial breakdown of residents was as follows: 0.4% American Indian/Alaska Native, 0.8% Asian/Pacific Islander, 3.0% Black, 4.3% Hispanic, and 84.5% White.

The excluded counties were predominantly non-metropolitan and had a smaller population size and a reduced socio-demographic diversity. Related StoriesDaily aspirin linked to higher mortality in older adults, study findsStudy suggests high levels of vitamin B3 breakdown products are linked to higher risk of mortality, heart attacks, and strokeCirculatory cholesterol levels are inversely linked to mortality of patients with sepsis and critical illness

The study investigated three health outcome sets from public data sources, including self-reported health status, premature death measured by years of potential life lost, and age-adjusted all-cause mortality rates and cause-specific mortality rates for leading causes such as cancers, heart disease, Alzheimer's, diabetes, and suicide, at the county level in the US.

Furthermore, the study considered county-level sociodemographic factors from the US Census data, including racial distribution, educational attainment, uninsured status, unemployment, and metropolitan status, as potential confounders.

The analysis considered two medical debt measures: the primary measure assessed the percentage of individuals with medical debt in collections, while the secondary measure focused on the median amount of medical debt (in 2018 US dollars).

Overall debt, including medical and other kinds of debt, were also included in the supplementary analyses.

Statistical analysis involved the use of descriptive analysis as well as bivariate and multivariable linear models, incorporating random state-level intercepts and weighted by county population size. Results and discussion

An average of 19.8% of the studied population had medical debt. Counties with fewer White and more Black residents, lower education levels, increased poverty, lack of insurance, and unemployment appeared to have higher medical debt rates.

It was found that a 1% increase in the population of medical debt-holders was associated with 18.3 more physically unhealthy days and 17.9 more mentally unhealthy days per 1,000 people in 30 days.

The percent-increase in medical debt-holders was also found to be associated with 1.12 years of life lost per 1,000 people and a rise of 7.51 per 100,000 person-years in age-adjusted all-cause mortality rate.

Consistent associations were found for major causes of death, including heart disease, cancer, chronic obstructive pulmonary disease, diabetes, and suicide.

Patterns were found to be similar for associations between the median amount of medical debt and the selected health outcomes. Supplemental analyses showed similar association patterns between medical debt and health outcomes.

This nationwide study reaffirms that medical debt remains a significant social determinant of public health.

However, the study is limited by the potential underrepresentation of medical debt in less populous counties, the inability to examine specific sources of medical debt, the exclusion of individuals not in the credit system, and the need for further research on the impact of coronavirus disease 2019 (COVID-19)-related policies on medical debt and population health.

Additionally, a broader focus on overall debt suggested that policies addressing various debts, like student loans, may impact population health. Conclusion

In conclusion, the study revealed associations between medical debt and adverse health outcomes, such as increased unhealthy days, premature deaths, and elevated mortality rates.

The results highlight the need for collaborative efforts among various stakeholders, including government entities, healthcare systems, hospitals, and employers, to mitigate medical debt with paid sick leave, clear financial assistance policies, and improved cost-related communication with patients.

Further, enhancing access to affordable healthcare through policies like expanding health insurance coverage may improve the overall health of the US population. Journal reference:

X. et al., (2024) Associations of Medical Debt with Health Status, Premature Death, and Mortality in the US. Han JAMA Network Open, 7(3):e2354766. doi: 10.1001/jamanetworkopen.2023.54766.https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2815530 

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World

Belgian prime minister tells Sky News he is ‘sceptical’ about Ukraine loan using Russian assets

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Belgian prime minister tells Sky News he is 'sceptical' about Ukraine loan using Russian assets

The Belgian prime minister said he is “sceptical” about giving Ukraine a loan using frozen Russian assets, and tells Sky News that it would need to be done with European partners.

Bart De Wever met Sir Keir Starmer at Downing Street on Friday for talks on using frozen Russian assets, the majority of which are held in Belgium, to fund Ukraine.

European Council president Antonio Costa said this week that members were close to greenlighting the proposal, but the Belgian prime minister has not ruled out taking legal action against the EU if the bloc decides to confiscate the assets.

Asked by Sky News’ people and politics correspondent Nick Martin if Belgium holds the key to Ukraine’s future defence, Mr De Wever said “that’s a bit of a cynical question”.

“I don’t think we hold the key, but we do hold a lot of Russian assets,” he said. “Will we do it with a European solution or with the reparation loan? I’m sceptical about a loan. I’m not going to lie.

“That’s because I’m heavily exposed to the liabilities of such an operation. But I’m a loyal European. I’m loyally pro Ukraine.”

'I'm not the only one who holds immobilised assets, there are other countries'. Pic: Reuters
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‘I’m not the only one who holds immobilised assets, there are other countries’. Pic: Reuters

The Belgian prime minister then said “if you want to go through with this, we could,” but said there would need to be “the mutualisation of the risk of it being a liquidity safety net”.

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“The idea that we do this all together,” he said. “But I’m not the only one who holds immobilised assets, there are other countries like the UK, like France.

“If you go together, then you’re under a big umbrella and you’re not the only one that is exposed to all the risks.”

Russian assets worth €190bn are held in Belgium, De Wever said outside Number 10, compared with €8bn worth in the UK.

When asked if he received assurances on shared liability from Sir Keir, Mr De Wever added: “I’m not sure that I’m at liberty to say what the Prime Minister has told me… but it was a constructive meeting”.

Pics: Reuters
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Pics: Reuters

‘It’s something historic’

Mr De Wever also said that the meeting was timely and noted “I’ve even been described as a Russian asset” for his stance on the proposal.

“It worries me a lot, of course. The exposure risk is huge. €190bn plus damages, and litigation that could go on, go on for two decades.

“It’s a tall order, because until two months ago, we considered this to be an operation that we would never do… It’s not a detail. It’s something historic.

“So to get that all in the right wording, with the right reassurances, it’s quite something.”

A Downing Street spokesperson said in a statement that Mr De Wever and Sir Keir “discussed ongoing work, together with European partners, on addressing Ukraine’s financial needs, including through the use of the value of immobilised Russian Sovereign Assets”.

“They agreed to continue to work together closely to make progress on this complex issue,” they added.

Read more from Sky News:
Everyone in new Epstein photos identified
UK ‘rapidly developing’ plans to prepare for war

EU indefinitely freezes assets

It comes as Russia’s central bank said on Friday that the plan was “illegal” and that it reserved the right to take any means necessary to protect its interests.

Meanwhile, the EU has indefinitely frozen Russia’s assets in Europe using a special procedure meant for economic emergencies to prevent the billions of euros from being used to support Ukraine.

Hungarian prime minister Viktor Orban – who has friendly relations with Russian President Vladimir Putin – accused the European Commission, which prepared the decision, “of systematically raping European law.”

“It is doing this in order to continue the war in Ukraine, a war that clearly isn’t winnable,” he added on social media.

Slovakian prime minister Robert Fico has also said that he would refuse to support any move that “would include covering Ukraine’s military expenses for the coming years”.

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Michael Clarke answers your Ukraine questions

Zelenskyy to visit Ukraine, Sky News learns

It comes as Sky News learnt from a source that Ukrainian President Volodymyr Zelenskyy is planning to visit Berlin on Monday.

He is set to meet German chancellor Friedrich Merz and also speak with representatives of Britain and France, it’s understood.

It also comes as Ukraine’s deputy energy minister said that Russia has launched 1,800 missiles, 50,000 drones and attacked energy facilities 4,500 times since the start of the year.

Roman Andarak told a briefing: “There are no examples in recent history of an energy system existing under such conditions – such large-scale, targeted terror.

“Unfortunately, this terror is intensifying every day.”

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US

Who’s pictured in the newly released photos from Epstein estate?

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Who's pictured in the newly released photos from Epstein estate?

Donald Trump, Andrew Mountbatten-Windsor and Bill Clinton are among high-profile figures pictured in a new selection of photos from Jeffrey Epstein’s estate, released by Democrats in Congress.

Warning: This article contains images of a sexual nature that some readers may find offensive.

An initial tranche of 19 photos was shared on Friday, and all of the people whose faces had not been redacted were identified by Sky News. They have been contacted for comment.

A second batch of dozens of photos was released the same day, including one of former Israeli prime minister Ehud Barak and another of Epstein himself in the bath.

Former Israeli prime minister Ehud Barak. Pic: @OversightDems
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Former Israeli prime minister Ehud Barak. Pic: @OversightDems

Jeffrey Epstein in the bath. Pic: @OversightDems
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Jeffrey Epstein in the bath. Pic: @OversightDems

Latest updates from release of Epstein photos

The photos were shared by House Oversight Committee Democrats, who said they are reviewing more than 95,000 images from the estate.

There is no suggestion of wrongdoing on the part of those pictured in the images released on Friday and the context surrounding the photos is not known.

Mr Barak told the New York Times this week: “I now deeply regret having any association with him.

“However, not any point in my dealings with him I did ever witness any improper behaviour and certainly I never participated in anything like that.”

In one image, Mr Trump is seen with the late sex offender Jeffrey Epstein and Belgian model Ingrid Seynhaeve.

Donald Trump, Jeffrey Epstein, and Belgian model Ingrid Seynhaeve. Pic: @OversightDems
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Donald Trump, Jeffrey Epstein, and Belgian model Ingrid Seynhaeve. Pic: @OversightDems

Two further photos show the US president with women whose faces are redacted.

One image is black and white and shows him with six women; three on either side of him. The other is out of focus, and shows him sitting alongside an unidentified woman.

Mr Trump alongside six unidentified women Pic: @OversightDems
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Mr Trump alongside six unidentified women Pic: @OversightDems

Mr Trump with an unidentified woman. Pic: @OversightDems
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Mr Trump with an unidentified woman. Pic: @OversightDems

Speaking after Epstein took his own life in jail in 2019, Mr Trump admitted knowing Epstein, but added: “I had a falling out with him. I haven’t spoken to him in 15 years. I was not a fan of his, that I can tell you.”

In July, the White House also released a statement saying Epstein had been banned from Trump’s Mar-a-Lago resort in Florida for acting like a “creep”.

When asked about the latest release of Epstein material at the White House on Friday, Mr Trump said he “knows nothing about it” and that the disgraced financier “has photos with everybody”.

Bill Clinton with Epstein and Ghislaine Maxwell, as well as Jimmy Buffett and Mr Buffett's wife Jane Slagsvol. Pic: @OversightDems
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Bill Clinton with Epstein and Ghislaine Maxwell, as well as Jimmy Buffett and Mr Buffett’s wife Jane Slagsvol. Pic: @OversightDems


In another photo released by Democrats, Bill Clinton is seen with Epstein and convicted sex offender Ghislaine Maxwell, as well as singer Jimmy Buffett and Mr Buffett’s wife Jane Slagsvol.

In 2019, a spokesperson for the former US president said he had “not spoken to Epstein in well over a decade” and “knows nothing about the terrible crimes”.

Further images show Epstein with long-time Trump ally, Steve Bannon. In one he sits across from him at his desk, while in another the men are seen side-by-side taking a selfie in a mirror.

Jeffrey Epstein with long-time Trump ally Steve Bannon. Pic: @OversightDems
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Jeffrey Epstein with long-time Trump ally Steve Bannon. Pic: @OversightDems

Steve Bannon and Jeffrey Epstein. Pic: @OversightDems
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Steve Bannon and Jeffrey Epstein. Pic: @OversightDems

Mr Bannon appeared again in the later batch of images, photographed alongside Noam Chomsky, an American professor perhaps best known for his political activism.

American professor Noam Chomsky and Steve Bannon. Pic: @OversightDems
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American professor Noam Chomsky and Steve Bannon. Pic: @OversightDems

Hollywood filmmaker Woody Allen appears in four photos; two of them taken with Epstein.

Woody Allen with Jeffrey Epstein and an unidentified woman. Pic: @OversightDems
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Woody Allen with Jeffrey Epstein and an unidentified woman. Pic: @OversightDems

Woody Allen and Jeffrey Epstein. Pic: @OversightDems
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Woody Allen and Jeffrey Epstein. Pic: @OversightDems

In another, Allen is photographed with Mr Bannon, while one more shows him sat with Bill Clinton’s former treasury secretary, Larry Summers, and his wife Elisa New, seemingly on a private plane.

Woody Allen and Steve Bannon. Pic: @OversightDems
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Woody Allen and Steve Bannon. Pic: @OversightDems

Bill Clinton's former treasury secretary, Larry Summers, and his wife Elisa New. Pic: @OversightDems
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Bill Clinton’s former treasury secretary, Larry Summers, and his wife Elisa New. Pic: @OversightDems

Speaking to The Times in September, Allen said he had been to dinner at Epstein’s home, but suggested he was unaware of the nature of his crimes.

Allen said: “He told us he’d been in jail and that he had been – I can’t remember the word – but that he’d been falsely put in jail in some way.”

Meanwhile, Mr Summers told the Harvard Crimson that his former association with Epstein was “a major error of judgement”.

Andrew Mountbatten-Windsor, then Prince Andrew, is seen just once, alongside tech billionaire Bill Gates. Epstein is not pictured. The original photo at a malaria summit also shows the then Prince Charles but he is cropped out of the version released by the Democrats. It is not clear why the picture has been included in the Epstein files.

Bill Gates with Andrew Mountbatten-Windsor, then a prince. Pic: @OversightDems
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Bill Gates with Andrew Mountbatten-Windsor, then a prince. Pic: @OversightDems

Bill Gates talks to the then Prince Andrew and then Prince Charles during a malaria summit in London on 18 April 2018. Pic: Reuters
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Bill Gates talks to the then Prince Andrew and then Prince Charles during a malaria summit in London on 18 April 2018. Pic: Reuters

Andrew relinquished his titles in October amid continued controversy over his friendship with Epstein, but said at the time: “I vigorously deny the accusations against me”.

Mr Gates himself appears twice more, once alongside Epstein’s long-time pilot, Larry Visoski, and once in a framed photo which appears in an image above a black cabinet.

Bill Gates and Epstein's long-time pilot, Larry Visoski. Pic: @OversightDems
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Bill Gates and Epstein’s long-time pilot, Larry Visoski. Pic: @OversightDems

A photo released in the Epstein files shows Bills Gates's picture framed above a cabinet. Pic: @OversightDems
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A photo released in the Epstein files shows Bills Gates’s picture framed above a cabinet. Pic: @OversightDems

In 2021, the tech billionaire told the New York Times he had met Epstein to discuss philanthropy and Gates’s spokeswoman said he regretted ever meeting him.

The following year Mr Gates told the BBC: “I made a mistake ever meeting with Jeffrey Epstein.

“Any meeting I had with him could be viewed as almost condoning his evil behaviour. So, that was a mistake.”

Another photo shows British entrepreneur Richard Branson with Epstein and Dean Kamen, an American engineer, inventor, and businessman.

Richard Branson with Epstein and Dean Kamen. Pic: @OversightDems
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Richard Branson with Epstein and Dean Kamen. Pic: @OversightDems

Epstein is seen with his lawyer, Alan Dershowitz, in one more image.

Epstein with his lawyer, Alan Dershowitz. Pic: @OversightDems
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Epstein with his lawyer, Alan Dershowitz. Pic: @OversightDems

Mr Dershowitz said he fell out with Epstein after making a plea deal for him in 2007, leading to his conviction.

He told the Harvard Crimson in November: “Jeffrey Epstein despised me after I had made the deal. Epstein and I did not get along personally after I represented him and helped get the deal.”

Emirati businessman Ahmed bin Sulayem is also among those pictured, appearing twice in the second cache of photos.

A picture of Sultan Ahmed Bin Sulayem released from the Epstein files. Pic: @OversightDems
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A picture of Sultan Ahmed Bin Sulayem released from the Epstein files. Pic: @OversightDems

A number of images of a sexual nature appear in the first cache.

One shows a bowl of novelty condoms with a caricature of Trump’s face, each one bearing the phrase “I’m HUUUUGE!” A handwritten sign reads: “Trump condom $4.50.”

Pic: @OversightDems
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Pic: @OversightDems

Various sex toys are also featured in pictures, including a glove with ribbed fingers, and a safety notice from a “jawbreaker” gag warning of the risk of injury or death.

Many of the newer batch of photos appear to show parts of Epstein’s properties, including a toilet, various service areas, and a small beachfront construction project.

Among the photos are several additional images which are thought to be from the disgraced financier’s private island, Little Saint James, showing a dental suite previously seen in an earlier release of pictures.

Pic: @OversightDems
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Pic: @OversightDems

Pic: @OversightDems
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Pic: @OversightDems

The images, obtained from the Epstein estate, were released by Democrats on the House Oversight Committee in a bid to pressure the US Justice Department to release the full Epstein files.

President Trump signed a bill in November compelling the department to release case files within 30 days, in a U-turn after he opposed the bill for months. The end of that window is Friday 19 December.

The images released on Friday were described by Democrats as being “of the wealthy and powerful men who spent time with Jeffrey Epstein” and “photographs of women and Epstein properties”.

A spokesperson for the Republican-led House Oversight Committee accused the Democrats of “cherry-picking photos and making targeted redactions” to create a “false narrative” about Donald Trump.

“Democrats’ hoax against President Trump has been completely debunked,” they added.

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Environment

Genesis GV90 leaks as breathtaking ultra-luxe SUV with coach doors [Video]

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Genesis GV90 leaks as breathtaking ultra-luxe SUV with coach doors [Video]

Genesis is gearing up to launch the stunning new flagship SUV. Ahead of its official debut, the GV90 leaked during an internal presentation, revealing our first look at the ultra-luxe electric SUV.

Genesis GV90 leak reveals coach doors and more

The GV90 is arriving as the largest, most luxurious Genesis SUV to date. Based on the Neolun Concept, the new flagship SUV will sit above the GV80 as Genesis expands into new segments.

As Genesis calls it, the “ultra-luxe, state-of-the-art SUV” stole the spotlight at the New York Auto Show last March.

It wasn’t the stunning, reductive design inspired by Korea’s moon-shaped porcelain jars or the premium Royal Indigo and Purple silk materials that caught most people’s attention at the event, but the B-pillarless coach doors.

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The SUV was showcased with Rolls-Royce-like coach doors, offering a new level of luxury for Genesis. Although we’ve seen the GV90 spotted out in public testing a few times now with coach doors, we wondered if they would make it to the production model.

Genesis-GV90-leak-coach-doors
The Genesis Neolun electric SUV concept, a preview of the GV90 (Source: Genesis)

After the full-size SUV reportedly leaked during an internal presentation, it looks like we’ve found our answer. The Genesis GV90 leak reveals two versions: a standard model and a coach-door model.

The leaked images from our friends at ShortsCar offer our first look at the production version in full. Earlier this month, a GV90 prototype was spotted out in public with the coach doors wide open, providing a sneak peek of the interior.

From what was shown, the cabin will feature a similar layout to the concept, with high-end purple and indigo materials. The GV90 was also caught with an all-black interior, which is expected to be the standard version.

A new video from the folks over at HealerTV offers a closer look at the breathtaking interior ahead of its official debut.

The GV90 appears to retain the gear selector located near the top of the steering wheel from the Neolun concept.

Another report, from TheKoreanCarBlog, confirms the new gear selector after the first interior spy shots surfaced.

From what we’ve seen so far, the GV90 is shaping up to be a near replica of the ultra-luxe Neolun concept. Genesis has yet to announce a launch date for the GV90, but it is expected to make an official debut by the end of the year with sales starting in mid-2026.

Prices and final specs, like driving range, will be revealed closer to launch, but the Genesis GV90 is rumoured to be the first vehicle to ride on Hyundai’s new eM platform.

Hyundai said the new platform will deliver a 50% improvement in range compared to its current E-GMP-based EVs, such as the IONIQ 5. It’s also expected to offer Level 3 autonomous driving as well as other advanced driver assistance system (ADAS) features.

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